Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance

Nassr, Ahmed A.; Abdelmagied, Ahmed M.; Shazly, Sherif

doi:10.1515/jpm-2015-0274

Cited by 44 publications

(49 citation statements)

References 5 publications

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“…The equivalent sensitivities for each of these outcomes were 44-70%, 50-80%, 40-81%, and 39-86%, respectively. The corresponding specificities were 56-93%, 54-80%, 53-96%, and 53-97%, respectively [62]. Furthermore, the findings of the PORTO study reinforced the importance of CPR in identifying at risk fetuses; FGR fetuses with abnormal CPR had a 11-fold increase in the risk of adverse pregnancy outcomes, in particular neonatal morbidity, when compared to those with normal CPR [59].…”

Section: Fetal Dopplermentioning

confidence: 78%

“…In a recent meta-analysis, abnormal CPR in SGA fetuses was associated with an increased risk of cesarean section for presumed fetal distress (OR 7.4; 95% CI 2.5 to 21.5), low 5-minute Apgar score (OR 6.9; 95% CI 0.96 to 49.1), neonatal unit admission (OR 13.0; 95% CI 6.0 to 27.9) and neonatal complications (OR 20.4; 95% CI 8.7 to 47.6) [62]. The equivalent sensitivities for each of these outcomes were 44-70%, 50-80%, 40-81%, and 39-86%, respectively.…”

Section: Fetal Dopplermentioning

confidence: 99%

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Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth. HIGHLIGHTS Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, the majority of fetuses suffering from stillbirth at term are not small for gestational age. Serial measurements to assess growth velocity, combined with fetal Doppler, are preferable than a single point estimate. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term  The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth Highlights (for review) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 ABSTRACT Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) -a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. Doppler cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the t...

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Section: Fetal Dopplermentioning

confidence: 78%

Section: Fetal Dopplermentioning

confidence: 99%

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Khalil

Thilaganathan

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…We identified three systematic reviews on the predictive accuracy of CPR for adverse perinatal outcome. Nassr et al .…”

Section: Discussionmentioning

confidence: 99%

“…We identified three systematic reviews on the predictive accuracy of CPR for adverse perinatal outcome [70][71][72] . Nassr et al 70 included seven studies, and reported that abnormal CPR in pregnancies at high risk for FGR or with a diagnosis of FGR increased the risk for adverse perinatal outcome. Summary ROC curves showed that CPR had a better predictive accuracy for neonatal complications and NICU admission.…”

Section: Interpretation In Light Of Previous Systematic Reviewsmentioning

confidence: 99%

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

Conde‐Agudelo

Villar

Kennedy

et al. 2018

Ultrasound in Obstet & Gyne

126

121

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“…To the Editor, Sir, we would like to thank authors for their valuable comments [1] on our recently published meta-analysis [2]. We agree with them that fetal growth restriction (FGR) is initiated by different pathological mechanisms with variable hemodynamic consequences according to the time of onset.…”

mentioning

confidence: 83%

Reply to: Fetal cerebroplacental ratio and adverse perinatal outcome

Nassr¹,

Abdelmagied²,

Shazly³

2016

Journal of Perinatal Medicine

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Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance

Abstract: Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

Cited by 44 publications

References 5 publications

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

Reply to: Fetal cerebroplacental ratio and adverse perinatal outcome

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