Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study

Prior, Tomas; Mullins, Edward; Bennett, Phillip R.; Kumar, Sailesh

doi:10.1016/j.ajog.2012.11.016

Cited by 184 publications

(253 citation statements)

References 18 publications

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“…More recently, a large study on unselected pregnancies has shown that CPR was highly sensitive to even small deviations from the optimal birth weight [44]. Consistent with these results, Prior et al [45] recently demonstrated in a small prospective study that independent of fetal size, fetal CPR measured within 72 h of delivery could identify those likely to require obstetric intervention for intrapartum fetal compromise. It is intriguing then why we failed to find an association of this parameter when measured at routine third-trimester scan with subsequent growth failure.…”

Section: Discussionsupporting

confidence: 66%

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

et al. 2015

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Objective: To evaluate in normally growing fetuses at routine 32-36 weeks scan the performance of maternal angiogenic factors, Doppler and ultrasound indices in predicting smallness for gestational age (SGA) at birth. Methods: A cohort of 1,000 singleton pregnancies with normal estimated fetal weight (EFW, ≥10th centile) at 32-36 weeks scan was included. At inclusion, Doppler indices (mean uterine artery pulsatility index [mUtA-PI], cerebroplacental ratio and normalized umbilical vein blood flow by EFW (ml/min/kg) were evaluated, and blood samples were collected and frozen. Nested in this cohort, maternal circulating placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by enzyme-linked immunosorbent assay in all cases with a birth weight <10th centile by customized standards and in an equivalent number of controls (birth weight ≥10th centile). Results: 160 cases were included (80 SGA and 80 controls). EFW (2,128 vs. 2,279 g, p < 0.001), mUtA-PI z-values (-0.25 vs. -0.65, p = 0.034) and sFlt-1/PlGF ratio (11.10 vs. 6.74, p < 0.005) were lower in SGA. The combination of sFlt-1/PlGF ratio and EFW resulted in a 66.3% detection rate for subsequent SGA, with 20% of false-positives. Fetal Doppler indices were not predictive of SGA. Conclusions: In normally growing fetuses, maternal angiogenic factors add to ultrasound parameters in predicting subsequent SGA at birth. This supports further research to investigate composite scores in order to improve the definition and identification of fetal growth restriction.

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Section: Discussionsupporting

confidence: 66%

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

et al. 2015

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“…MCA Doppler was the best predictor of adverse outcome in AGA fetuses, whereas prediction was better achieved with UA Doppler and CPR in case of the SGA fetuses [17] . In a recent study, an association between low CPR and poor labor outcome was also established in AGA fetuses [18] . In this study, however, examinations were performed just before the active phase of labor and were not clearly independent of changes caused by the onset of labor and labor contractions [19][20][21][22][23][24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Neonatal Acid-Base Status in Term Fetuses: Mathematical Models Investigating Cerebroplacental Ratio and Birth Weight

Morales‐Roselló¹,

Khalil²,

Alberola-Rubio³

et al. 2015

Fetal Diagn Ther

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Objective: Cerebroplacental ratio (CPR) is emerging as a marker of fetal hypoxia at term. The aim of this study was to demonstrate graphically the interrelationships among CPR, birthweight (BW), and neonatal pH, and construct 2D and 3D representations of the areas with potential low pH. Methods: This was a retrospective study of 2,927 term fetuses evaluated according to BW and CPR. The outcome was the acid-base status at birth. Multivariate relationships among CPR, BW, and arterial and venous pH were depicted in 3D scattergrams. Subsequently, trend surfaces were calculated and represented in 2D contour graphs. Finally, 3D representations were constructed by smothering pH data using moving average filters. Results: The trend surfaces and the 2D and 3D contour graphs showed the complex association among the three variables. Although pH changed with CPR and BW, the influence of the BW was smaller than the influence of the CPR, with this effect being more evident in the venous than in the arterial pH. Conclusions: Two scenarios threaten fetal well-being at term: a very low birth weight and a very low fetal CPR. Our findings suggest that the importance of fetal hemodynamics in determining the acid-base status at birth surpasses that of fetal weight.

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“…As many emergency caesarean and instrumental births are related to either non-reassuring fetal status or poor progress in labour or a combination of both, identifying at risk fetuses may help reduce the risk of intrapartum complications. To this end, the fetal cerebro-placental ratio (CPR) or maternal Placental Growth Factor (PlGF) levels measured before the onset of labour appears to hold promise [14][15][16] to identify fetuses at risk of intrapartum compromise. In addition, identification of both small and large for gestational age fetuses would also assist in delivery planning and thus reduce the risk of emergency operative birth.…”

Section: Discussionmentioning

confidence: 99%

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

Thavarajah

Flatley

Kumar

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes. Methods: This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers' Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories -low (0-3), intermediate (4-6), and normal (7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group. Results: The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (7) Apgar score, 439 (1.1%) had an intermediate score (4-6) and 114 (0.3%) had a low (0-3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes. Conclusions: Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes. ARTICLE HISTORY

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Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study

Cited by 184 publications

References 18 publications

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

Neonatal Acid-Base Status in Term Fetuses: Mathematical Models Investigating Cerebroplacental Ratio and Birth Weight

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

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