Comparison of Cerebroplacental Ratio, Intergrowth-21st Standards, Customized Growth, and Local Population References for the Prediction of Fetal Compromise: Which Is the Best Approach?

Abstract

<b><i>Objective:</i></b> The aim of this work was to compare the accuracy of the cerebroplacental ratio (CPR), Intergrowth 21st standards (IG21), customized growth (CG), and local population references (LPR) in the prediction of intrapartum fetal compromise (IFC). <b><i>Methods:</i></b> This was a prospective study of 714 fetuses that underwent an ultrasound examination at 34–41 weeks and were delivered within a 2-week interval. The CPR was converted into multiples of the median and the estimated fetal weight (EFW) transformed into CG, IG21, and LPR centiles. IFC was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean section, 5-min Apgar score, and admission to pediatric care units. The accuracies of the CPR and the EFW centiles for the prediction of IFC were evaluated alone and in combination with other gestational characteristics using univariate and multivariate analysis. <b><i>Results:</i></b> Individually, the CPR was the parameter that best predicted the existence of IFC (AUC = 0.66). The multivariate analysis showed that the best prediction was again achieved with the CPR, alone or in combination with any of the EFW centiles (AUC = 0.74). No significant differences were seen between the different centile methods. <b><i>Conclusion:</i></b> The best prediction of IFC is obtained with CPR. Evaluation of CPR should be encouraged in term and late-preterm fetuses.

The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery

“…Correlation of birth weight (BW) with stillbirth, adverse perinatal outcome (APO), and cesarean section for intrapartum fetal compromise (CS-IFC) is known to be poor [1][2][3][4]. On the 1 hand, many small for gestational age (SGA) fetuses are constitutionally small [5].…”

Cerebroplacental ratio and estimated fetal weight, the 2 different yardsticks

“…Moreover, clinical studies and mathematical models have proved that fetal hemodynamics, which are represented by CPR, excels EFW in the association with surrogate markers of APO. 4,5 However, many researchers still argue that CPR should be interrogated only in case of smallness for gestational age (SGA) and forget that EFW is in itself a less accurate parameter and that the finding of a higher CPR accuracy in SGA fetuses would also apply, probably in a more notable way, by permuting the order of examination. In fact, many clinicians indicate CPR is not accurate enough to screen for APO and IFC.…”

“…Current clinical decisions are still influenced by a ponderal mentality, which prevents the full consideration of hemodynamics as an initial approach. However, if, as recently published, CPR excels all the proposed biometric approaches, 5 we should ask ourselves whether the appropriate screening approach should be to perform hemodynamic evaluation in SGA or conversely to perform fetal biometry in cases of low CPR. Using the same yardstick, the answer is clear.…”

Information about fetal sex neither affects CPR nor improves CPR prediction of adverse perinatal outcome at end of pregnancy

“…The cerebroplacental ratio (CPR) has emerged as a good predictor of adverse perinatal outcome (APO) at the end of pregnancy, comparing favorably with estimated fetal weight (EFW) regardless of the reference thresholds applied 1 . In their work, Acharya et al developed CPR references according to fetal sex 2 , suggesting a possible role in the surveillance of fetal wellbeing.…”

“…J. Morales-Roselló 1,2 * , G. Loscalzo 1 , S. Buongiorno1 and A. J.Cañada Martínez 3 1 Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2 Departmento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain; 3 Unidad de Bioestadística, Instituto de Investigación Sanitaria La Fe, Valencia, Spain *Correspondence. (e-mail: jose.morales@uv.es) DOI: 10.1002/uog.22130…”