Cerebroplacental Ratio Versus Nonstress Test in Predicting Adverse Perinatal Outcomes in Hypertensive Disorders of Pregnancy: A Prospective Observational Study

Abstract

Introduction: In developing countries, nonstress test (NST) is the most widely used method for antenatal fetal surveillance. Lately, cerebroplacental ratio (CPR) has emerged as a predictor for adverse perinatal outcomes, especially in hypertensive disorders in pregnancy (HDP). Against this background, the present study was conducted with the primary objective of quantifying the diagnostic accuracy of cerebroplacental ratio (CPR) versus nonstress test (NST) in predicting adverse perinatal outcomes in women with HDP.Methods: This was a prospective observational cohort study conducted in a tertiary care institute in eastern India. All consecutive women with hypertension in pregnancy at a gestational age of ≥32 weeks were recruited into the study. Both CPR and NST were performed at baseline and repeated weekly till delivery. The parameters obtained within one week of delivery were entered for analysis.Results: Sixty-two of the 65 women completed the study. There were 22 women (35.5%) in group A (both CPR and NST normal), 17 (27.4%) in group B (CPR abnormal, NST normal), 14 (22.6%) in group C (CPR normal and NST abnormal), and nine (14.5%) in group D (both CPR and NST abnormal). CPR had greater sensitivity (93.33% versus 46.67%), with higher positive predictive value (53.85% versus 30.43%), specificity (74.47% versus 65.91%), and negative predictive value (97.22% versus 79.49%) than NST for predicting neonatal intensive care unit admission. CPR also had higher sensitivity (84.62% versus 61.54%) and specificity (91.34% versus 69.39%) than NST in predicting neonatal complications. The negative predictive value (NPV) of CPR was 100% for predicting requirement of bag and mask ventilation and continuous positive airway pressure. Conclusion: CPR had greater diagnostic accuracy in terms of both higher sensitivity and greater specificity than NST in predicting adverse perinatal outcomes in women with hypertensive disorders of pregnancy.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices

“…Similarly, a previous study from India reported that CPR had a high sensitivity (93.3% ), specificity (74.47%), PPV (53.85% ), and NPV (97.22%) for prediction of NICU admission in hypertensive disorders of pregnancy [20]. The current study showed a statistically significant correlation between abnormal CP ratio and stillbirth/perinatal death, estimated as 12.50 % with 100 % sensitivity, 70.83 % specificity, 12.50% PPV, and 100% NPV.…”

“…Also, Sahinaj et al reported a significant positive correlation between abnormal CP ratio and NICU admission with sensitivity, specificity, PPV, and NPV as 50.1%, 79.3%, 77.6%, and 52.5% respectively [ 18 ]. Similarly, a previous study from India reported that CPR had a high sensitivity (93.3% ), specificity (74.47%), PPV (53.85% ), and NPV (97.22%) for prediction of NICU admission in hypertensive disorders of pregnancy [ 20 ]. Table 5 summarizes the comparison of the sensitivity, specificity, PPV, and NPV of cerebroplacental ratio for NICU admission among various previous studies.…”

Fundoscopic Findings in Pregnancy Related Hypertensive Disorders and Its Association with Maternal and Fetal Outcomes

“…Methyldopa is a centrally-acting medication declared secure for both the mother and also describe fetus by the US contained Food and special brand of Drug Administration (FDA). In extreme instances of preeclampsia and eclampsia, FDA category C medication labetalol was used [8][9][10]. Patients with eclampsia were given magnesium-based sulfate according to the Pritchard type regimen to reduce seizures; they were also given fluid replenishment and underwent close observation.…”