Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term

 

Introduction The cerebroplacental ratio (CPR: ACM-PI/UA-PI) is associated with adverse perinatal outcome (APO) in low-risk pregnancies at term. Similarly, the rate of “brain sparing” and obstetric interventions seems to be increased with increasing mean uterine pulsatility index (mUtA-PI). A Doppler parameter combining information from the uterine, placental and fetal vessels could potentially improve detection of subclinical uteroplacental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR: CPR/mUtA-PI) related to APO prediction in low-risk term pregnancies in >40+0 weeks of gestation.

Material and Methods This is a retrospective cohort study. All low-risk pregnancies in which the feto-maternal Doppler (PI of umbilical artery: UA-PI, PI of middle cerebral artery: ACM-PI and mUtA-PI) was examined from 40+0 SSW and an AGA (appropriate for gestational age) fetus was present (without other abnormalities) were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR with respect to the occurrence of APO. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): Operative delivery (OD) due to intrapartum fetal compromise (IFC) and/or admission to the neonatal intensive care unit (NICU) and/or umbilical cord arterial pH ≤7.15 and/or 5-minute APGAR ≤7.

Results A total of n=114 cases were included. The mean gestational age at examination and delivery were 40+3 weeks and 40+6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC=0.67, 95% CI: 0.55-0.78, p=0.004) and CPR (AUC=0.68, 95% CI: 0.57-0.78, p=0.002) with CAPO. Additionally, the CPUR (AUC=0.64, 95% CI: 0.50-0.77, p=0.040) showed a predictive value for OD due to IFC.

Discussion The CPUR showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies >40+0 weeks. However, the extent to which CPUR can be used to optimize delivery management at term warrants further investigations in large prospective interventional studies.

Publication History

Article published online:
20 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany