Cerebro‐placental ratio as a prognostic factor of fetal outcome in pregnancy complicated by maternal sickle cell disease

Abstract

Objectives To assess the role of the cerebro‐placental ratio (CPR) in predicting adverse fetal outcomes among women with sickle cell disease (SCD). Methods A prospective cohort study at Korle‐Bu Teaching Hospital, Accra, Ghana, between January and June 2016. Pregnant women with SCD at 34 gestational weeks or more underwent weekly fetal umbilical and middle cerebral artery Doppler assessment until delivery. Participants were categorized into two study arms based on CPR (<1.1 or ≥1.1). The primary outcome, a composite of adverse perinatal outcomes including intrauterine growth restriction, stillbirth, low birthweight, and neonatal intensive care unit admission, was compared between groups. Results Overall, 48 pregnant women with SCD were enrolled, and 5 had a fetus with CPR less than 1.1. Low CPR (<1.1) had a sensitivity and specificity of 29.4% and 100%, respectively, for predicting composite adverse perinatal outcomes. Sensitivity and specificity were, respectively, 100% and 93.5% for predicting stillbirth, and 40.2% and 97.4% for predicting low birthweight. Perinatal outcomes did not differ between the two major sickle cell genotypes (hemoglobin SS and hemoglobin SC). Conclusions Among women with SCD, CPR less than 1.1 was associated with adverse perinatal outcomes, particularly low birthweight and stillbirth.

Diagnostic Accuracy of Cerebroplacental Ratio in Prediction of Postnatal Outcomes in Oligohydramnios

“…Consistent with our findings, a study from 2017 at Lady Willingdon Hospital, Lahore, found that the diagnostic accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of the CPR for low APGAR score were 86.94%, 97.18%, 84.21%, 97.64%, respectively [ 16 ]. The cerebroplacental ratio has the highest sensitivity in predicting fetal heart rate anomalies and unfavorable newborn outcomes in term, uncomplicated pregnancies, according to research from Suez Canal University in Ismailia, Egypt [ 17 ].…”

Maternal morbidity and mortality associated with mode of delivery in Sickle cell disease: an observational study

“…24 Recent studies have the proven prognostic value of fetal umbilical and middle cerebral artery doppler evaluations in predicting stillbirth and neonatal intensive care unit admission and may be useful for intrapartum planning. 25 There was no overall increased perinatal risk for infants born vaginally to women with HbSS compared to controls, with equal numbers of stillbirths and neonatal deaths seen in the single and multiple vaginal delivery groups. Conversely, there were no stillbirths and fewer neonatal deaths in women with HbSS disease who underwent cesarean delivery.…”