Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor

Abstract

Objective To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 h prior to induction of labor. MethodsThis was a prospective observational study of 1902 singleton pregnancies undergoing induction of labor at ≥ 37 weeks' gestation. Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) within 24 h before induction of labor. The measured UA-PI and MCA-PI and their ratio were converted to multiples of the median after adjustment for gestational age. Univariable and multivariable logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for Cesarean section for presumed fetal distress and adverse neonatal outcome, which included umbilical arterial or venous cord blood pH ≤ 7 and ≤ 7.1, respectively, 5-min Apgar score < 7, admission to the neonatal intensive care unit for > 24 h or hypoxic ischemic encephalopathy.Results A combination of maternal and pregnancy characteristics, including age, weight, racial origin, previous obstetric history, pre-eclampsia, gestational age at delivery and amniotic fluid volume, identified 39% of pregnancies requiring Cesarean section for fetal distress at a FPR of 10%; addition of CPR did not improve the performance of screening. In screening for adverse neonatal outcome by a combination of parity and CPR, the DR was 17% at a FPR of 10%.Conclusion Low CPR, measured within 24 h prior to induction of labor, is associated with increased risk of Cesarean section for fetal distress and adverse neonatal outcome, but the performance of CPR for such surrogate measures of fetal hypoxic morbidity is poor.

Correlation of Cerebroplacental Ratio (CPR) With Adverse Perinatal Outcome in Singleton Pregnancies

“…Fiona et al, have examined 1,902 singleton pregnancies undergoing induction of labor at ≥37 weeks' gestation in a prospective analysis. They were able to demonstrate that low CPR, measured within 24 hours of induction of labor, is associated with increased risk of cesarean section for fetal distress and adverse neonatal outcome (8).…”

Prediction of adverse perinatal outcome by serum placental growth factor and soluble fms‐like tyrosine kinase‐1 in women undergoing induction of labor

“…In order to overcome this problem, we decided to investigate the potential value of biomarkers measured within 24 h prior to induction of labor at term. In a previous study of 1902 women with a singleton pregnancy undergoing induction of labor at ≥ 37 weeks' gestation, we found that low CPR was associated with increased risk of Cesarean section for non‐reassuring fetal status in labor and adverse neonatal outcome, but the performance of CPR for such surrogates of adverse perinatal outcome was poor.…”

“…Previous studies examining the value of low CPR in predicting adverse outcome in pregnancies undergoing induction of labor at ≥ 37 weeks' gestation reported contradictory results 7,16,17 . A study of 19 207 women with a singleton pregnancy undergoing routine assessment at 35-37 weeks' gestation reported that serum PlGF < 5 th percentile and sFlt-1 > 95 th percentile were associated with increased risk of Cesarean delivery for suspected fetal compromise in labor and neonatal unit admission for ≥ 48 h; however, the performance of screening for these adverse outcomes by maternal factors and estimated fetal weight was not improved by the addition of these biochemical markers 18 .…”

“…In women at term, impaired placentation and fetal hypoxemia, reflected in low serum levels of the angiogenic placental growth factor (PlGF), high levels of the antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and reduced cerebroplacental ratio (CPR), are associated with increased risk of adverse perinatal outcome in both small-for-gestational-age (SGA) and non-SGA fetuses [1][2][3][4][5][6][7] .…”

Relação cerebroplacentária como método preditor de resultados adversos perinatais: um estudo retrospectivo observacional

“…A relação cerebroplacentária (RCP), ou seja, a divisão entre os índices de impedância da ACM pelos da AU, vem surgindo como um importante preditor de RAP, tanto para fetos restritos como para aqueles adequados para a idade gestacional (AIG). Essa relação representa mais claramente a redistribuição do débito cardíaco fetal secundariamente à hipoxia fetal (Gramellini et al, 1992;Baschat, Gembruch, 2003 Prior et al, 2013;Figueras et al, 2015;Khalil et al, 2015a,b;Morales-Roselló et al, 2015;Bligh et al, 2018b;Dall'Asta et al, 2019;Fiolna et al 2019). Estudos em modelos experimentais também demonstraram melhor correlação entre uma RCP anormal e hipoxia do que os índices individualmente (Arbeille et al, 1995).…”