Is it possible to predict late antepartum stillbirth by means of cerebroplacental ratio and maternal characteristics?

Abstract

Objective: To examine the potential value of fetal ultrasound and maternal characteristics in the prediction of antepartum stillbirth after 32 weeks' gestation. Methods: This was a retrospective multicenter study in Spain. In 29 pregnancies, umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), estimated fetal weight (EFW), and maternal characteristics were recorded within 15 days prior to a stillbirth. The values of UA PI, MCA PI, and CPR were converted into multiples of the normal median (MoM) for gestational age and the EFW was expressed as percentile according to a Spanish reference range for gestational age. Data from the 29 pregnancies with stillbirths and 2298 control pregnancies resulting in livebirths were compared and multivariate logistic regression analysis was used to determine significant predictors of stillbirth. Results: The only significant predictor of stillbirth was CPR (OR ¼ 0.161, 95% confidence interval [CI] 0.035, 0.654; p ¼ .014); the area under the receiver operating characteristics curve was 0.663 (95% CI 0.545, 0.782) and the detection rate (DR) was 32.14% at a 10% false-positive rate (FPR). In addition, when we included MCA and UA PI MoM instead of CPR, only MCA PI MoM was significant (OR ¼ 0.104, 95% confidence interval [CI] 0.013, 0.735; p ¼ .029), with similar prediction abilities (area under the curve (AUC) 0.645, DR 28.6%, FPR 10%). Conclusions: The CPR and MCA PI are predictors of late stillbirth but the performance of prediction is poor.

Cerebroplacental ratio and estimated fetal weight, the 2 different yardsticks

“…They opined that the randomization in the Laparoscopic Approach to Cervical Cancer (LACC) trial ensured balance among measured and unmeasured confounders between the 2 comparison groups. 2 We disagree. First, it is difficult for any surgical RCT to provide any such balance because it is impossible to blind or mask a surgical procedure or perform a "sham" surgery; the unblinded nature of surgical RCTs inevitably leads to an unmeasured observer bias.…”

“…In the LACC trial, cervical cancer recurrences occurred in only 14 of the 33 centers. 2 Should the remaining 19 centers, which had no recurrences, change their practice based on the results of the 14 centers when surgical proficiency has not been taken into serious consideration in the performance of the minimally invasive radical hysterectomy? Cerebroplacental ratio and estimated fetal weight, the 2 different yardsticks TO THE EDITORS: We read with interest the work of Akolekar et al 1 and agree with the authors in that cerebroplacental ratio (CPR) as a stand alone measurement is unable to predict adverse perinatal outcome accurately, unless it incorporates extra information that is provided by estimated fetal weight (EFW), maternal characteristics, and future biochemical markers.…”

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

“…Color flow mapping was used to identify the umbilical artery in a free-floating loop of the umbilical cord and the proximal segment of the MCA as it emerges from the circle of Willis in an axial section of the brain. The PI was then determined by recording at least three consecutive uniform waveforms without fetal body or respiratory movements using pulsed Doppler at an angle of insonation of less than 15º [ 16 ]. Fetal biometry and fetal–maternal Doppler ultrasound examinations were performed by certified sonographers.…”

“…Age and BMI were centered by subtracting their mean from their raw values. CPR values were transformed to multiples of the median (MoMs) [ 16 , 17 ]. EFW was also transformed to its centile [ 18 ].…”

The CErebro Placental RAtio as indicator for delivery following perception of reduced fetal movements, protocol for an international cluster randomised clinical trial; the CEPRA study

“…A low cerebroplacental ratio (CPR) on Doppler ultrasound reflects a decrease in resistance in the middle cerebral artery (cerebral flow) and/or an increased resistance in the umbilical artery (placental flow) indicating redistribution of the fetal circulation: a compensatory adaptation to nutrient and oxygen deprivation due to placental insufficiency. A low CPR can identify a compromised fetus regardless of fetal size [6][7][8][9], and using the CPR combined with RFM may aid prediction and consequently prevention of stillbirth [10].…”