Diagnostic performance of cerebroplacental and umbilicocerebral ratio in appropriate for gestational age and late growth restricted fetuses attempting vaginal delivery: a multicenter, retrospective study

Villalaín, Cecilia; Galindo, Alberto; Mascio, Daniele Di; Buca, Danilo; Morales‐Roselló, José; Loscalzo, Gabriela; Sileo, Filomena Giulia; Finarelli, A.; Bertucci, Emma; Facchinetti, Fabio; Rizzo, Giuseppe; Brunelli, Roberto; Giancotti, Antonella; Muzii, Ludovico; Maruotti, Giuseppe Maria; Carbone, Luigi; D’Amico, Alice; Tinari, Sara; Morelli, Roberta; Cerra, Chiara; Nappi, Luigi; Greco, Pantaleo; Liberati, Marco; D’Antonio, F.; Herraı̀z, Ignacio

doi:10.1080/14767058.2021.1926977

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…Lebovitz et al included 120 gestations exceeding 40 weeks and showed that the CPR was not associated with adverse perinatal outcomes in low-risk pregnancies or in the subgroup of small for gestational age fetuses [ 11 ]. Villalain et al in 2021 described the CPR as a poor predictor of adverse perinatal outcomes regardless of fetal weight, with AUCs of 0.44 (95% CI 0.39 to 0.51) adequate for gestational age fetuses and 0.56 (95% CI 0.49 to 0.61) for late fetal growth restriction [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies

Martin-Alonso,

Rolle,

Akolekar

et al. 2023

Medicina

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Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40–42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies

Martin-Alonso,

Rolle,

Akolekar

et al. 2023

Medicina

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A systematic review and critical evaluation of quality of clinical practice guidelines on fetal growth restriction

Alameddine

Capannolo

Rizzo

et al. 2023

Journal of Perinatal Medicine

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Introduction To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR). Content Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR. Summary Diagnostic criteria of FGR, recommended growth charts, recommendation for detailed anatomical assessment and invasive testing, frequency of fetal growth scans, fetal monitoring, hospital admission, drugs administrations, timing at delivery, induction of labor, postnatal assessment and placental histopathological were assessed. Quality assessment was evaluated by AGREE II tool. Twelve CPGs were included. Twenty-five percent (3/12) of CPS adopted the recently published Delphi consensus, 58.3% (7/12) an estimated fetal weight (EFW)/abdominal circumference (AC) EFW/AC <10th percentile, 8.3% (1/12) an EFW/AC <5th percentile while one CPG defined FGR as an arrest of growth or a shift in its rate measured longitudinally. Fifty percent (6/12) of CPGs recommended the use of customized growth charts to assess fetal growth. Regarding the frequency of Doppler assessment, in case of absent or reversed end-diastolic flow in the umbilical artery 8.3% (1/12) CPGs recommended assessment every 24–48, 16.7% (2/12) every 48–72 h, 1 CPG generically recommended assessment 1–2 times per week, while 25 (3/12) did not specifically report the frequency of assessment. Only 3 CPGs reported recommendation on the type of Induction of Labor to adopt. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 50%. Outlook There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.

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The value of ultrasound spectra of middle cerebral artery and umbilical artery blood flow in adverse pregnancy outcomes

Zhao,

Shen

2024

Journal of Perinatal Medicine

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Objectives To evaluate the diagnostic value of ultrasound spectra of the middle cerebral artery (MCA) and umbilical artery (UA) blood flow in predicting adverse pregnancy outcomes. Methods Data from 202 late singleton pregnancies (32–34 weeks gestation) were analyzed. Group A included 155 normal pregnancies, while Group B comprised 47 high-risk pregnancies. Color Doppler ultrasonography was used to measure and compare pulsatility index (PI), resistance index (RI), and end-systolic peak/end-diastolic peak (S/D) ratios of fetal MCA and UA between the groups. Results UA-related parameters (PI, RI, and S/D) were significantly higher in Group B compared to Group A, whereas MCA-related parameters (PI, RI, and S/D) were significantly lower in Group B than in Group A. In pregnancies with adverse outcomes, fetal UtA and UA-related parameters were elevated, while MCA parameters were decreased compared to those with favorable outcomes. Conclusions Ultrasound spectra of MCA and UA blood flow provide valuable clinical information for assessing fetal intrauterine growth and predicting adverse pregnancy outcomes.

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Diagnostic performance of cerebroplacental and umbilicocerebral ratio in appropriate for gestational age and late growth restricted fetuses attempting vaginal delivery: a multicenter, retrospective study

Cited by 4 publications

References 29 publications

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies

A systematic review and critical evaluation of quality of clinical practice guidelines on fetal growth restriction

The value of ultrasound spectra of middle cerebral artery and umbilical artery blood flow in adverse pregnancy outcomes

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