Doppler study (cerebroplacental ratio) as a predictor of adverse perinatal outcome

Abstract

Background: Objective of the current study was to determine the importance of Doppler screening (cerebroplacental ratio i.e. CPR) in antenatal mothers and its effect on perinatal outcome of the baby so that appropriate management can be planned effectively for a better reduction in perinatal mortality and morbidity.Methods: A prospective study conducted on hundred antenatal women in GMKMCH, Salem with gestational age >32 weeks, with singleton pregnancies. Doppler ultrasonogram of fetal middle cerebral artery and umbilical artery and thus CPR obtained.Results: 25 out of the 100 patients in the study had CPR<1. CPR was compared against factors such as maternal age, parity, associated risk factors, gestational age (GA) at diagnosis (LMP GA and scan GA), time duration to delivery from diagnosis, requiring neonatal intensive care unit (NICU) admission, duration of stay in NICU and perinatal mortality. The CPR≤1 has a good sensitivity of 68% but a very high specificity of around 98% in predicting neonatal complications which was found to be statistically significant with a p value <0.0001.Conclusions: Since CPR has a high negative predictive value, CPR>1 helps to rule out adverse perinatal outcomes. When CPR<1, it acts as an effective tool in helping the obstetrician to decide on the mode of delivery to ensure that the baby is delivered within 12 hours of diagnosis, to improve the perinatal outcome of the baby.

Effectiveness of Cerebroplacental Ratio Estimation Early in Labor as A predictor of Adverse Perinatal Outcomes in Full-term Low-risk Pregnancy

“…This result agrees with Dall'Asta et al [14] who found that obstetric intervention for suspected fetal distress in labor was frequently higher among cases with reduced CPR MoM compared to cases with normal CPR MOM [9/54 [16.7%] vs 28/508 [5.5%]; P = 0.001. Similarly, Sengodan and Mathiyalagan [20] found that 25 babies out of 100 full term uncomplicated pregnancy that had CPR<1, 18 of them were delivered by CS and only 7 of them were delivered vaginally [spontaneous vaginal delivery]. We found that was a significant negative correlation between the rate of emergency CS due to Fetal distress and abnormal CPR, r=-0.293, p=0.001.…”

Cerebroplacental ratio and its relation to poor perinatal outcomes in singleton pregnancies: a cross sectional study in a tertiary care centre of Eastern India

“…9 According to Subha S and Sankari M, the route of birth was LSCS in 64%, and the mean age was 24.9 years whereas in the present study LSCS rate was lower (38.9%). 10 According to Subha et al, 52% were primigravidae (78.8% in the present study) and 70% had gestational hypertension whereas in our study only 17.7% had hypertensive disorders of pregnancy. 10 Cerebroplacental ratio was not found to be useful in the investigation by Vollgraff et al in predicting any negative perinatal outcome.…”

“…10 According to Subha et al, 52% were primigravidae (78.8% in the present study) and 70% had gestational hypertension whereas in our study only 17.7% had hypertensive disorders of pregnancy. 10 Cerebroplacental ratio was not found to be useful in the investigation by Vollgraff et al in predicting any negative perinatal outcome. 11 In the present study 26.9% of women were delivered before 36weeks which concurred with a study by Dall'asta et al {n=562}, in which women with reduced CPR MoM delivered at an early gestational age.…”

“…9 In patients with inadequate CPR, Subha et al observed that admission to the NICU was a significant perinatal outcome which was evident in the present study. 10 This study has some limitations. In this study, doppler evaluation results were not blinded, which could have created the possibility that this information may have influenced future clinical intervention and treatment outcome, one of the study's shortcomings.…”

Role of cerebro-placental ratio in prediction of perinatal outcome in high-risk Pregnancies with intrauterine growth restriction

“…There is a substantial variation in the groups in term of low APGAR, fetal distress, meconium aspiration, hypoxic ischemic encephalopathy and NICU admission. The weight at birth of the newborns, the Apgar score at 1 and 5 minutes, the need for admittance to the NICU, the length of stay in the NICU, and perinatal mortality were all examined in Sengodan and Mathiyalagan's, 19 research.…”