Magnitude of change in fetal cerebroplacental ratio in third trimester and risk of adverse pregnancy outcome

Flatley, Christopher; Greer, Ristan M.; Kumar, Sailesh

doi:10.1002/uog.17371

Cited by 29 publications

(29 citation statements)

References 21 publications

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“…Fetal Doppler assessment, particularly CPR ratio, is apparently useful for evaluating the wellbeing of AGA fetuses close to term. Recently, Flatley et al . found that CPR and change in CPR during the third trimester can identify pregnancies at risk of various adverse perinatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Maternal hemodynamics early in labor: a possible link with obstetric risk?

Valensise

Tiralongo

Pisani

et al. 2018

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 99%

Maternal hemodynamics early in labor: a possible link with obstetric risk?

Valensise

Tiralongo

Pisani

et al. 2018

Ultrasound in Obstet & Gyne

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“…Despite advances in antenatal care, the search for a test to identify the fetus at risk for intrauterine demise continues. The cerebroplacental ratio (CPR), a marker of brain sparing, is emerging as a predictor of adverse perinatal outcome, fetal growth restriction (FGR), neonatal care unit admission, intrapartum fetal compromise, episodes of recurrent reduced fetal movements, postnatal circulatory problems and perinatal death in near-term fetuses [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Low CPR reflects redistribution of the cardiac output to the brain and has been shown to improve the accuracy of predicting adverse outcome, as compared with middle cerebral artery (MCA) or umbilical artery (UA) Doppler alone [19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

Kalafat

Öztürk

Sivanathan

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To investigate whether assessment of longitudinal change in Doppler variables in small‐for‐gestational‐age (SGA) fetuses improves the prediction of those at risk of stillbirth. Methods This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate‐for‐gestational‐age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)‐PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear‐mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last‐scan measurement) models. Results In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA‐PI, UA‐PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6–77.2%) and UA‐PI (accuracy, 71.0%; 95% CI, 68.6–73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA‐PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5–7.3%). The accuracies of the standard, compared with the longitudinal, models for UA‐PI (71.0% vs 72.8%), MCA‐PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, −3.3 to 3.3%), 35.2% (MC, −0.1%; 95% CrI, −4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, −1.5 to 5.3%) for CPR, MCA‐PI and UA‐PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last‐scan measurement. Conclusion Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single‐point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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“…Similar results were reported by Triunfo et al 58 who showed that a low CPR in the third trimester of pregnancy had a higher association with adverse perinatal outcomes such as, nonreassuring fetal status requiring emergent cesarean section, 5-minute Apgar score <7, or neonatal metabolic acidosis at birth (UA pH ≤7.15 and base excess greater than 12 mEq/L) than EFW. These observations led to the evaluation of the CPR as a screening tool for pregnant women during the third trimester of pregnancy to identify fetuses at risk of late SGA, 5962 stillbirth, low pH in the umbilical cord, low Apgar scores, cesarean delivery for fetal distress, and admission to the neonatal intensive care unit. 60–62 .…”

Section: Discussionmentioning

confidence: 99%

“…These observations led to the evaluation of the CPR as a screening tool for pregnant women during the third trimester of pregnancy to identify fetuses at risk of late SGA, 5962 stillbirth, low pH in the umbilical cord, low Apgar scores, cesarean delivery for fetal distress, and admission to the neonatal intensive care unit. 60–62 .…”

Section: Discussionmentioning

confidence: 99%

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

et al. 2017

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Aim: To determine whether Doppler evaluation at 20-24 weeks of gestation can predict reduced fetal size later in pregnancy or at birth. Methods: Fetal biometry and Doppler velocimetry were performed in 2,986 women with a singleton pregnancy at 20-24 weeks of gestation. Predictive performances of the umbilical artery pulsatility index (UA-PI) or the mean uterine artery pulsatility index (UtA-PI) >95th percentile, middle cerebral artery pulsatility index, or cerebroplacental ratio (CPR) <5th percentile for early small for gestational age (SGA; <34 weeks of gestation), late SGA (≥34 weeks of gestation), or SGA at birth (birthweight <10th percentile) were analyzed. Results: The prevalence of early SGA, late SGA, and SGA at birth was 1.1, 9.6, and 14.7%, respectively. A CPR <5th percentile had a positive likelihood ratio (LR+) of 8.2 (95% confidence interval [CI] 5.7-12.0) for early SGA, a LR+ of 1.6 (95% CI 1.1-1.2) for late SGA, and a LR+ of 1.9 (95% CI 1.4-2.6) for SGA at birth. A UtA-PI >95th percentile was associated with late SGA and SGA at birth, while an UA-PI >95th percentile was associated with early SGA. Associations were higher in fetuses with an estimated fetal weight <10th percentile. Conclusion: Fetal biometry and Doppler evaluation at 20-24 weeks of gestation can predict early and late SGA as well as SGA at birth.

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Magnitude of change in fetal cerebroplacental ratio in third trimester and risk of adverse pregnancy outcome

Cited by 29 publications

References 21 publications

Maternal hemodynamics early in labor: a possible link with obstetric risk?

Maternal hemodynamics early in labor: a possible link with obstetric risk?

Longitudinal change in cerebroplacental ratio in small‐for‐gestational‐age fetuses and risk of stillbirth

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

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