Fetal Biophysical Profile and Cerebro-Umbilical Ratio in Assessment of Perinatal Outcome in Growth-Restricted Fetuses

Abstract

Aim: To examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of perinatal outcome in growth-restricted and hypoxic fetuses. Study Design: The prospective clinical study included 87 pregnant women with singleton pregnancies at 28–42 weeks of gestation with clinically verified intrauterine growth restriction (IUGR). After assessment of FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and FBP were assessed twice a week. At delivery, umbilical arterial pH, the occurrence of meconium-stained amniotic fluid (MAF), Apgar score at 5 min and the incidence of cesarean sections were used as outcome parameters. Results: The mean FBP value was 5.5 ± 0.96 in cases with MAF, and 6.88 ± 0.26 in cases without MAF. Also, there was no statistical significance in the relation between the C/U ratio and the appearance of MAF. At pH >7.2, the mean FBP value was 7.11 ± 0.23, while it was 2.83 ± 0.79 in newborns with acidosis. Both FBP and C/U values were statistically correlated with pH (p < 0.01). The mean umbilical arterial pH was 7.31 ± 0.0 at a C/U ratio of ≧1 and 7.21 ± 0.03 at a C/U ratio of <1. In cases with Apgar scores of 8–10, the mean FBP value was 7.28 ± 0.23, at Apgar scores of 5–7 it was 3.9 ± 0.52, while at Apgar scores of 0–4 the mean FBP value was 1.5 ± 0.5. The mean Apgar score at 5 min was 9.54 ± 0.09 at a C/U ratio of ≧1, and 8.12 ± 0.49 at a C/U ratio of <1. The mean FBP value in cases of vaginal delivery was 7.55 ± 0.31. In cesarean section deliveries, the mean FBP value was 5.97 ± 0.37. Also, there was a high frequency of cesarean sections in growth-restricted fetuses with a C/U ratio of <1 (p < 0.05), i.e. slightly less than FBP. Conclusions: FBP and C/U ratio were associated with low arterial pH, low Apgar score and the rate of cesarean sections (p < 0.05), but there was no association between FBP or C/U ratio and the appearance of MAF (p > 0.5). Due to their good predictive value the FBP and C/U ratio could be used in the prenatal monitoring of growth-retarded and hypoxic fetuses. These two methods can be used as important parameters in the decision to end pregnancies with IUGR, when pathological values occur. Thus a reduction in perinatal morbidity, mortality and the incidence of infants with poor neurologic outcome can be expected.

Fetal Hemodynamic Adaptive Changes Related to Intrauterine Growth

“…Middle cerebral artery PI has been described to be a poor prognostic factor alone and performs better in combination with the umbilical artery PI, the cerebroumbilical ratio. 29 The present study suggests that the anterior cerebral artery PI might perform better to describe the brain-sparing effect. The finding of a lower PSV in the middle cerebral artery with declining fetal growth may directly reflect the lower PSV in the cardiac outflow tracts in smaller fetuses.…”

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

“…Elevation in the U/C PI has been suggested to be a sensitive marker of the 'brain-sparing effect' in fetuses with placental insufficiency and intrauterine growth restriction [22] . Similarly, the current study supports a trend towards a significant elevation in the U/C PI (p !…”

Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

“…A number of authors have proposed that the calculation of the cerebroplacental ratio (CPR) is of additional value to diagnose brain-sparing [9,10,11,12,13,14,15,16]. This ratio between the MCA and UA-PI or -RI can be decreased, while the individual values remain within normal limits.…”