Doppler Cerebroplacental Ratio Research Articles

Correlation between cerebroplacental doppler ratio and neonatal respiratory disorders: A reference marker of fetal lung maturation.

The aim of this study was to investigate the role of cerebroplacental ratio (CPR) in the final prenatal care for neonatal respiratory diseases and to analyze the risk of relevant factors associated with neonatal respiratory disorders. A prospective cohort study of 795 singleton pregnancies was conducted. The pulsatility indices (PI) of the umbilical artery (UA) and the middle cerebral artery (MCA) were measured, and the MCA to UA ratio (CPR) was determined. The severity of the case is determined by whether or not the newborn has respiratory problems. Compare the CPR correlation between the two groups and examine the illness prediction factors through a binary logistic regression method. Of the 795 participants, 124 had neonatal respiratory disorders. The mean values of CPR between neonatal respiratory diseases group and control group were 1.78±0.6, 1.97±0.9, respectively (P < 0.001). Maternal age, abortion history, cesarean section history, placental thickness, placental maturity, and amniotic fluid index (AFI) were determined to have no significant link between the two groups after comparison analysis (P > 0.05). It could be found that compared with the control group, CPR MoM indicators of neonatal respiratory distress syndrome, neonatal pneumonia and wet lung disease all show significant decreases. In binary logistic regression analysis, among the variables included in the model, CPR (OR:2.90, P = 0.015), fetal heart monitoring (OR:5.26, P < 0.001), delivery mode (OR:2.86, P < 0.001) and gestational age of delivery (OR:0.92, P < 0.001) were statistically significant in both groups. The findings of this study showed that infant respiratory problems were substantially related to CPR value. The correlation indicates that CPR was a powerful reference marker for respiratory disorders.

Comparison of the Diagnostic Accuracy of Doppler Cerebroplacental Ratio Versus Standard Fetal Biometry for Fetal Growth Restriction

Objective: To assess the diagnostic accuracy of the Doppler Cerebroplacental ratio for fetal growth restriction keeping fetal biometry as the reference standard.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Multan Pakistan, from May to Oct 2020.&#x0D; Methodology: Two hundred and fifty-six-singleton pregnancies ≥ 30 weeks were included and underwent fetal biometry, including estimated fetal weight (EFW) by trans-abdominal ultrasound. The umbilical artery and middle cerebral artery resistive indices were evaluated using Doppler ultrasound, and Cerebroplacental ratio (CPR) was calculated. The presence or absence of fetal growth restriction (FGR) was noted using cut-off EFW of 10th centile and CPR of 1.0. &#x0D; Results: Cerebroplacental ratio showed FGR in 145(56.64%) patients. Fetal biometry showed FGR in 141 (55.08%) patients,whereas 115(44.92%) patients revealed none. Of 145 CPR-positive patients, 127(87%) were true positive, while 18(12%) were false positive. Among 111 CPR-negative patients, 14(0.12%) were false negative, while 97(87%) were true negative. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the Cerebroplacental ratio were 90.07%, 84.35%, 87.59%, 87.39% and 87.50%, respectively.&#x0D; Conclusions: Doppler Cerebroplacental ratio is sensitive for diagnosing fetal growth restriction; however, its role as a stand alone test needs further evaluation and may be enhanced with other tools such as estimated fetal weight.

INTRAUTERİN GELİŞME KISITLILIĞI OLAN HASTALARDA SEREBROPLASENTAL ORANIN FETAL İYİLİK HALİNİN BELİRLENMESİNDEKİ ETKİSİNİN GÖSTERİLMESİNE DAİR RETROSPEKTİF ÇALIŞMA

ABSTRACT&#x0D; Objective: To investigate and predict perinatal outcomes of pregnancies affected with fetal growth restriction by cerebroplacental ratio. &#x0D; Material and Methods: A retrospective study was conducted based on 100 high-risk pregnant who referred to the antenatal clinic. 66 pregnant women were diagnosed with ıntrauterine growth restriction. And 34 pregnant women were diagnosed with small for gestational age. Baseline demographic, past obstetric and medical histories were recorded for all patients. Intrauterine growth retardation was defined as an estimated weight below the 10th percentile for gestational age based on sonographic measurement.‘ small for gestational age’ diagnosis shows that fetal weight or fetal abdomainal circunference measurement is below 10th percentile; but it was diagnosed in fetuses with normal doppler parameters and no pathological factors were preventing the fetus from reaching its expected growth potential. Doppler ultrasound of middle cerebral arteries and umbilical arteries were used to assess pregnancies. Cerebroplacental rate (CPR); It is calculated by dividing MCA percentile index to UA percentile index. The cerebroplacental doppler ratio less than 1 was accepted abnormal. Adverse perinatal outcomes for newborns were documented for all cases. Results: 100 pregnant women were classified into two groups according to cerebroplacental ratio. Cerebroplacental ratio ratio of Group A is greater than 1 (n=87). And cerebroplacental ratio ratio of Group B is less than 1 (n=13). Perinatal morbidity statistically significantly increased in Group B. The fetuses with abnormal cerebroplacental ratıo were strongly correlated with worse fetal prognosis. Respiratory distress syndrome rates (p = 0.043; p

Cerebroplacental Doppler Ratio in Prediction of Adverse Perinatal Outcome in Full Term Normal Pregnancy

Cerebroplacental Doppler Ratio in Prediction of Adverse Perinatal Outcome in Full Term Normal Pregnancy

Predictive value of doppler cerebroplacental ratio for adverse perinatal outcomes in postdate pregnancies in Northwestern Nigeria.

Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency. To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies. A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death. : Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively. The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.

Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction

The purpose of this study was to determine whether gestational age-specific levels of the cerebroplacental ratio (CPR) as a third-trimester ultrasound marker has benefits in the prediction of perinatal morbidity and mortality on foetuses with late-onset foetal growth restriction (FGR). A retrospective study of singleton pregnancies diagnosed with late-onset FGR was performed. Of 407 pregnancies meeting our inclusion criteria, 313 had normal (Group 1) and 94 had abnormal CPR (Group 2). Both groups were similar in age, gestational age at diagnosis, body mass index and parity. There was a significant association between the presence of oligohydramnios and abnormal CPR. Mean gestational age at delivery and mean neonatal birth weight were significantly lower in Group 2. Neonatal intensive care unit admission, foetal distress, low 5–minute Apgar score <7, and low cord pH < 7.1 rates were significantly higher in Group 2. There was one neonatal death in both groups. Multivariable regression analysis demonstrated that, in the prediction of APO, there was a significant contribution from neonatal birth weight <10th percentile, CPR <5th percentile and oligohydramniosis. Our findings revealed that CPR value less than 5th centile can be used as a predictor of APO in late-onset FGR. IMPACT STATEMENT What is already known on this subject? Low cerebroplacetal ratio (CPR) is a marker of failure to reach the growth potential regardless of foetal weight. What do the results of this study add? The CPR can be used as an adequate predictor of adverse perinatal outcome in pregnancies with late-onset foetal growth restriction. What are the implications of these findings for clinical practice and/or further research? Routine calculation and report of CPR during basic ultrasound examination may help to identify foetuses with FR with a higher risk of adverse perinatal outcome. Future prospective studies on pregnancies with FGR with oligohydroamnios or normal amniotic fluid volume should focus on determining CPR threshold.

Role of Cerebro-Placental Doppler Ratio in prediction of perinatal outcome in Intrauterine Growth Restriction

Background: The Doppler examination of fetal and maternal blood vessels is one of the most important evaluation tools of the blood supply to the embryo specially whenintrauterine growth restriction(IUGR) diagnosed duringintrauterine life. We conducted an observational study toassess the role of Cerebro-Placental Doppler Ratio (CPR)in prediction of adverse perinatal outcome of IUGR.Methods: This prospective observational cohort study wasconducted at Mansoura University Hospital-departmentof obstetrics and gynecology among 100 pregnant womendiagnosed with IUGR. We performed two-dimensionalultrasound examination of fetus and placenta associated withDoppler waveform analysis of umbilical and middle cerebral arteries (UA & MCA). Estimation of CPR was performed by the following equation (MCA pulsatility index/UA pulsatility index).Results: We divided our patients into two groups eitherwith CRP <1 or with CRP ≥1.An emergencycesarean delivery (CD) was the dominant mode of delivery in 66.7%of cases with CPR<1, versus 35.4% in cases with CPR≥1.There was no statistically significant difference betweenboth groups in the mean gestational age at delivery(35.38±1.53 & 36.15±1.77p=0.07) respectively. The meanneonatal weightswere (1497.6±227.2 gm& 1813.9±304.76gm p < 0.001) in both groups respectively. All neonates withCPR<1were bornewith Apgar score< 7 at 5 minutes andwere admitted to neonatal intensive care units (NICU). Only 62% of neonates were admitted to NICUwhen CPR was ≥1.Conclusion: Data from our study showedthat the cutoff point for CPR is ≤1.1, and ithas95.5% sensitivity in predicting adverseperinatal outcomes.

Considering evidence in the management of fetal growth restriction.

Considering evidence in the management of fetal growth restriction.

Measurement of Cerebro-Placental Doppler Ratio and Amniotic Fluid Index as a Predictor of Perinatal Outcome in Prolonged Pregnancy

Background: The terms post-term, prolonged, postdates and post mature are often loosely used interchangeably to signifypregnancies that have exceeded a duration considered to be the upper limit of normal.Objective: The aim of this work was to study the role of Doppler velocimetry of the umbilical and middle cerebral arteriesrepresented by the cerebroplacental ratio and amniotic fluid volume in the prediction of adverse fetal outcome in post-termpregnancies.Materials and Methods: This is a prospective case control study conducted at Ain-Shams University Teaching Hospitalfor Obstetrics and Gynecology, Egypt. The study included 50 pregnant patients who were divided into two groups; group1included 25 pregnant ladies with gestational age of 41 weeks attending the casuality department in labour or in prodromaof labor. while, group 2 included 25 pregnant ladies with gestational age of 41 weeks not in labor and reaching thehospital for ANC, who were selected for termination based on the biophysical profile and poor Doppler indices or CTGchanges. All patients were submitted to antenatal fetal surveillance tests including modified biophysical profile (MBPP)which consists of the non-stress test (NST), amniotic fluid index (AFI), and color Doppler velocimetry of fetoplacentaland fetal vessels including MCA PI, UA PI, and CPR. The accuracy of cerebroplacental ratios (the middle cerebral arteryPI divided by the umbilical artery PI) and amniotic fluid volume as a means of predicting intrauterine fetal distress andadverse perinatal outcome in post-term pregnancies.Results: Cerebroplacental ratio showed the highest sensitivity (95%) in comparison with other parameters, so it is a goodtest to reassure the obstetricians of the fetal well being. Prominent changes in AFI (i.e. 5.0 cm. Asignificant association with FHR decelerations and presence of meconium is proved to exist when AFI is <5.0 cm.Conclusion: The addition of cerebral/umbilical ratios to antenatal surveillance protocols is expected to improve the perinataloutcome. It should be tried in the various high risk pregnancies whenever uteroplacental insufficiency is suspected.

Inferior Adrenal Artery PI in Fetuses with IUGR: Value Indicating Early Blood Redistribution and Steroidogenic Response.

To characterize the inferior adrenal artery (IAA) pulsatility index (PI) in intrauterine growth-restricted (IUGR) fetuses without brain sparing. Twenty-three IUGR fetuses with a normal Doppler cerebroplacental ratio (CPR) and 23 normal controls were included in this prospective cross-sectional study. The PI of the IAA was recorded using routine transabdominal Doppler ultrasound. The differences in Doppler characteristics, perinatal outcomes, and steroidogenesis in the umbilical vein at birth (adrenocorticotropic hormone [ACTH] and cortisol [F] levels) were compared between the 2 groups. The correlations between IAA-PI and steroidogenesis were assessed in the IUGR group. IAA-PI was significantly lower in IUGR fetuses than in normal controls (0.85 vs 1.18 at first scan, 0.78 vs 0.92 at last scan; both P < 0.001). The plasma F and ACTH levels in IUGR cases were significantly higher than those of the normal controls (18.2 vs 12.4 µg/dL and 280.5 vs 125.6 pg/mL for F and ACTH, respectively; both P < 0.001). There were negative correlations between IAA-PI and plasma F values and between IAA-PI and ACTH values in the IUGR group (r = -0.774 and -0.82 at first scan, r = -0.525 and -0.45 at last scan, respectively; P < 0.001). Increased adrenal gland blood flow with concomitant increases in ACTH and F levels were observed in IUGR fetuses. IAA-PI is useful to assess early blood redistribution and may be beneficial for evaluating the steroidogenic response in high-risk pregnancies.

OC16.02: Intrapartum fetal cerebroplacental Doppler ratio in first and second stage of labour in uterine rest and contractions in low‐risk pregnancies

OC16.02: Intrapartum fetal cerebroplacental Doppler ratio in first and second stage of labour in uterine rest and contractions in low‐risk pregnancies

The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses

ObjectivesThe cerebroplacental ratio (CPR) Doppler has been proposed as an instrument for predicting adverse perinatal outcomes particularly during antepartum period. Abnormal CPR is associated with non-reassuring fetal status requiring operative delivery, low Apgar score and neonatal complications. The aim of this study was to assess the role of CPR Doppler in the labor triage suite, so as to identify fetuses at risk for non-reassuring status as well as other adverse perinatal outcomes. MethodsThis was a prospective cohort study of term pregnancies who attended the labor room during the latent phase of labor. Both fetal Middle Cerebral Artery Pulsatility Index (MCA-PI) and Umbilical Artery Pulsatility Index (UA-PI) were measured and these values were converted to CPR values. Non-reassuring fetal status requiring operative delivery and other adverse perinatal outcomes were compared between women with normal and abnormal CPR values. Accuracy of CPR for predicting non-reassuring fetal status and abnormal fetal heart rate patterns were calculated. ResultsA total of 384 women were recruited. Lower CPR values were observed in women who underwent operative delivery for non-reassuring fetal status. However, when dividing women into normal and abnormal CPR groups, using 3 different cut-off values, the rate of non-reassuring fetal status was not significantly different between the groups. There was a significantly higher rate of abnormal fetal heart rate monitoring in fetuses with CPR < 5th percentile and CPR < 1. CPR appeared to have a low positive predictive value (PPV) for predicting non-reassuring fetal heart rate patterns, however, the negative predictive value (NPV) was high. ConclusionsIn term fetuses, lower CPR is associated with non-reassuring fetal status. CPR measurement during the intrapartum period with currently available CPR cut-off values is not a good predictor for adverse perinatal outcomes, with the exception of abnormal fetal heart rate patterns. However, the high NPV may be used to stratify pregnant women who may benefit from continuous fetal heart rate monitoring.

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

BackgroundDoppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow.MethodsColour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated.ResultsOf 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight.Discussion/conclusionBoth microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections.Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010

P17.06: Fetal middle cerebral artery and umbilical artery flow and cerebroplacental Doppler ratio in first and second stage of labour: a preliminary study

P17.06: Fetal middle cerebral artery and umbilical artery flow and cerebroplacental Doppler ratio in first and second stage of labour: a preliminary study

Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance.

The objective of this meta-analysis is to assess the value of fetal cerebro-placental Doppler ratio (CPR) in predicting adverse perinatal outcome in pregnancies with fetal growth restriction (FGR). Three databases were used: MEDLINE, EMBASE (with online Ovid interface) and SCOPUS and studies from inception to April 2015 were included. Studies that reported perinatal outcomes of fetuses at risk of FGR or sonographically diagnosed FGR that were evaluated with CPR were considered eligible. Perinatal outcomes include cesarean section (CS) for fetal distress, APGAR scores at 5 min, neonatal complications and admission to neonatal intensive care unit (NICU). Pooled data were expressed as odds ratio (OR) and confidence intervals (CI), and the summary receiver operating characteristic (SROC) curve was used to illustrate the diagnostic accuracy of CPR. Seven studies were eligible (1428 fetuses). Fetuses with abnormal CPR were at higher risk of CS for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. These risks were higher among studies that included fetuses diagnosed with FGR than fetuses at risk of FGR. Abnormal CPR had higher diagnostic accuracy for adverse perinatal outcomes among "sonographically diagnosed FGR" studies than "at risk of FGR" studies. Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

OP14.06: Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction

OP14.06: Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction

Stage-based approach to the management of fetal growth restriction.

Fetal growth restriction (FGR) is among the obstetrical entities with the greatest variation in clinical practice. The first clinically relevant step in the management of FGR is the distinction of 'true' FGR, associated with signs of abnormal feto-placental function and poorer perinatal outcome, from small for gestational age fetuses, which do not present abnormal Doppler and have near normal perinatal outcome. Such distinction should not be only relied on umbilical artery Doppler, as this parameter identifies only severe, early-onset, forms of placental insufficiency. Instead, FGR should be diagnosed in the presence of any of the factors associated with a poorer perinatal outcome, including Doppler cerebroplacental ratio and uterine artery Doppler, a growth centile below the third centile. Upon diagnosis, differentiating into early-onset and late-onset FGR is useful to distinguish two clear phenotypes, with differences in severity, association with preeclampsia, and sequence of fetal deterioration. Finally, management of FGR aims at an optimal balance between minimizing fetal injury or death versus the risks of iatrogenic preterm delivery. We propose a protocol that integrates current evidence to classify stages of fetal deterioration, and establishes follow-up intervals and optimal delivery timings, which may facilitate decision-making and minimize variability in the clinical management.

Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome

ABSTRACT Objective This study was done to assess the Doppler cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome especially in growth restricted pregnancies. Materials and methods In this study, 62 antenatal women were subjected to Doppler studies at 34 to 42 weeks of gestations. CPR was calculated and less than 1 was taken as predictor of adverse perinatal outcome. Adverse perinatal outcomes was evaluated by mode of delivery, meconium staining, 1 and 5-minute Apgar scores, birth weight, admission to NICU and other neonatal complications. Results Of 62 antenatal women, with an abnormal CPR had higher incidence of meconium, clinical fetal distress, operative delivery, low Apgar score (5 mins), NICU admission and neonatal death, 42.88, 47.62, 26.57, 76.19, 66.17 and 66.67% respectively as compared to women with normal CPR who had 4.88, 2.88, 2.88. 2.88, 12.19, 17.07 and 0% respectively. With the use of an abnormal CPR, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 62, 80, 62 and 80%, respectively, with an odds ratio (95% confidence interval). Conclusion An abnormal CPR is associated with adverse perinatal outcomes, especially in growth-restricted fetuses. How to cite this article Shaheen S, Bano I, Ahmad I, Singh A. Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(1):25-27.

Cerebroplacental Doppler ratio and placental histopathological features in pregnancies complicated by fetal growth restriction

To correlate placental pathologic lesions, as defined by the Society for Pediatric Pathology, to the severity of the ratio of the pulsatility Doppler index (PI) of the fetal middle cerebral artery to that of the umbilical artery (cerebroplacental ratio, CPR). A cohort-study of 176 singleton pregnancies complicated by fetal growth restriction (FGR). The mean values of gestational age, birth weight and CPR of the entire cohort were 33.9±3.6 weeks, 1552±561 g, and 1.33±0.68, respectively. In ordered logistic regression analysis, after adjustment for potential confounders, muscularised arteries (Odds Ratio [OR]=3.14; 95% confidence intervals [CI]=1.58-6.28, P=0.001), mural hypertrophy (OR=2.35; 95% CI=1.26-4.4, P=0.008), immature intermediate trophoblast (OR=2.0; 95% CI=1.07-3.71, P=0.03) and maternal vascular underperfusion (OR=2.32; 95% CI=1.25-4.23, P=0.007) were the only parameters associated with severity of CPR. The correlation between placental histological findings indicating maternal underperfusion and placental occlusion suggest that forced centralization of fetal circulation in FGR could be at least partially attributable to the hemodynamic consequences of increased placental vascular resistance.

Sonographic evaluation of fetal abdominal circumference and cerebroplacental Doppler indices for the prediction of fetal macrosomia in full term pregnant women. Cohort study

Abstract Objectives The aim of the study was to explore the relationship between cerebroplacental Doppler ratio and birth weight in cases of suspected fetal macrosomia. Methods The pulsatility indices of the umbilical (UA-PI) and middle cerebral (MCA-PI) arteries, the cerebroplacental pulsatility index ratio (CPR) and the estimated fetal weight (EFW) were obtained in a cohort of 150 ultrasound-dated pregnancies at ⩾ 37 weeks’ gestation divided into two groups as follows; large for gestational age (LGA, n = 50) and average for gestational age (AGA, n = 100). Results There is a significant difference between groups in abdominal circumference (AC), head circumference (HC), biparital diameter (BPD), estimated fetal weight (EFW) and actual fetal weight with a mean difference of 92.7 g in the LGA group and 84 g in the AGA group. MCA-RI and PI were significantly lower in the LGA group with no difference in UA-RI, PI and CPR-PI between both groups. Conclusions CPR-PI could not differentiate between LGA and AGA.