Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome

131

121

“…We identified three systematic reviews on the predictive accuracy of CPR for adverse perinatal outcome. Nassr et al .…”

Section: Discussionmentioning

confidence: 99%

Section: Interpretation In Light Of Previous Systematic Reviewsmentioning

confidence: 99%

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

Conde‐Agudelo

Villar

Kennedy

et al. 2018

131

121

“…Primary outcomes of interest were delivery mode (spontaneous vaginal birth, operative vaginal birth, emergency Cesarean section (CS) and emergency CS for intrapartum fetal distress), intrapartum fetal distress, placental abruption, 5‐min Apgar score < 7, admission to the neonatal intensive care unit (NICU), birth asphyxia, acidosis, periventricular hemorrhage (PVH) and PND. These outcomes were selected as they reflect adverse intrapartum and neonatal outcomes and are consistent with other studies evaluating suboptimal obstetric and perinatal sequelae. Secondary outcomes were PE, LBW (birth weight < 10 th centile) and PTB (birth < 37 weeks' gestation).…”

Section: Methodsmentioning

confidence: 99%

Impact of low‐dose aspirin on adverse perinatal outcome: meta‐analysis and meta‐regression

Turner

Robertson

Härtel

2020

Self Cite

CONTRIBUTIONWhat are the novel findings of this work? Aspirin intake, when commenced at ≤ 16 weeks' gestation at a dose ≥ 100 mg, results in a reduction in the risk of perinatal death, independently of its concomitant beneficial effect on reducing the risk of pre-eclampsia and preterm birth. What are the clinical implications of this work?Given that low-dose aspirin is a simple, cheap and effective intervention and is relatively well tolerated by women, our results suggest that it may be reasonable to consider its use in a wider, more general context, prior to 16 weeks' gestation, to improve perinatal outcome. ABSTRACTObjective To perform a meta-analysis and metaregression of randomized controlled trials (RCTs) to evaluate the impact of low-dose aspirin (LDA) on perinatal outcome, independent of its effect on pre-eclampsia (PE), preterm birth and low birth weight.

“…The cerebroplacental ratio (CPR) is calculated as the ratio of MCA to UA Doppler, and has been hypothesized to be more accurate than its individual components. An association with adverse perinatal outcome has been the focus of several literature reviews. CPR and MCA Doppler in FGR are gradually becoming integrated into clinical practice and international guidelines, but reported estimates of their accuracy vary considerably.…”

Section: Introductionmentioning

confidence: 99%

Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis

Heidweiller-Schreurs

Boer

Heymans

et al. 2018

181

127

ObjectiveDoppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. However, reported estimates of its accuracy vary considerably. The aim of this study was to review systematically the prognostic accuracies of CPR and MCA Doppler in predicting adverse perinatal outcome, and to compare these with UA Doppler, in order to identify whether CPR and MCA Doppler evaluation are of added value to UA Doppler.MethodsPubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, from inception to June 2016, for studies on the prognostic accuracy of UA Doppler compared with CPR and/or MCA Doppler in the prediction of adverse perinatal outcome in women with a singleton pregnancy of any risk profile. Risk of bias and concerns about applicability were assessed using the QUADAS‐2 (Quality Assessment of Diagnostic Accuracy Studies‐2) tool. Meta‐analysis was performed for multiple adverse perinatal outcomes. Using hierarchal summary receiver–operating characteristics meta‐regression models, the prognostic accuracy of CPR vs MCA Doppler was compared indirectly, and CPR and MCA Doppler vs UA Doppler compared directly.ResultsThe search identified 4693 articles, of which 128 studies (involving 47 748 women) were included. Risk of bias or suboptimal reporting was detected in 120/128 studies (94%) and substantial heterogeneity was found, which limited subgroup analyses for fetal growth and gestational age. A large variation was observed in reported sensitivities and specificities, and in thresholds used. CPR outperformed UA Doppler in the prediction of composite adverse outcome (as defined in the included studies) (P < 0.001) and emergency delivery for fetal distress (P = 0.003), but was comparable to UA Doppler for the other outcomes. MCA Doppler performed significantly worse than did UA Doppler in the prediction of low Apgar score (P = 0.017) and emergency delivery for fetal distress (P = 0.034). CPR outperformed MCA Doppler in the prediction of composite adverse outcome (P < 0.001) and emergency delivery for fetal distress (P = 0.013).ConclusionCalculating the CPR with MCA Doppler can add value to UA Doppler assessment in the prediction of adverse perinatal outcome in women with a singleton pregnancy. However, it is unclear to which subgroup of pregnant women this applies. The effectiveness of the CPR in guiding clinical management needs to be evaluated in clinical trials. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.