Predictors of adverse perinatal outcome up to 34 weeks, a multivariable analysis study

Abstract

To evaluate the best ultrasound predictors of adverse perinatal outcome (APO) in fetuses examined up to 34 weeks and delivered by spontaneous or induced labor. MethodsThis was a retrospective study of 129 pregnancies that underwent an ultrasound Doppler examination at 23-34 weeks and entered into labor within 30 days. Umbilical artery pulsatility index (UA PI), middle cerebral artery PI (MCA PI), cerebroplacental ratio (CPR) and mean uterine artery pulsatility index (mUtA PI) were converted into multiples of the median (MoM) and estimated fetal weight (EFW) into centiles to adjust for gestational age (GA). Sonographic and clinical parameters were evaluated using logistic regression analysis. ResultsThe multivariable model for the prediction of APO presented an area under the curve of 0.82. Significant predictors were EFW centile, GA, MCA PI MoM, and CPR (if this was considered instead of its individual components). In addition, when more objective criteria for intrapartum hypoxia were applied, CPR became the only predictor of APO, with similar prediction ability (AUC 0.76). ConclusionUp to 34 weeks, prediction of APO can be done evaluating EFW and fetal cerebral flow. No added benefit is obtained examining the mUtA PI.