Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

Abstract

<b><i>Introduction:</i></b> The role of cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) to predict adverse intrapartum and perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR) remains controversial. <b><i>Methods:</i></b> This was a multicenter, retrospective cohort study involving 5 referral centers in Italy and Spain, including singleton pregnancies complicated by late FGR, as defined by Delphi consensus criteria, with a scan 1 week prior to delivery. The primary objective was to compare the diagnostic accuracy of the CPR and UCR for the prediction of a composite adverse outcome, defined as the presence of either an adverse intrapartum outcome (need for operative delivery/cesarean section for suspected fetal distress) or an adverse perinatal outcome (intrauterine death, Apgar score <7 at 5 min, arterial pH <7.1, base excess of >−11 mEq/mL, or neonatal intensive care unit admission). <b><i>Results:</i></b> Median CPR absolute values (1.11 vs. 1.22, <i>p</i> = 0.018) and centiles (3 vs. 4, <i>p</i> = 0.028) were lower in pregnancies with a composite adverse outcome than in those without it. Median UCR absolute values (0.89 vs. 0.82, <i>p</i> = 0.018) and centiles (97 vs. 96, <i>p</i> = 0.028) were higher. However, the area under the curve, 95% confidence interval for predicting the composite adverse outcome showed a poor predictive value: 0.580 (0.512–0.646) for the raw absolute values of CPR and UCR, and 0.575 (0.507–0.642) for CPR and UCR centiles adjusted for gestational age. The use of dichotomized values (CPR <1, UCR >1 or CPR <5th centile, UCR >95th centile) did not improve the diagnostic accuracy. <b><i>Conclusion:</i></b> The CPR and UCR measured in the week prior delivery are of low predictive value to assess adverse intrapartum and perinatal outcomes in pregnancies with late FGR.

Value of Cerebroplacental Ratio and Uterine Artery Doppler as Predictors of Adverse Perinatal Outcome in Very Small for Gestational Age at Term Fetuses

“…Previous studies have reported a poor performance of CPR as an APO predictor except for perinatal death [25][26][27]. Furthermore, Di Mascio et al recently reported a poor performance of CPR as well as of UCA (umbilicocerebral ratio) in late-onset FGR as outcome predictors [28]. Accordingly, our analysis confirmed a low predictive performance of CPR in the SGA group.…”

Cerebroplacental Doppler Indices in Intrauterine Growth Restriction Fetuses before and after Maternal Dexamethasone Management

“…In Doppler studies, this is reflected in decreased resistance in these three vascular beds. "The middle cerebral artery is the vessel of choice to assess the fetal cerebral circulation because it is easy to identify, has a high reproducibility, and provides information on the brain-sparing effect" [4,5]. "The circulation in the brain is normally high impedance.…”