Modeling gestational age centiles for fetal umbilicocerebral ratio by quantile regression analysis: a secondary analysis of a prospective cross-sectional study

Rizzo, Giuseppe; Pietrolucci, Maria Elena; Mappa, Ilenia; Maqina, Pavjola; Makatsarya, A.; D’Antonio, F.

doi:10.1080/14767058.2020.1849123

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Biometric variables, estimated fetal weight, and Doppler indices change with gestational age, so data were expressed as the number of standard deviations (z score) by which they diverged from the expected mean difference obtained from previously constructed reference limits. 16,18,19 A sample size analysis was performed to evaluate the sample size necessary. Given a significance of .05 and power of −.80, a sample size of 47 in the study group and 94 in the control group is necessary to demonstrate differences of 0.5 z scores in the variables considered.…”

Section: Discussionmentioning

confidence: 99%

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Effect of SARS‐CoV‐2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study

Rizzo

Mappa

Maqina

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Our objective was to compare the fetal growth velocity and fetal hemodynamics in pregnancies complicated and in those not complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Material and methods: Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. The z scores of head circumference, abdominal circumference, femur length, and estimated fetal weight were compared between the two groups. Fetal growth was assessed by analyzing the growth velocity of head circumference, abdominal circumference, femur length, and estimated fetal weight between the second-and third-trimester scans. Similarly, changes in the pulsatility index of uterine, umbilical, and middle cerebral arteries, and their ratios were compared between the two study groups. Results: Forty-nine consecutive pregnancies complicated, and 98 not complicated, by SARS-CoV-2 infection were included. General baseline and pregnancy characteristics were similar between pregnant women with and those without SARS-CoV-2 infection. There was no difference in head circumference, abdominal circumference, femur length, and estimated fetal weight z scores between pregnancies complicated and those not complicated by SARS-CoV-2 infection at both the second-and thirdtrimester scans. Likewise, there was no difference in the growth velocity of all these body parameters between the two study groups. Finally, there was no difference in the pulsatility index of both maternal and fetal Doppler scans throughout gestation between the two groups. Conclusions: Pregnancies complicated by SARS-CoV-2 infection are not at higher risk of developing fetal growth restriction through impaired placental function. The findings from this study do not support a policy of increased fetal surveillance in these women.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of SARS‐CoV‐2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study

Rizzo

Mappa

Maqina

et al. 2021

Acta Obstet Gynecol Scand

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“…and cerebroplacental ratio, defined as a ratio between the middle cerebral artery and umbilical artery pulsatility index according to a previously published methodology. 21,22 Umbilical vein (UV) diameter and time-averaged maximum velocity were measured in UV intra-abdominal portion by real time and Doppler ultrasonography. A semi-automatic measurement software was used to obtain UV diameter values.…”

Section: Key Messagementioning

confidence: 99%

“…23 The primary outcome of the study was the prediction of fetal macrosomia, defined as a birthweight >90th centile for our national reference limits, 24 while the secondary outcome was a birthweight >4000 g. Since all the biometric, Doppler variables and EFW changes with gestational age data were expressed as z values (ie the number of standard deviations they differ from the expected mean for gestation calculated with the formula: observed value -expected value for gestational age/standard deviation for gestational age) derived from our reference limits for gestation. 22,23 Data were expressed as median and interquartile range or number (n) and percentage (%). Continuous variables were compared using Mann-Whitney U test and categorical variables using Chisquare test.…”

Section: Key Messagementioning

confidence: 99%

The added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: A prospective cohort study

Rizzo

Mappa

Bitsadze

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Current models based on fetal biometry and maternal characteristics have a poor performance in predicting macrosomia. The primary aim of this study was to elucidate the diagnostic performance of fetal venous and arterial Dopplers in predicting macrosomia in the third trimester of pregnancy; the secondary aim was to build a multiparametric prediction model including pregnancy, ultrasound and Doppler characteristics able to predict macrosomia accurately. Material and methods Prospective cohort study including 2156 singleton pregnancies scheduled for routine ultrasound assessment at 36 weeks of gestation. Fetal biometry, estimated fetal weight (EFW), pulsatility index of the uterine, umbilical, and middle cerebral arteries, cerebroplacental ratio and umbilical vein blood flow (UVBF) normalized for fetal abdominal circumference (UVBF/AC) were recorded. Primary outcome was the prediction of fetal macrosomia, defined as a birthweight >90th percentile; secondary outcome was the prediction of newborns >4000 g. Logistic regression and area under the curve (AUC) analyses were used to analyze the data. Results Fetal macrosomia complicated 9.8% of pregnancies, and 7.7% of newborns had a birthweight >4000 g. At multivariate logistic regression analysis, maternal body mass index (adjusted odds ratio [aOR] 1.23), pregestational diabetes (aOR 1.83), a prior newborn with a birthweight >95th centile (aOR 1.49), EFW (aOR 2.23) and UVBF (aOR1.84) were independently associated with macrosomia, whereas gestational diabetes mellitus (P = .07) or any of the other Doppler parameters were not. EFW had an AUC of 0.750 and of 0.801 alone and in association with maternal characteristics for the prediction of macrosomia, respectively. The addition of UVBF to this model significantly improved the prediction of fetal macrosomia provided by maternal and ultrasound parameters with an AUC of 0.892 (De Long P = .044 and P = .0078, respectively). The predictive performance for birthweight >4000 g was similar and significantly improved when UVBF was included in the diagnostic algorithm. Conclusions Umbilical vein blood flow evaluation in the third trimester improves the diagnosis of fetal macrosomia. The optimal diagnostic performance for macrosomia is achieved by a multiparametric model including umbilical vein flow, maternal characteristics and EFW.

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“…Recently, it has been proposed that the ratio between the umbilical and middle cerebral artery pulsatility index, the umbilicocerebral ratio (UCR), had a higher diagnostic accuracy compared to CPR in predicting adverse outcome and therefore gestational age-specific normative centile reference limits have been established for UCR. 26 A study by Mascio et al, however, showed no difference between CPR and UCR in predicting adverse perinatal outcome in the third trimester of pregnancy. 27 We have not used UCR in our study although further studies can be undertaken to assess and compare these two parameters in RFM patients too.…”

Section: Discussionmentioning

confidence: 96%

An emerging method in evaluation of reduced fetal movements using cerebroplacental ratio: A prospective case–control study

Inukollu

Sulthana

Solipuram

et al. 2021

J of Obstet and Gynaecol

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Aim: Nearly half of the patients with stillbirths experience reduced fetal movements (RFM) in the preceding week. The standardized evaluation will help reduce stillbirths. Placental dysfunction is the underlying pathophysiology for RFM and low cerebroplacental ratio (CPR). We attempted to determine the application of CPR in evaluation of RFM. Methods: A prospective case-control study with 100 patients each of cases and controls were studied at a tertiary care hospital. Middle cerebral artery pulsatility index (MCA-PI), umbilical artery PI (UA-PI), and CPR were calculated as multiples of median (MoM) in patients presenting with RFM after 30 weeks and their matched controls and followed up. CPR values of various gestation ranges and single versus multiple episodes of RFM were analyzed. Results: Compared to controls, women with RFM showed a significantly low MCA PI MoM (0.94 vs 1.4; p = 0.00008) and low CPR MoM (1.48 vs 1.6; p = 0.015). Women with multiple RFM episodes had lower CPR MoM (1.2 vs 1.5; p < 0.00001) compared to single episode RFM. Multiple RFM episode patients had low MCA PI MoM (1.3 vs 1.4; p = 0.0038) and low CPR MoM (1.2 vs 1.6; p < 0.00001) compared to controls. There was a significantly low CPR in 32-34 weeks (1.35 vs 1.81; p = 0.004) and 36-38 weeks subgroups (1.39 vs 1.58; p = 0.002). No significant difference in birthweight centiles or AGA versus SGA categories between cases and controls was noted questioning current guidelines where ultrasound evaluation is done for RFM patients with FGR. Conclusion: Incorporation of routine CPR measurements can standardize evaluation of RFM patients, especially those with AGA to pick up patients at risk of poor outcome and bring down stillbirth rates.

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Modeling gestational age centiles for fetal umbilicocerebral ratio by quantile regression analysis: a secondary analysis of a prospective cross-sectional study

Cited by 7 publications

References 27 publications

Effect of SARS‐CoV‐2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study

Effect of SARS‐CoV‐2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study

The added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: A prospective cohort study

An emerging method in evaluation of reduced fetal movements using cerebroplacental ratio: A prospective case–control study

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