Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome

Sunantha Perumal; Chitra Andrew

doi:10.5005/jp-journals-10006-2285

SEARCH WITHIN CONTENT

Online First

Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome

Sunantha Perumal, Chitra Andrew

Keywords : Adverse pregnancy outcome, Cerebroplacental ratio percentile, Fetal cerebral redistribution, Fetal hypoxia

Citation Information : Perumal S, Andrew C. Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome. J South Asian Feder Obs Gynae 2023; 15 (4):445-450.

DOI: 10.5005/jp-journals-10006-2285

License: CC BY-NC 4.0

Published Online: 16-09-2023

ARTICLE
REFERENCES

Abstract

Aim: To evaluate the predictive efficacy of cerebroplacental ratio (CPR) percentile in the third trimester, to identify fetuses at risk of adverse pregnancy outcome (APO) in a tertiary care center. The secondary objectives were to compare the performance of CPR percentile to conventional parameters—estimated fetal weight (EFW), umbilical artery-pulsatility index (UA-PI), and CPR (<1). Materials and methods: This study was a retrospective cohort study conducted at the Fetal Medicine Unit, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India (from September 2018 to September 2019). Following institutional ethics committee approval, 600 women with a singleton non-anomalous fetus, delivered within 3 weeks of fetal Doppler study in the third trimester were included in the study. The parameters EFW (<5th percentile), UA-PI (>95th percentile), and CPR (<5th percentile) were calculated using ultrasound software and were evaluated separately and in combination. Perinatal outcomes assessed were intrapartum cardiotocography (CTG) abnormalities, operative delivery for fetal distress, preterm delivery, stillbirth, low birth weight (BW) percentiles stillbirth, and a composite neonatal outcome. Statistical indices calculation and analysis were done using the statistical package for the social sciences (SPSS) software, version 16. Results: Cerebroplacental ratio (<5th centile) has better sensitivity of 47% when compared to other parameters. 50% of fetuses with abnormal CPR percentile had adverse outcomes even when other parameters were normal. Combination of CPR percentile and EFW has high specificity of 99.8% and positive predictive value of 97.1%. Conclusion: Comparatively, the CPR percentile is a better predictor of adverse outcomes. The addition of the CPR percentile to EFW improves the positive predictive value of the test to predict adverse outcomes. Significance: The CPR percentile can be used to risk stratify apparently low-risk pregnancies, and reallocate them for closer monitoring to optimize the perinatal outcome without increasing unnecessary interventions. However, since the sensitivity was 47% further studies are required to define the risk–benefit ratio of such a protocol.

HTML PDF Share

Maurer HS, Behrman RE, Honig GR. Dependence of the oxygen affinity of blood on the presence of foetal or adult haemoglobin. Nature 1970;227(5256):388–390. DOI: 10.1038/227388a0.
Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014;36(2):86–98. DOI: 10.1159/000357592.
Rouse DJ. ACOG practice bulletin No. 145: Antepartum fetal surveillance. Obstet Gynecol 2014;124:182–192. DOI: 10.1097/01.AOG.0000451759.90082.7b.
DeVore GR. Cerebroplacental ratio in fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213(1):5–15. DOI: 10.1016/j.ajog.2015.05.024.
Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022;59(6):840–856. DOI: 10.1002/uog.24888.
Bhide A, Acharya G, Bilardo CM, et al. ISUOG practice guidelines: Use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013;41(2):233–239. DOI: 10.1002/uog.12371.
Figueras F, Savchev S, Triunfo S, et al. An integrated model with classification criteria to predict small-for-gestational-age fetuses at risk of adverse perinatal outcome. Ultrasound Obstet Gynecol 2015;45(3):279–285. DOI: 10.1002/uog.14714.
Triunfo S, Crispi F, Gratacos E, et al. Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks’ gestation. Ultrasound Obstet Gynecol 2017;49(3):364–371. DOI: 10.1002/uog.15979.
Prior T, Mullins E, Bennett P, et al. Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: A prospective observational study. Am J Obstet Gynecol 2013;208(2):124.e1–6. DOI: 10.1016/j.ajog.2012.11.016.
Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database of Syst Rev 2017;6(6):CD007529. DOI: 10.1002/14651858.CD007529.pub4.
Heidweiller–Schreurs CAV, Boer MAD, Heymans MW, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: Systematic review and meta-analysis Ultrasound Obstet Gynecol 2018;51(3):313–322. DOI: 10.1002/uog.18809. DOI: 10.1002/uog.18809.
Morales–Roselló J, Khalil A, et al. Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet Gynecol 2015;45(2):156–161. DOI: 10.1002/uog.14647.
MacDonald TM, Hui L, Robinson AJ, et al. Cerebral–placental–uterine ratio as novel predictor of late fetal growth restriction: Prospective cohort study. Ultrasound Obstet Gynecol 2019;54(3):367–375. DOI: 10.1002/uog.20150.

PDF Share