Use of conditional centiles of middle cerebral artery pulsatility index and cerebroplacental ratio in the prediction of adverse perinatal outcomes

Abstract

Introduction. Centiles of middle cerebral artery pulsatility index and cerebroplacental ratio are useful for predicting adverse perinatal outcomes. A 'conditional centile' is conditioned by a previous measurement reflecting degree of individual change over time. Here we test whether such centiles are independent predictors and whether their combination improves prediction. Material and methods. This prospective longitudinal study included 220 pregnant women diagnosed with or at risk of having a small-for-gestational-age fetus. Serial Doppler measurements of the umbilical artery and middle cerebral artery pulsatility indexs were used to calculate cerebroplacental ratio. Preterm birth, operative delivery due to fetal distress, admission to neonatal intensive care unit, 5-min Apgar score <7, newborn hypoglycemia, and perinatal mortality were considered adverse outcomes. Possible associations were analyzed by logbinomial regression analysis. Results. Serial Doppler measurements of the middle cerebral artery were available in 207 participants and cerebroplacental ratio in 205. Conditional centiles ≤5 and ≤10 for both middle cerebral artery pulsatility index and cerebroplacental ratio were associated with increased risk for adverse perinatal outcomes. However, only the combination of cerebroplacental ratio centile and conditional centile ≤10 showed a better performance in the prediction of operative delivery due to fetal distress (p = 0.032), admission to neonatal intensive care unit (p = 0.048), and the combined variable "any adverse outcomes" (p = 0.034) compared with the use of centile ≤10 alone. Conclusions. Conditional centile for middle cerebral artery pulsatility index and cerebroplacental ratio ≤5 and ≤10 are associated with adverse perinatal outcomes. When adding conditional centile to conventional centile for cerebroplacental ratio, the prediction improved compared with the use of conventional centile alone.

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

“…It is conceivable that the rate and/or magnitude of this fall might be greater in at risk fetuses. In a recent study, the conditional centile for CPR ≤5th and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 10 ≤10th was associated with adverse perinatal outcomes [70]. Moreover, adding the conditional centile to the conventional centile for CPR has improved the prediction of adverse perinatal outcomes, compared to the use of the conventional centile alone [70].…”

“…In a recent study, the conditional centile for CPR ≤5th and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 10 ≤10th was associated with adverse perinatal outcomes [70]. Moreover, adding the conditional centile to the conventional centile for CPR has improved the prediction of adverse perinatal outcomes, compared to the use of the conventional centile alone [70]. The adverse perinatal outcomes described in this study included preterm birth, operative delivery for fetal distress, neonatal unit admission, 5-minute Apgar score less than 7, neonatal hypoglycemia and perinatal mortality.…”

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

“…Ebbing et al suggested that longitudinal reference ranges may be more appropriate than cross-sectional reference ranges for evaluating FGR as the follow-up protocol requires repeat measurements 29 . In a more recent study, the same research group suggested that conditional centiles of CPR values offer better prediction for operative delivery for presumed fetal compromise or neonatal care unit admission 30 . Moreover, similar positive findings have been reported for conditional centiles of EFW, though these findings are contested in more recent studies 11,31,46 .…”

“…It is possible that the magnitude of reduction and/or the speed of its change could be useful in identifying the at‐risk fetus. In a recent study, CPR ≤ 5 th and ≤ 10 th centiles was associated with adverse perinatal outcome. Moreover, using the conditional centile of CPR has improved the prediction of adverse perinatal outcome, compared with the use of the conventional centile alone.…”

Mind the gap: fetal physiology from bench to bedside

“…The chick embryo is interesting as it is the only established animal model in which the direct effects of developmental hypoxia on fetal cardiovascular function can be isolated independent of effects on the maternal and placental physiology . In this volume of Acta Obstetricia et Gynecologica Scandinavica , a cluster of studies using Doppler ultrasonography report that human fetuses with transposition of the great arteries have greater than normal pulmonary blood flow and left ventricular cardiac dominance , that maternal glucose loading induced a reduction in fetal cerebral vascular resistance and that adding ‘conditional’ to ‘conventional’ centiles in the assessment of fetal brain sparing improved prediction of adverse perinatal outcome . The group of Baschat remind us that the study of waveforms in the ductus venosus has a critical role in directing the clinical management of fetuses at risk of cardiovascular deterioration.…”