Which is the best ultrasound parameter for the prediction of adverse perinatal outcome within 1 day of delivery?

Morales‐Roselló, José; Loscalzo, Gabriela; Gallego, Ana; Jakaitė, Vaidilė; Marín, Alfredo Perales

doi:10.1080/14767058.2021.1989401

Cited by 4 publications

(9 citation statements)

References 36 publications

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“…The way of onset of labor was not taken into account as an inclusion criterion. Some of the studies included only elective inductions of labor [ 10 , 11 , 12 , 13 , 14 , 15 ], while others included only spontaneous onset of labor [ 9 ], both elective and spontaneous, or did not specify the means of onset of labor [ 2 , 3 , 16 , 17 , 18 , 19 , 20 , 21 ] ( Table 1 ). Two of the studies excluded patients with previous uterine scars in their examination of previous CSs, including those resulting from myomectomies [ 9 , 11 ] ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…In these last cases, the results were also heterogeneously expressed. Some authors used the area under the curve (AUC): AUC 0.73 [ 16 ], AUC 0.71 [ 3 ], and AUC 0.82 [ 2 ], while other authors suggested the existence of a poor prediction, showing the sensitivity (26%), specificity (87%), positive likelihood ratio (2.0), and negative likelihood ratio (0.85) of the measurement of the CPR to predict CS for IFC [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies from Morales-Roselló et al fulfilled the inclusion criteria for this systematic review [ 2 , 3 , 16 ]. All of them demonstrated an association between a low CPR Doppler and a higher rate of CS for IFC.…”

Section: Resultsmentioning

confidence: 99%

“…All of them demonstrated an association between a low CPR Doppler and a higher rate of CS for IFC. Nonetheless, in one of those studies, the authors placed the MCA PI multiples of median (MoM) as the best predictor of adverse perinatal outcome (AUC = 0.76) versus CPR MoM (AUC = 0.73) [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

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Cerebroplacental Ratio as a Predictive Factor of Emergency Cesarean Sections for Intrapartum Fetal Compromise: A Systematic Review

Novillo-Del Álamo,

Martínez-Varea,

Satorres-Pérez

et al. 2024

JCM

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Background: This systematic review aimed to clarify the association between the cerebroplacental ratio (CPR) and emergency cesarean sections (CSs) due to intrapartum fetal compromise (IFC). Methods: Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies published up to January 2024 regarding the relationship between the CPR and the rate of CS for IFC, as well as the predictive value of the CPR. Results: The search identified 582 articles, of which 16 observational studies were finally included, most of them with a prospective design. A total of 14,823 patients were involved. A low CPR was associated with a higher risk of CS for IFC. The predictive value of the CPR was very different among the studies due to substantial heterogeneity regarding the group of patients included and the time interval from CPR evaluation to delivery. Conclusions: A low CPR is associated with a higher risk of CS for IFC, although with a poor predictive value. The CPR could be calculated prior to labor in all patients to stratify the risk of CS due to IFC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cerebroplacental Ratio as a Predictive Factor of Emergency Cesarean Sections for Intrapartum Fetal Compromise: A Systematic Review

Novillo-Del Álamo,

Martínez-Varea,

Satorres-Pérez

et al. 2024

JCM

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“…Cerebroplacental ratio (CPR) has emerged as the best individual parameter to predict adverse perinatal outcome and intrapartum fetal compromise (IFC) near term 1 . Nevertheless, its predictive accuracy is moderate 2 . This can be improved by combination with estimated fetal weight (EFW) and clinical information like maternal body mass index and type of labor onset 3 .…”

Section: Introductionmentioning

confidence: 99%

Management of fetuses with apparent normal growth and abnormal cerebroplacental ratio: A risk‐based approach near term

Morales‐Roselló,

Khalil,

Martínez‐Varea

2023

Acta Obstet Gynecol Scand

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IntroductionCerebroplacental ratio (CPR) has been shown to be an independent predictor of adverse perinatal outcome at term and a marker of failure to reach the growth potential (FRGP) regardless of fetal size, being abnormal in compromised fetuses with birthweight above the 10th centile. The main aim of this study was to propose a risk‐based approach for the management of pregnancies with normal estimated fetal weight (EFW) and abnormal CPR near term.Material and methodsThis was a retrospective study of 943 pregnancies, that underwent an ultrasound evaluation of EFW and CPR at or beyond 34 weeks. CPR values were converted into multiples of the median (MoM) and EFW into centiles according to local references. Pregnancies were then divided into four groups: normal fetuses (defined as EFW ≥10th centile and CPR ≥0.6765 MoM), small for gestational age (EFW <10th centile and CPR ≥0.6765 MoM), fetal growth restriction (EFW <10th centile and CPR <0.6765 MoM), and fetuses with apparent normal growth (EFW ≥10th centile) and abnormal CPR (<0.6765 MoM), that present FRGP. Intrapartum fetal compromise (IFC) was defined as an abnormal intrapartum cardiotocogram or pH requiring cesarean delivery. Risk comparisons were performed among the four groups, based on the different frequencies of IFC. The risks of IFC were subsequently extrapolated into a gestational age scale, defining the optimal gestation to plan the birth for each of the four groups.ResultsFetal growth restriction was the group with the highest frequency of IFC followed by FRGP, small for gestational age, and normal groups. The “a priori” risks of the fetal growth restriction and normal groups were used to determine the limits of two scales. One defining the IFC risk and the other defining the appropriate gestational age for delivery. Extrapolation of the risk between both scales placed the optimal gestational age for delivery at 39 weeks of gestation in the case of FRGP and at 40 weeks in the case of small for gestational age.ConclusionsFetuses near term may be evaluated according to the CPR and EFW defining four groups that present a progressive risk of IFC. Fetuses in pregnancies complicated by FRGP are likely to benefit from being delivered at 39 weeks of gestation.

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Cerebral Doppler identifies very small fetuses that are less likely to experience intrapartum acidosis

Morales-Roselló,

Martínez-Varea,

Khalil

2024

Preprint

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Purpose To evaluate whether, in late pregnancy, the cerebral Doppler can identify very small fetuses that are less likely to experience intrapartum acidosis (IA). Methods This was a retrospective study of 282 singleton pregnancies that underwent an ultrasound scan at 32+ 0- 40+ 6 weeks and were delivered after induction, or spontaneous onset of labor. Very small fetuses were defined as fetuses with estimated weight less than the 3rd centile. IA was diagnosed in case of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH < 7.20, requiring urgent cesarean section, neonatal pH below 7.10 and Apgar score at 5 minutes < 7. The ability of the cerebral Doppler, middle cerebral artery pulsatility index, and cerebroplacental ratio, expressed in multiples of the median (MCA PI MoM and CPR MoM), to rule out the risk of IA was evaluated alone and combined with other sonographic and clinical parameters by means of logistic regression and ROC curve analyses. Results The only significant parameters determining IA were parity, MCA PI, and CPR MoM. [AUC 0.62 (95% CI 0.54–0.71, P = 0.012), 0.62 (95% CI 0.53–0.71, P = 0.008), 0.60 (95% CI 0.51–0.69, P = 0.020), respectively], while the best prediction was obtained combining parity with MCA PI or CPR [AUC 0.68 (95% CI 0.60–0.76), 0.67 (95% CI 0.60–0.75), P < 0.0001 for both]. Moreover, 90% of IA cases had MCA PI and CPR values below 1.1 MoM, while 100% had MCA and CPR values below 1.5 and 1.3 MoM. Finally, the negative predictive value was 82% for any combination of parameters that included either the MCA MoM or CPR MoM. Conclusion The cerebral Doppler can select very small fetuses that are less likely to experience IA. These fetuses might be to some extent constitutionally small and might be candidates for a more conservative management.

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Which is the best ultrasound parameter for the prediction of adverse perinatal outcome within 1 day of delivery?

Cited by 4 publications

References 36 publications

Cerebroplacental Ratio as a Predictive Factor of Emergency Cesarean Sections for Intrapartum Fetal Compromise: A Systematic Review

Cerebroplacental Ratio as a Predictive Factor of Emergency Cesarean Sections for Intrapartum Fetal Compromise: A Systematic Review

Management of fetuses with apparent normal growth and abnormal cerebroplacental ratio: A risk‐based approach near term

Cerebral Doppler identifies very small fetuses that are less likely to experience intrapartum acidosis

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