The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses

DeVore, Greggory R.

doi:10.1016/j.ajog.2015.05.024

Cited by 268 publications

(206 citation statements)

References 30 publications

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“…We recently reported that the CPR is a marker of failure to reach growth potential and adverse pregnancy outcomes, in both AGA and SGA fetuses [55,56], and this has been discussed in a recent review [63]. Most studies that assessed the utility of CPR in identifying at risk fetuses used point estimates and lacked longitudinal data.…”

Section: Fetal Dopplermentioning

confidence: 99%

“…Given that fetuses considered to be at risk, such as those diagnosed to be SGA, are monitored with serial ultrasound examinations, it should be possible, and indeed would be preferable, to use reference ranges for CPR based on studies with a longitudinal design [64]. However, the reference ranges currently used for CPR are based on cross sectional studies and thus more suitable for single observations rather than serial monitoring [63][64][65][66][67][68].…”

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: 99%

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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“…[21] The CPR therefore reflects suboptimal placental function and associated fetal cardiovascular compensation and thus appears to be a better predictor of outcome than either the UA PI or MCA PI individually. [7] Hence, it is likely to be a good modality for assessment of fetal wellbeing given the previously described specific placental abnormalities seen in diabetic pregnancies.…”

Section: Commentmentioning

confidence: 99%

“…It represents the severity of increased cerebral perfusion resulting from fetal hypoxia and is associated with a myriad of adverse perinatal outcomes. [7] Although there is relatively little research regarding the utility of the CPR in a diabetic cohort, recent data suggests that a low CPR (<10 th centile) regardless of GDM treatment was associated with worse perinatal outcomes, increased rates of low birth weight and higher preterm birth rates. [8] The objective of this study thus was to assess the relationship between the CPR and outcomes in pregnancies complicated by pre-existing Type 1 DM (pT1DM), pre-existing Type 2 DM (pT2DM) as well as women with GDM and to determine if the CPR measured at 34+0-36+6 weeks gestation is predictive of adverse obstetric and perinatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index

Gibbons

Flatley

Kumar

2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Please cite this article as: Gibbons Anthea, Flatley Christopher, Kumar Sailesh.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index.European Journal of Obstetrics and Gynecology and Reproductive Biology http://dx.doi.org/10.1016/j.ejogrb.2017.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index Abstract ObjectiveThis study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM). Study DesignThis was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the ResultsOf the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5 th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10 th centile (OR 3.01, 95%CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90 th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10 th centile vs. >10 th centile) demonstrated a lower birth weight in the CPR <10 th centile cohort for all DM categories. The proportion of neonates with birth weights <10 th centile were higher in the CPR <10 th centile cohort with the GDM cohort having an odds ratio of 8.28 p<0.0001) of this complication. The CPR <10 th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM. ConclusionsRegardless of the type of DM, a low CPR was associated with poorer neonatal outcomes.Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.

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“…Unfortunately, there is not enough evidence to consider MCA Doppler effective in managing FGR fetuses. A recent review by DeVore et al [93] reports that an abnormal CPR is associated with adverse pre-and post-natal outcomes even in fetuses with early-onset SGA; however, it has never been demonstrated whether delivering earlier fetuses who show features of redistribution could add any benefit [64,93,94].…”

Section: Managementmentioning

confidence: 99%

Early onset fetal growth restriction

Nawathe

Lees

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.

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The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses

Cited by 268 publications

References 30 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

The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index

Early onset fetal growth restriction

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