Are fetuses that fail to achieve their growth potential at increased risk of intrapartum compromise?

Prior, Tomas; Paramasivam, G.; Bennett, Phillip R.; Kumar, Sailesh

doi:10.1002/uog.14758

Cited by 80 publications

(95 citation statements)

References 15 publications

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“…Global screening performance of the CPR 10th centile was highest for CS IFC (AUROC 0.72), followed by birthweight <5th centile, birthweight Data presented as n (%) or median (IQR), as appropriate. CPR, cerebroplacental ratio; meconium liquor, meconium-stained liquor; FHR abnormalities, fetal heart rate suspicious or pathological; SVD, spontaneous vaginal delivery; IFC, intrapartum fetal compromise; CS, cesarean section; IOL excl, induction of labour cases excluded; BW, birthweight; abnormal cord gases, umbilical artery pH ≤7.0 and/or base excess ≤-12 and/or lactate >6 mmol/L; low Apgar, Apgar score ≤5 at 5 min; NICU, neonatal intensive care unit; composite ANO, composite adverse neonatal outcome (abnormal cord gases [umbilical artery pH ≤7.0, base excess ≤-12 and/or lactate >6 mmol/L], Apgar score ≤5 at 5 min, and/or NICU admission Although low birthweight is associated with late-onset growth restriction and intrapartum and neonatal complications [21][22][23], some babies born with birthweights above the 10th centile may have failed to reach their growth potential [11,24] and are therefore also at risk of these complications. In our view, a 41.9% sensitivity for birthweight <10th centile based on CPR <10th centile may be reasonable and acceptable, given the imperfect presumption of birthweight as a reliable indicator of underlying placental insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Cerebroplacental Ratio Thresholds at Term for Prediction of Low Birthweight and Adverse Intrapartum and Neonatal Outcomes in a Term, Low-Risk Population

et al. 2017

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Objectives: To investigate the screening performance and best threshold centile (5th vs. 10th) of the cerebroplacental ratio (CPR) in low-risk, term pregnancies to predict low birthweight and adverse intrapartum and neonatal outcomes in a term, low-risk population. Methods: This was a blinded, prospective, cross-sectional study of low-risk singleton pregnancies at term. Women attended fortnightly from 36 weeks for CPR and estimated fetal weight assessment. Intrapartum and neonatal outcomes were recorded. Primary outcomes assessed were low birthweight, cesarean section for intrapartum fetal compromise, and composite adverse neonatal outcome. Results: A total of 483 women participated in the study. The CPR 10th centile (1.48) threshold resulted in the best screening performance. Sensitivities for low birthweight, cesarean section for intrapartum fetal compromise, and composite adverse neonatal outcome of 41.9, 61.1, and 38.3% were achieved for false-positive rates of 17.7, 17.7, and 15.2%, respectively. The corresponding areas under the receiver operating characteristic curves were 0.62, 0.72, and 0.62. Conclusion: The CPR 10th centile resulted in the best screening performance, although this would be considered fair at best. The CPR 10th centile may be useful as part of a risk stratification tool for prediction of low birthweight and adverse intrapartum and neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Cerebroplacental Ratio Thresholds at Term for Prediction of Low Birthweight and Adverse Intrapartum and Neonatal Outcomes in a Term, Low-Risk Population

et al. 2017

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“…[14] There is now good data, both from prospective [15,16] and retrospective studies [17,18] demonstrating that a low CPR is associated with suboptimal growth at term, increased rates of intrapartum compromise and emergency caesarean, poor condition at birth and increased rates of neonatal unit admission. In addition, a low CPR may also reflect a failure of a fetus to reach its genetic growth potential at term [19,20] despite having a normal birth weight.…”

Section: Commentmentioning

confidence: 99%

The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index

Gibbons

Flatley

Kumar

2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Please cite this article as: Gibbons Anthea, Flatley Christopher, Kumar Sailesh.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index.European Journal of Obstetrics and Gynecology and Reproductive Biology http://dx.doi.org/10.1016/j.ejogrb.2017.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index Abstract ObjectiveThis study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM). Study DesignThis was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the ResultsOf the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5 th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10 th centile (OR 3.01, 95%CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90 th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10 th centile vs. >10 th centile) demonstrated a lower birth weight in the CPR <10 th centile cohort for all DM categories. The proportion of neonates with birth weights <10 th centile were higher in the CPR <10 th centile cohort with the GDM cohort having an odds ratio of 8.28 p<0.0001) of this complication. The CPR <10 th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM. ConclusionsRegardless of the type of DM, a low CPR was associated with poorer neonatal outcomes.Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.

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“…Whilst fetal growth restriction (FGR) and SGA are often used interchangeably, SGA is more broadly defined as any fetus with an estimated fetal weight (EFW) below the 10th centile for gestation. Not all cases of FGR are SGA, and, indeed, there is increasing recognition that even fetuses with EFWs >10th centile may have failure to reach their genetic growth potential and that these fetuses are characterised by an abnormal cerebroplacental ratio [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Screening Performance of Placental Growth Factor for the Prediction of Low Birth Weight and Adverse Intrapartum and Neonatal Outcomes in a Term Low-Risk Population

Bligh

Greer

Kumar³

2017

Fetal Diagn Ther

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Introduction: Fetuses who fail to reach their genetic growth potential are thought to have sub-optimal placental function. Low placental growth factor (PlGF) levels have been shown to be predictive of placentally mediated conditions, such as pre-eclampsia or fetal growth restriction. We investigated the screening performance of PlGF for the prediction of low birth weight (<10th centile for gestation) and adverse intrapartum and neonatal outcomes in apparently low-risk term pregnancies. Materials and Methods: Maternal PlGF levels were measured fortnightly in a blinded, prospective, observational study from 36 weeks of pregnancy. Women and clinicians were blinded to PlGF results, and pregnancies were managed according to local policies and guidelines. Intrapartum and neonatal outcomes were recorded. PlGF was analysed for association with, and predictive capacity for, low birth weight, caesarean section for intrapartum fetal compromise (CS-IFC) and adverse neonatal outcomes. Results: A total of 438 women were included in the final analysis. Lower PlGF levels were associated with low birth weight, CS-IFC and adverse neonatal outcome. For a false-positive rate of 10 and 20%, respectively, the corresponding sensitivities were 9.7-11.1% and 22.2-26.8%. Conclusion: As a sole predictor for low birth weight, CS-IFC and adverse neonatal outcome, PlGF was poor as a test.

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Are fetuses that fail to achieve their growth potential at increased risk of intrapartum compromise?

Abstract: Objective The true growth potential of a fetus is difficult to predict but recently a new definition, independent of fetal weight, using cerebroplacental (cerebro-umbilical) ratio (CPR)<

Cited by 80 publications

References 15 publications

Diagnostic Performance of Cerebroplacental Ratio Thresholds at Term for Prediction of Low Birthweight and Adverse Intrapartum and Neonatal Outcomes in a Term, Low-Risk Population

Diagnostic Performance of Cerebroplacental Ratio Thresholds at Term for Prediction of Low Birthweight and Adverse Intrapartum and Neonatal Outcomes in a Term, Low-Risk Population

The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index

Screening Performance of Placental Growth Factor for the Prediction of Low Birth Weight and Adverse Intrapartum and Neonatal Outcomes in a Term Low-Risk Population

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