The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses

Chainarong, Natthicha; Petpichetchian, Chusana

doi:10.1016/j.ejogrb.2018.06.016

Cited by 12 publications

(6 citation statements)

References 19 publications

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“…Our current results are in line with that approach, confirming CPR as the predominant parameter for the prediction of APO and CS-IFC at the end of pregnancy and indicating that a proportion of fetuses, regardless of maternal characteristics and EFW, are at a risk of adverse outcome during the peripartum period. According to our data, and considering the high NPV of CPR [23,24], which has also been confirmed in this study, a large proportion of these fetuses might be screened prior to labor. This NPV could potentially be applied to help the selection of the low-risk pregnancy that might be suitable for home planned birth or delivery in another low-risk setting [25].…”

Section: Discussionsupporting

confidence: 87%

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

Morales‐Roselló

Loscalzo

Jakaitė

et al. 2021

Gynecol Obstet Invest

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Objectives: The objectives of this study were to evaluate the diagnostic abilities of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome (APO) and cesarean section for intrapartum fetal compromise (CS-IFC) within 1 day of delivery. Design: Retrospective observational case-control study. Methods: This was a study of 254 high-risk fetuses attending the day hospital unit of a tertiary referral hospital that underwent an ultrasound examination at 32–41 weeks and gave birth within 1 day of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring urgent cesarean section, neonatal umbilical cord pH <7.10, 5-min Apgar score <7, and postpartum admission to neonatal or pediatric intensive care units. CS-IFC was defined in case of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring urgent cesarean section. The diagnostic ability of CPR for the prediction of APO and CS-IFC was calculated alone and in combination with estimated fetal weight and gestational clinical parameters, including the type of labor onset, using ROC curves and logistic regression analysis. Results: CPR in multiples of the median (MoM) was a moderate predictor of APO (area under the curve [AUC] = 0.77, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001). The predictive abilities of the multivariable model for APO (AUC = 0.81, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001) did not differ from those of CPR alone . Limitations: The small number of cases and the scarcity of information concerning labor induction. Conclusion: In high-risk pregnancies, CPR MoM is a moderate predictor of APO and CS-IFC when performed within 24 h of delivery.

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Section: Discussionsupporting

confidence: 87%

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

Morales‐Roselló

Loscalzo

Jakaitė

et al. 2021

Gynecol Obstet Invest

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“…A number of studies have demonstrated an association between low CPR in low-risk AGA pregnancies and increased risk of operative delivery due to presumed fetal compromise and/or adverse neonatal outcomes, [22][23][24][25][26][27][28][29][30][31][32][33] while other studies have failed to show this association. 34,35 Unlike these studies, our study included only GDM patients, a population that represents a combination of low risk for SGA but high-risk for adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association of the Cerebro‐Placental Ratio With Adverse Outcomes in Pregnancies Affected by Gestational Diabetes Mellitus

Paz

Idriss

Murray‐Davis

et al. 2022

J of Ultrasound Medicine

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Objectives Cerebro‐placental ratio (CPR) is a doppler tool contributes to clinical decision‐making in pregnancies affected by small for gestational age weight (SGA). Pregnancies affected by gestational diabetes mellitus (GDM) tend to have higher newborn weight, but greater risk of adverse perinatal outcomes. We hypothesized that in GDM‐complicated‐pregnancies CPR will be associated with adverse perinatal outcomes even in the absence of SGA. Methods This prospective single‐center cohort study included non‐anomalous singleton pregnancies in women with GDM. Those with pre‐pregnancy diabetes mellitus, hypertensive disorder or suspected SGA were excluded. Routine fetal sonographic assessment included CPR—defined as middle cerebral artery pulsatilty index/umbilical artery pulsatilty index. Masked CPR measurement closest to birth was used, classified as >10th (normal) or ≤10th centile (low). Primary outcome was a composite, consisting of stillbirth, Caesarean birth due to abnormal fetal heart rate pattern, 5‐minute Apgar <7, cord arterial pH < 7.0, hypoxic ischemic encephalopathy, or NICU admission >24 hours. Results Of 281 participants, 24 (8.5%) had low CPR, at a mean gestational age of 36.3 weeks (IQR 34.0–37.4). Birthweight percentile was significantly lower among the low CPR group (35th [IQR 16–31] versus 60th [IQR 31–82]; P = .002). There was no statistically difference in the primary composite outcome between the groups (8.3% versus 7.0%, P = .68). Low CPR was significantly associated with a higher risk of neonatal hypoglycemia (adjusted odds ratio 3.2, 95% CI 1.2–8.3). Conclusion In pregnancies affected by GDM, CPR ≤10th percentile was not associated with adverse perinatal outcome but was associated with neonatal hypoglycemia.

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“…Interestingly, while the evidence of an association between CPR and adverse outcome is out of doubt [25][26][27][28][29][30], the controversy persists regarding CPR accuracy: for some authors it is good (AUC = 0.96 [31], 0.88 [32] and 0.723 [33,34]); while for others, it is moderate (AUC 0.69) [35] or even very low [36]. In this study, we inquired whether a different interval to labor might be partially the cause of this difference.…”

Section: Interpretation Of Study Findings and Comparison With The Pub...mentioning

confidence: 99%

Cerebroplacental Ratio Prediction of Intrapartum Fetal Compromise according to the Interval to Delivery

et al. 2022

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Objectives To evaluate whether the interval to delivery modifies the predictive accuracy of the cerebroplacental ratio (CPR) for the prediction of cesarean section for intrapartum fetal compromise (CS-IFC), either as a single marker or combined with estimated fetal weight centile (EFWc), type of labor onset (TLO) and other clinical variables. Material and methods This was a multicenter retrospective study of 5193 women with singleton pregnancies who underwent an ultrasound scan at 35+0- 41+0 weeks and gave birth within one month of examination, at any of the participating hospitals in Spain, UK, and Italy. CS-IFC was diagnosed in case of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH<7.20, requiring urgent cesarean section. The diagnostic ability of CPR in multiples of the median (CPR MoM) was evaluated at different intervals to delivery, alone and combined with EFWc, TLO, and other pregnancy data such as maternal age, maternal body mass index, parity, and fetal sex, for the prediction of CS-IFC by means of ROC curves and logistic regression analysis. Results The predictive ability of CPR MoM for CS-IFC worsened with the interval to delivery. In general, the best prediction was obtained prior to labor, and adding information related with EFWc and TLO [AUC 0.71 (95% CI 0.64-0.79), 0.73 (95% CI 0.66-0.80) and 0.75 (95% CI 0.69-0.81); P<0.0001]. Addition of more clinical data did not improve prediction. In addition, results did not vary when only cases with spontaneous onset of labor were studied. Conclusion CPR MoM prediction of CS-IFC at the end of pregnancy worsens with the interval to delivery. Accordingly, it should be done in the short term and considering EFWc and TLO.

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The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses

Cited by 12 publications

References 19 publications

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

Association of the Cerebro‐Placental Ratio With Adverse Outcomes in Pregnancies Affected by Gestational Diabetes Mellitus

Cerebroplacental Ratio Prediction of Intrapartum Fetal Compromise according to the Interval to Delivery

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