Using cerebroplacental ratio in non‐SGA fetuses to predict adverse perinatal outcome: caution is required

Kumar, Sailesh; Figueras, F.; Ganzevoort, Wessel; McCowan, Lesley

doi:10.1002/uog.19191

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…Despite this, the actual role of CPR in predicting perinatal outcome remains controversial; the large heterogeneity in inclusion criteria, gestational age at assessment and outcomes observed among the previously published studies do not allow the extrapolation of robust evidence on the prognostic value of CPR, thus suggesting caution in its use in clinical practice. 34 In the present study, despite being associated, MCA and CPR were not predictive of adverse outcome when applied to pregnancies from 36 weeks of gestation; thus their use as a screening test for adverse pregnancy outcome is not supported, although the study was not powered for the detection of rare outcomes, such as fetal death.…”

Section: Discussioncontrasting

confidence: 59%

Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study

D’Antonio

Rizzo

Gustapane³

et al. 2019

Acta Obstet Gynecol Scand

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Introduction: To explore the strength of association and the diagnostic accuracy of umbilical (UA), middle cerebral (MCA), uterine arteries pulsatility index (PI) and the cerebroplacental ratio in predicting an adverse outcome when applied to singleton pregnancies at term. Material and methods: Prospective study carried out in a dedicated research ultrasound clinic. Attended clinicians were blinded to Doppler findings. Inclusion criteria were consecutive singleton pregnancies between 36 +0 and 37 +6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome. Logistic regression and ROC curve analyses were used to analyze the data. Results: In all, 600 consecutive singleton pregnancies from 36 weeks of gestation were included in the study. Mean MCA PI (1.1 ± 0.2 vs 1.5 ± 0.4, P < 0.001) and cerebroplacental ratio (1.4 ± 0.4 vs 1.9 ± 0.6, P < 0.001) were lower, whereas uterine arteries PI (0.8 ± 0.2 vs 0.7 ± 0.3, P = 0.001) was higher in pregnancies experiencing than in those not experiencing composite adverse outcome. Conversely, there was no difference in either UA PI (P = 0.399) or estimated fetal weight centile (P = 0.712) between the two groups, but AC centile was lower in fetuses experiencing composite adverse outcome (45.4 vs 53.2, P = 0.040). At logistic regression analysis, MCA

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Section: Discussioncontrasting

confidence: 59%

Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study

D’Antonio

Rizzo

Gustapane³

et al. 2019

Acta Obstet Gynecol Scand

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“…145,146 However, despite the broad association with adverse outcomes, the predictive utility of the CPR, particularly in a non-SGA cohort at term, remains modest, and caution should be exercised before incorporating its routine use into clinical care. 147 Biochemical markers. Low PAPP-A levels are indicative of failure of trophoblast invasion and placental dysfunction 22 and associated with an increased risk of FGR, preeclampsia, intrauterine fetal demise, placental abruption, preterm birth, emergency cesarean delivery for IFC, and neonatal acidosis.…”

Section: Figurementioning

confidence: 99%

The physiology of intrapartum fetal compromise at term

Turner

Mitchell

Kumar

2020

American Journal of Obstetrics and Gynecology

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129

115

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BP, blood pressure; [Ca2 þ ] I , intracellular calcium; CBF, cerebral blood flow; CO, cardiac output; CVS, cardiovascular system; E 2 , estrogen; EDV, end-diastolic volume (cardiac); FHR, fetal heart rate; IFC, intrapartum fetal compromise; MAP, mean arterial pressure; PaO 2 , partial pressure of oxygen; PGE, prostaglandin E 2 and F 2 ; PVR, peripheral vascular resistance; ROS, reactive oxygen species.

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“…Although the AUROC curve for our model was good, the PLR was modest suggesting only a small increase in the likelihood of the outcome. When combined with a low pretest probability of adverse outcomes at term, the veracity and clinical utility of any model needs to be interpreted with caution 33…”

Section: Discussionmentioning

confidence: 99%

Cross-validated prediction model for severe adverse neonatal outcomes in a term, non-anomalous, singleton cohort

Flatley

Gibbons

Hurst

et al. 2019

bmjpo

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ObjectiveThe aim of this study was to develop a predictive model using maternal, intrapartum and ultrasound variables for a composite of severe adverse neonatal outcomes (SANO) in term infants.DesignProspectively collected observational study. Mixed effects generalised linear models were used for modelling. Internal validation was performed using the K-fold cross-validation technique.SettingThis was a study of women that birthed at the Mater Mother’s Hospital in Brisbane, Australia between January 2010 and April 2017.PatientsWe included all term, non-anomalous singleton pregnancies that had an ultrasound performed between 36 and 38 weeks gestation and had recordings for the umbilical artery pulsatility index, middle cerebral artery pulsatility index and the estimated fetal weight (EFW).Main outcome measuresThe components of the SANO were: severe acidosis arterial, admission to the neonatal intensive care unit, Apgar score of ≤3 at 5 min or perinatal death.ResultsThere were 5439 women identified during the study period that met the inclusion criteria, with 11.7% of this cohort having SANO. The final generalised linear mixed model consisted of the following variables: maternal ethnicity, socioeconomic score, nulliparity, induction of labour, method of birth and z-scores for EFW and cerebroplacental ratio. The final model had an area under the receiver operating characteristic curve of 0.71.ConclusionsThe results of this study demonstrate it is possible to predict infants that are at risk of SANO at term with moderate accuracy using a combination of maternal, intrapartum and ultrasound variables. Cross-validation analysis suggests a high calibration of the model.

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Using cerebroplacental ratio in non‐SGA fetuses to predict adverse perinatal outcome: caution is required

Cited by 25 publications

References 24 publications

Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study

Diagnostic accuracy of Doppler ultrasound in predicting perinatal outcome in pregnancies at term: A prospective longitudinal study

The physiology of intrapartum fetal compromise at term

Cross-validated prediction model for severe adverse neonatal outcomes in a term, non-anomalous, singleton cohort

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