Does Uterine Doppler Add Information to the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome at the End of Pregnancy?

Abstract

<b><i>Objective:</i></b> To evaluate whether the addition of the mean uterine arteries pulsatility index (mUtA PI) to the cerebroplacental ratio (CPR) improves its ability to predict adverse perinatal outcome (APO) at the end of pregnancy. <b><i>Methods:</i></b> This was a prospective study of 891 fetuses that underwent an ultrasound examination at 34–41 weeks. The CPR and the mUtA PI were converted into multiples of the median (MoM) and the estimated fetal weight (EFW) into centiles according to local references. APO was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean section, 5′ Apgar score <7, neonatal pH <7.10 and admission to pediatric care units. The accuracies of the different parameters were evaluated alone and in combination with gestational characteristics using univariate and multivariate analyses by means of the Akaike Information Criteria (AIC) and the area under the curve (AUC). Finally, a comparison was similarly performed between the CPR and the cerebro-placental-uterine ratio (CPUR; CPR/mUtA PI) for the prediction of APO. <b><i>Results:</i></b> The univariate analysis showed that CPR MoM was the best parameter predicting APO (AIC 615.71, AUC 0.675). The multivariate analysis including clinical data showed that the best prediction was also achieved with the CPR MoM (AIC 599.39, AUC 0.718). Moreover, when EFW centiles were considered, the addition of UtA PI MoM did not improve the prediction already obtained with CPR MoM (AIC 591.36, AUC 0.729 vs. AIC 589.86, AUC 0.731). Finally, the prediction by means of CPUR did not improve that of CPR alone (AIC 623.38, AUC 0.674 vs. AIC 623.27, AUC 0.66). <b><i>Conclusion:</i></b> The best prediction of APO at the end of pregnancy is obtained with CPR whatever is the combination of parameters. The addition of uterine Doppler to the information yielded by CPR does not result in any prediction improvement.

Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

“…When early-onset FGR is suspected, the inclusion of uterine artery Doppler in the assessment has the advantage that it reflects placental insufficiency from the maternal side and captures the placental insufficiency secondary to pathophysiological mechanisms other than early defective trophoblastic invasion 15 . There is expert consensus that abnormal uterine artery Doppler is a diagnostic criterion for early-onset FGR, while, for late-onset FGR, there was agreement between only 55% of experts and it was therefore not included as a diagnostic criterion 9,16 . While it could be speculated that uterine artery Doppler has the potential confounding characteristic of being useful both for prediction of outcome and for diagnosis, it may be argued that its prediction capacity overshadows its diagnostic performance.…”

New Markers for Placental Dysfunction at Term – Potential for More

“…A multicenter prospective study showed that in the low-risk population (n = 804) at term, too, there was a six-fold increase in the rate of emergency surgical delivery due to intrapartal fetal distress as well as a higher rate of APO in cases with a CPUR < 10th percentile, even though the predictive power of the CPUR was moderate at best 43 . Morales-Rosello et al, however, could not determine an added predictive value of the CPUR with regard to APO when compared to the CPR in the low-risk population between 34 + 0 – 41 + 0 WG (n = 891) 44 .…”

“…Aus der Überlegung heraus, die mütterliche Seite der Plazenta in die Doppler-Sonografie-basierende APO-Risikoabschätzung und fetale Zustandsbeschreibung zu integrieren, gehen erste Studien hervor, welche die Rolle der zerebroplazentar-uterinen Ratio (CPUR = CPR/mUtA-PI) ( Abb. 2 ) im High- und Low-Risk-Kollektiv beleuchten 42 , 43 , 44 . Macdonald et al konnten erstmalig an einem Kollektiv von n = 347 Patientinnen zeigen, dass die CPUR die stärkste Assoziation mit Indikatoren für eine späte, milde Plazentainsuffizienz aufwies und im Vergleich zur CPR und/oder mUtA-PI allein mehr Fälle von FGR (BW < 3.…”

Prelabor and intrapartum Doppler ultrasound to predict fetal compromise

“…Two studies investigating the role of uterine artery (UtA) Doppler for the prediction of adverse perinatal events in third-trimester AGA fetuses also demonstrated poor test performance 100,101 .…”

“…The use of biomarkers reflective of poor placental function (i.e. sFlt-1, PlGF or the sFlt-1/PlGF ratio) in combination with fetal Dopplers has been evaluated in two prospective observational studies in uncomplicated pregnancies between 35 +0 and 36 +6 weeks or beyond 36 weeks of gestation [101][102][103] . However, the addition of placental biomarkers did not yield an improvement in test performance for screening of adverse perinatal outcomes.…”