Fetal Cerebroplacental Ratio Research Articles

Doppler abnormalities and perinatal outcome in growth restricted fetuses in a tertiary care center: A retrospective study

Intrauterine Growth Restriction (IUGR), is a significant contributor to foetal and neonatal morbidity and mortality. The majority of prenatal problems that result in negative outcomes can be avoided with early identification and prompt management measures. Doppler ultrasonography is widely used to make the diagnosis of IUGR in foetuses and to monitor the progression in-utero. The purpose of the current study is to predict the perinatal prognosis of foetuses with growth restriction based on doppler abnormalities. A retrospective analysis was conducted among 134 cases of diagnosed IUGR in routine ultrasound from the year 2015 to 2021. Socio-demographic data, baby delivery details, and the ultrasound details regarding doppler evaluation of Umbilical Artery (UA) and Middle cerebral artery (MCA) were collected. The fetal cerebro-placental ratio (CPR) was then analysed with the fetal outcomes in the cases. Abnormal doppler was found in 31 out of 134 cases, with a CPR<1. There was significant association of gestational age, mode of delivery and birth weight variables with abnormal doppler. The mean birth weight of the baby (2052 grams), and NICU admission of the babies (17.6%) have also shown statistical association with abnormal doppler (p<0.05).Doppler velocimetry is the non-invasive method for identifying foetal growth restriction and anticipating perinatal difficulties, which aids the obstetrician in providing good antenatal care and prompt intervention and prevention of perinatal morbidity and mortality.

Over-Expression of MicroRNA-210 and MicroRNA-185-5p in Normotensive Late-Fetal Growth Restriction: Preliminary Cohort Study

OBJECTIVE: Late Fetal Growth Restriction (LFGR), a condition associated with perinatal and long-term neurodevelopmental problems, is caused by inadequate placental transfer of oxygen and nutrients to the fetus. This preliminary study evaluates the expression profiles and clinical significance of hypoxia-sensitive microRNA-210 (miR-210) and microRNA-185-5p (miR-185-5p) in placental and maternal circulation. The potential clinical implications of this research could significantly enhance the management of LFGR. STUDY DESIGN: In this prospective cohort study conducted at the Gynecology and Obstetrics Clinic of Trakya University Faculty of Medicine Hospital, miR-210 and miR-185-5p expression was evaluated in the placenta of healthy (n=30) and LFGR (n=30) cases. In healthy (n=15) and LFGR (n=15) cases, miRNA levels in maternal plasma were studied. We determined these two miRNAs using Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) and statistically analyzed them with clinical data to determine robustness. We provided a comprehensive evaluation. RESULTS: Both the placenta and maternal plasma samples exhibited significant correlations with miR-210 and miR-185-5p expression (r=0.615; r=0.771, p<0.01). The expression levels in both placenta and plasma were significantly higher in the LFGR group. Placental miR-210 demonstrated an AUC (0.908), sensitivity (93.3%), and specificity (96.7%), while plasma miR-210 showed AUC (0.738), sensitivity (86.7%), and specificity (66.7%). In contrast, placental miRNA 185-5p displayed a diagnostic performance with AUC (0.926), sensitivity (76.1%), and specificity (63.8%); plasma miRNA 185-5p exhibited an AUC (0.778), sensitivity (86.7%), and specificity (86.7%). However, placental miR-210 and miR-185-5p did not fully correlate with birth weight, placental weight, and fetal cerebroplacental Doppler ratio. CONCLUSION: Placental miRNA-210 showed superior diagnostic performance over placental miRNA 185-5p in LFGR pregnancies. However, it is crucial to emphasize that further studies are needed to validate these findings and correlate them with clinical data, underscoring the ongoing importance of research in this field.

Cerebroplacental ratio and perinatal outcomes in mild-to-moderate idiopathic polyhydramnios cases.

This study will evaluate whether fetal cerebroplacental ratio (CPR) can predict perinatal adverse outcomes in singleton pregnancies with mild and moderate idiopathic polyhydramnios (IP). This study was designed as a prospective case-control study between January 2023 and November 2023. Pregnant women diagnosed with mild-to-moderate IP and low-risk singleton pregnancies were included in the study. In all cases, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured at 36-40 weeks of gestation, and CPR was calculated. The group with polyhydramnios was divided into two parts according to whether the CPR value was below 1.08 or 1.08 and above. Perinatal outcomes of all groups were compared. A total of 140 patients were included in the study. Seventy of these were IP cases, and 70 were low-risk pregnant women. UA PI in the IP group was not statistically different from that in the low-risk group, but MCA PI and CPR were significantly lower in the IP group (P = 0.07, P = 0.001, and P = 0.004, respectively). IP cases were divided into a low group (<1.08, n = 18) and a normal group (≥1.08, n = 52) according to the CPR value. Cesarean section rates due to fetal distress were significantly higher in the low-CPR group (n = 8 [44.4%] vs 5 [9.6%], P = 0.001). In the low-CPR group, 5-min Apgar <7, and neonatal intensive care unit (NICU) admission rates were significantly higher (P = 0.045 and P = 0.001, respectively). It is encouraging that in cases with mild-to-moderate IP, low CPR predicts emergency delivery due to fetal distress, a low Apgar score at 5 min, and NICU admission.

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

Fetal Cerebroplacental Artery Ratio versus Uterine Artery Doppler Ultrasonography for Prediction of Late Onset Intrauterine Fetal Growth Restriction among High Risk Pregnant Women

Predictive utility of the fetal cerebroplacental ratio for hypoxic ischaemic encephalopathy, severe neonatal morbidity and perinatal mortality in late-preterm and term infants.

The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). This was a retrospective cohort study of late-preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late-preterm gestations. A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM.

Fetal cerebroplacental ratio at term gestation in the prediction of adverse perinatal outcome

Introdction: Assessment of impedance to blood flow in fetal umbilical artery (UA) and middle cerebral artery (MCA) with Doppler ultrasonography is commonly used in surveillance of fetuses at high risk. Although high UA pulsatility index (PI) and low MCA PI, themselves are predictors of adverse perinatal outcome, combining these two parameters calculating the cerebroplacental ratio (CPR) further improves the predictive value. Objective: To find the association between the cerebroplacental ratio and adverse perinatal outcome. Methods: Prospective cohort study conducted in Teaching Hospital, Anuradhapura. 354 singleton pregnancies at 37-41 weeks gestation were included. Ultrasound scanning performed measuring fetal UAPI and MCAPI and CPR was calculated. Fetuses were followed up for intrapartum adverse outcome categorized as NNU admission, perinatal death, fetal distress, Apgar score &lt; 7 at 5 min and any adverse outcome. Descriptive statistics and the statistical applications for diagnostic test accuracy were used for data analysis. ROC curve were plotted to analyze the predictability of CPR for each category. Results: CPR has a significantly positive ability of predicting any type of adverse event. (AUC=0.501-.623, 95%CI) An overall predictability is shown by the other variables used in the study such as MCAPI (AUC=0.505:95%CI=0.444-0.567) and UAPI 0.518 (95% CI=0.457-0.579). But the predictability of CPR value is more superior to the MCAPI and UAPI values. Identified best cut off value for CPR is 0.8533 for predicting adverse events with 80.3% sensitivity. Conclusion: More reliable predictions to detect adverse perinatal outcomes can be achieved by the CPR value than the UAPI and MCAPI values.

Cerebroplacental ratio for prediction of adverse intrapartum and neonatal outcomes in a term uncomplicated pregnancy

BackgroundFetal hypoxia is one of the major causes of high perinatal morbidity and mortality rates. Doppler ultrasound tests such as cerebroplacental ratio (CPR) evaluation are commonly used to assess blood flow disturbances in placento-umbilical and feto-cerebral circulations. A low cerebroplacental ratio has been shown to be associated with an increased risk of stillbirth regardless of the gestation or fetal weight. We conducted this study to assess the fetal cerebroplacental ratio in prediction of adverse intrapartum and neonatal outcomes in a term, uncomplicated pregnancy to reduce fetal and neonatal morbidity and mortality.ResultsIt was found that neonates with CPR ≤1.1 had significantly higher frequencies of cesarean delivery (CS) for intrapartum fetal compromise compared to those with CPR >1.1 (p=0.043). Neonates with CPR ≤1.1 had significantly lower Apgar score at 1 min and 5 min than those with CPR >1.1 (p=0.004) and (p=0.003), respectively. Neonates with CPR ≤1.1 had significantly higher rates of NICU admission than those with CPR <1.1 (p=0.004).ConclusionThe cerebroplacental ratio shows the highest sensitivity in the prediction of fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at term. The cerebroplacental ratio index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

The fetal cerebroplacental ratio in pregnancies complicated by hypertensive disorders of pregnancy.

Hypertensive disorder in pregnancy is common and the optimal ultrasound surveillance of the fetus in this setting is unclear. The aim of this study is to assess the relationship between the fetal cerebroplacental ratio (CPR) and perinatal outcomes in pregnancies complicated by maternal hypertension. A retrospective cohort study was performed over tenyears at a single centre. All women who had an ultrasound scan between 34 and 37weeks gestation with a non-anomalous singleton pregnancy were included. The hypertensive cohorts were compared to a non-hypertensive cohort. Each cohort was divided into low CPR for gestational age, or normal/high CPR and these were correlated with intrapartum and perinatal outcomes. A low CPR in a hypertensive pregnancy is associated with an increased risk of induction of labour, emergency caesarean section and poor perinatal outcome. This significance persists when adjusted for gestational age and birth weight. The diagnosis of pre-eclampsia combined with a low CPR markedly increases the risk of poor perinatal outcome, with 52.6% (P<0.001) of fetuses in this group having either neonatal intensive care unit admission, respiratory distress, low Apgar score, or acidosis. The odds ratio of a fetus with low CPR in a woman with pre-eclampsia having a poor composite outcome is 4.09 (95% CI: 1.85-9.06). There is an association between low CPR and the perinatal outcomes of pregnancies complicated by a hypertensive disorder. This association appears to be stronger in pregnancies complicated by pre-eclampsia than in other types of hypertensive disorders.

Maternal cardiac adaptation and fetal growth

Pregnancies with small-for-gestational-age fetuses are at increased risk of adverse maternal-fetal outcomes. Previous studies examining the relationship between maternal hemodynamics and fetal growth were mainly focused on high-risk pregnancies and those with fetuses with extreme birthweights, such as less than the 3rd or 10th percentile and assumed a similar growth pattern in fetuses above the 10th percentile throughout gestation. This study aimed to evaluate the trends in maternal cardiac function, fetal growth, and oxygenation with advancing gestational age in a routine obstetrical population and all ranges of birthweight percentiles. This was a prospective, longitudinal study assessing maternal cardiac output and peripheral vascular resistance by bioreactance at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks' gestation, sonographic estimated fetal weight in the last 3 visits and the ratio of the middle cerebral artery by umbilical artery pulsatility indices or cerebroplacental ratio in the last 2 visits. Women were divided into the following 5 groups according to birthweight percentile: group 1, <10th percentile (n=261); group 2, 10 to 19.9 percentile (n=180); group 3, 20 to 29.9 percentile (n=189); group 4, 30 to 69.9 percentile (n=651); and group 5, ≥70th percentile (n=508). The multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables and z scores of the estimated fetal weight and cerebroplacental ratio. In visit 2, compared with visit 1, in all groups, cardiac output increased, and peripheral vascular resistance decreased. At visit 3, groups 1, 2, and 3, compared with 4 and 5, demonstrated an abrupt decrease in cardiac output and increase in peripheral vascular resistance. From visit 2, group 1 had a constant decline in estimated fetal weight, coinciding with the steepest decline in maternal cardiac output and rise in peripheral vascular resistance. In contrast, in groups 4 and 5, the estimated fetal weight had a stable or accelerative pattern, coinciding with the greatest increase in cardiac output and lowest peripheral vascular resistance. Groups 2 and 3 showed a stable growth pattern with intermediate cardiac output and peripheral vascular resistance. Increasing birthweight was associated with higher cerebroplacental ratio. Groups 3, 4, and 5 had stable cerebroplacental ratio across visits 3 and 4, whereas groups 1 and 2 demonstrated a significant decline (P<.001). In a general obstetrical population, maternal cardiac adaptation at 32 weeks' gestation parallels the pattern of fetal growth and oxygenation; babies with birthweight<20th percentile have progressive decline in fetal cerebroplacental ratio, decline in maternal cardiac output, and increase in peripheral vascular resistance.

Study of Association of Fetal Cerebroplacental Ratio with Adverse Perinatal Outcome in Uncomplicated Term AGA Pregnancies.

The cerebroplacental ratio (CPR) is emerging as a predictor for adverse perinatal outcome in term pregnancies. Earlier, it has shown a role in small for gestational age (SGA) pregnancies, but a proportion of appropriate for gestational age foetuses (AGA) despite of good size have impaired growth velocity and are thereby at risk of adverse outcome. CPR has implication for assessment of well being of SGA and AGA foetuses close to term. To investigate the association between foetal CPR and adverse perinatal outcome in uncomplicated term AGA pregnancies. This was a prospective observational study done in Department of Obstetric and Gynaecology, King George Medical University, Lucknow, over a period of one year. Women>37 week singleton pregnancy with no known risk factor who had Doppler USG done within a week of delivery were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR<1 was taken as abnormal. These patients were followed up till delivery to look for various perinatal outcomes. Results Out of 127 low-risk AGA pregnancies who went for USG colour Doppler scan, 117 patients who met our inclusion criteria were analysed; out of 117 patients 23(i.e. 19.65 %) were having CPR<1 and 94 patients (i.e. 80.34%) were having CPR>1. Among 23 patients with CPR<1, 22 (91.30%) had adverse outcome as compared to only 20.21% patients with CPR>1, and this is found to be statistically significant (p<0.001). Our study found CPR measure to be a very promising tool for optimising the identification of at risk foetus in low-risk AGA pregnancies.

Maternal irisin level in last trimester isolated intrauterine growth-restriction

Purpose Intrauterine Growth Restriction (IUGR) is the inability of the fetus to achieve the biologically accessible growth potential. Irisin is a recently discovered adipomyokine with a crucial role in energy metabolism. Our current study aimed to investigate the relationship between the isolated IUGR in the third trimester and maternal serum irisin level. Materials and methods This prospective case-control study included total 137 pregnant women who were between the 24th and 39th gestational weeks and who applied to the University of Health Sciences, Ankara Zekai Tahir Burak Women's Health Training and Research Center, between 2016 October-2017 May. The Study Group consisted of 68 pregnant women who were diagnosed with Isolated IUGR with Estimated Fetal Weight (EFW) <10th percentile. The Control Group consisted of 69 low-risk uncomplicated pregnant women, matched with the Study Group in terms of gestational week, and with EFW between 10th and 90th percentiles. Demographic data, clinical findings, fetal Doppler parameters, and obstetric-neonatal outcomes were evaluated. Maternal serum irisin levels were measured by ELISA (Enzyme-Linked Immunosorbent Assay) Method and compared between the groups. Results Maternal serum irisin level was found to be significantly lower in IUGR Group as compared to the Control (3.83 ng/ml vs. 4.78 ng/ml, p < .001, respectively). There was a positive correlation between maternal serum irisin level and duration of pregnancy, the weight gain during pregnancy, birth weight, fetal abdominal circumference measurement and cerebroplacental ratio (r = 0.18, p = .03; r = 0.17, p = .04; r = 0.37, p < .001; r = 0.35, p < .001; r = 0.27, p = .001, respectively). Binary Logistic Regression Analysis showed that maternal serum irisin level is an independent estimator of IUGR [OR %95 CI: 8.33 (3.22 − 25.01)]. AUC (Area Under the Curve) analysis of maternal irisin for IUGR estimation was 0.75 (p < .001, 95% CI = 0.67 − 0.82). The optimal cutoff value was below 3.86 ng/ml for maternal irisin level with a sensitivity of 54.41% and a specificity of 88.41%, positive predictive value of 82.22% and negative predictive value of 66.30%. Conclusion Low level of maternal serum irisin in pregnancies with isolated IUGR was consistent with the role of irisin in metabolic pathways and with the increased risk of metabolic diseases in the future life of IUGR fetuses and their mothers.

Role of doppler in the middle cerebral artery in prediction of fetal distress during labor in uncomplicated pregnancies at 40 weeks and beyond

The aim of this study was to reveal correlation between Doppler in the fetal middle cerebral artery and fetal decompensation during labor in uncomplicated pregnancies at 40 weeks and beyond. We by means of ultrasound Doppler examined 260 women at 40 to 42 weeks of uncomplicated pregnancy 48 hours before delivery, with fetal condition assessed subsequently during labor and immediately after delivery. We found out that in the group of women with caesarean section caused by fetal distress during labor, pulsatility indices in the middle cerebral artery evaluated just before labor were significantly lower than in the group of women whose fetus had better condition during labor. The same trend was observed when comparing Doppler velocimetry using the fetal cerebroplacental ratio. Moreover, we identified that in the group of women with newborns having Apgar 7 and less, middle cerebral artery measured less than 48 hours before delivery were lower than in the group of women having babies in better conditions. Furthermore, as result of this study, the trigger threshold for PI was found to be 0.835, below which fetuses have adverse perinatal outcome during labor. Thus, it was shown that Doppler in the fetal middle cerebral artery in uncomplicated pregnancies at 40 weeks and beyond could predict fetal distress and avoid hypoxic brain damage to the fetus during labor.

Association between the fetal cerebroplacental ratio and biomarkers of hypoxia and angiogenesis in the maternal circulation at term

ObjectivesA low fetal cerebroplacental ratio (CPR) in late pregnancy is a marker of a fetus that has failed to reach its growth potential and is associated with a variety of perinatal and pregnancy complications. It is not known if it is also correlated with aberrations in angiogenic, hypoxia-responsive or inflammatory cytokine levels in the maternal circulation. We investigated if there were any differences in levels of biomarkers of angiogenesis, endothelial cell dysfunction, hypoxia and/or inflammation in term pregnancies with a low fetal CPR compared to controls. We hypothesized that as the CPR is a marker of suboptimal growth, this would be reflected in a shift towards upregulation of hypoxia-responsive factors even in non-small for gestational age fetuses. Study designWe used Multiplex ELISA to measure a panel of 28 candidate biomarkers of angiogenesis and/or hypoxia in pre-labour maternal plasma from 113 women at term, stratified for CPR <10th centile vs. CPR >10th centile. Plasma levels of the biomarkers were measured using 2 multiplex Luminex assays - a commercially available human angiogenesis/growth factor panel (R&D Systems®), comprising 15 analytes and an in-house custom panel of a further 13 candidate biomarkers. ResultsOf the 28 candidate biomarkers investigated, we found significantly elevated levels of Carbonic Anhydrase 9 and soluble Fms-like tyrosine kinase (Vascular Endothelial Growth Factor Receptor 1), and lower levels of Placental Growth Factor in plasma from women with a low fetal CPR. The soluble Fms-like tyrosine kinase-1/Placental Growth Factor ratio was also markedly elevated in this cohort. We also demonstrated significant inverse correlations between the fetal CPR and Carbonic Anydrase 9, soluble Fms-like tyrosine kinase and Hepatocyte Growth Factor. ConclusionsA low fetal CPR is associated with changes in some hypoxia-responsive and angiogenesis factors in the maternal circulation in pregnancies with normally grown fetuses.

Correlation between fetoplacental Doppler indices and measurements of cardiac function in term fetuses.

Redistribution of cardiac output (CO) is responsible for the brain-sparing effect seen during periods of fetal stress. Our aim was to investigate prospectively the correlation between fetoplacental Doppler indices and measurements of cardiac function in uncomplicated term singleton pregnancy. This was a prospective observational study of normotensive women with appropriately grown, non-anomalous singleton pregnancy. Participants underwent fortnightly ultrasound examinations from 36 weeks' gestation until delivery, and intrapartum and neonatal outcomes were recorded. The correlation between fetoplacental Doppler indices and various measurements of cardiac function was evaluated. The study cohort comprised 273 singleton pregnancies. The cerebroplacental ratio (CPR) was correlated positively with left ventricular CO (LVCO) (P< 0.001, rho = 0.29), left-to-right ventricular CO ratio (LVCO/RVCO; P< 0.001, rho= 0.41), global left ventricular strain (P< 0.01, rho = 0.17) and global right ventricular strain (P< 0.001, rho = 0.22). The CPR was correlated inversely with the left ventricular myocardial performance index (P< 0.01, rho = -0.18) and the RVCO (P< 0.001, rho = -0.28). The LVCO and global left ventricular strain were correlated positively with umbilical venous flow (P= 0.04, rho = 0.18 and P< 0.001, rho = 0.25, respectively). There was minimal or no correlation between either the mean uterine artery pulsatility index (PI) or umbilical artery PI with any cardiac indices. The fetal CPR, middle cerebral artery PI and umbilical venous flow are correlated positively with LVCO, LVCO/RVCO and global left ventricular strain in low-risk term pregnancies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

935: Can cerebroplacental ratios predict perinatal and delivery outcomes for viable fetuses?

To evaluate the relationship between fetal ultrasound assessments and perinatal and delivery outcomes in singleton term pregnancies. A retrospective cohort study of singleton deliveries ≥ 24 weeks’ gestation was conducted at a community hospital between January 2016 and January 2018. The fetal cerebroplacental ratio (CPR) is the ratio of the fetal middle cerebral artery (MCA) pulsatility index (PI) to umbilical artery (UA) PI. CPR is gaining momentum to be a proxy for suboptimal fetal growth as it quantifies suboptimal placental function and subsequent fetal circulatory adaptations. We hypothesize the use of CPR as a generalized marker and potential screening tool as it looks as placental resistance and fetal physiologic response to reach growth potential for Small for Gestational Age (SGA) fetuses and Appropriate for Gestational Age (AGA) fetuses. The UA PI, MCA PI, and CPR were compared to maternal BMI, fetal weight at birth, delivery outcomes, and APGAR scores. Logistic regression analysis was performed to identify, and adjust for, potential confounders using SAS version 9.4 with a p < 0.05 considered as significant. The study cohort included 1732 singleton pregnancies. CPR had a linear association with fetal weight and gestational age (p < 0.0001). The average CPR ratio of spontaneous vaginal deliveries was higher than of caesarean-sections (C-sections) (p= 0.0193). The average UA PI of spontaneous vaginal deliveries was lower than of C-sections (p= 0.0150). The CPR had a weak positive and UA PI ratio had a weak negative correlation with APGAR score at 1 and 5 minutes. CPR and UA PI had no significant association with maternal BMI (p= 0.2330). Our study shows that lower fetal CPR is associated with higher C-section rates in both SGA and AGA fetuses. Since low CPR is directly correlated with an elevated UA PI Doppler, this surveillance may be independently associated with delivery outcomes. These fetal ultrasound assessments may be valuable in predicting delivery outcomes of pregnancies at risk of operative deliveries, potential placental hypoxemia and cerebral redistribution affecting long-term neurodevelopmental disability.

Prelabor screening for intrapartum fetal compromise in low‐risk pregnancies at term: cerebroplacental ratio and placental growth factor

To determine the screening performance of low fetal cerebroplacental ratio (CPR), a marker of fetal adaptation to suboptimal growth, and maternal placental growth factor (PlGF) level, both in isolation and in combination, for the prediction of Cesarean section (CS) for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (CANO). This was a prospective cohort study in low-risk women with uncomplicated singleton pregnancy from 36 weeks' gestation to delivery. CPR and PlGF were assessed fortnightly and intrapartum and neonatal outcomes were recorded. CPR and PlGF values from the final assessment for each woman were corrected for gestational age and assessed for screening performance, firstly as continuous variables and then as binary predictors. Of the 264 women who consented to participate in the study, 207 were included in the final analysis. Seven pregnancies required CS for IFC and 38 had CANO. Pregnancies delivered by CS for IFC had lower CPR and PlGF centiles than those in all other pregnancies. Pregnancies with CANO had a lower PlGF centile. The greatest areas under the receiver-operating characteristics curves (AUCs) for the prediction of CS for IFC (0.92; 95% CI, 0.86-0.97) and CANO (0.64; 95% CI, 0.54-0.74) were achieved by a combination of CPR 20th and PlGF 33rd centile thresholds. This produced sensitivities, specificities and positive likelihood ratios for the prediction of CS for IFC of 100%, 86% and 7.14, respectively, and 34.2%, 87.0% and 2.63, respectively, for the prediction of CANO. There was no statistical difference in the AUC for CS for IFC between the combined model and when CPR was used alone, or for CANO between the combined model and CPR or PlGF in isolation. This pilot proof-of-concept study describes the screening performance of CPR and maternal PlGF level for CS for IFC in low-risk women from 36 weeks' gestation. It was found that CPR and maternal PlGF improved the overall predictive utility for CS for IFC, as well as that for CANO. However, given the lack of significant difference between the combined model and its individual components, it is debatable whether the combined model is a superior screening test. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Emergency caesarean for intrapartum fetal compromise and admission to the neonatal intensive care unit at term is more influenced by fetal weight than the cerebroplacental ratio

Objective: Some studies have suggested that the fetal cerebroplacental ratio (CPR) is an independent predictor of intrapartum fetal compromise and admission to the neonatal intensive care unit (NICU) at term particularly in small for gestational age (SGA) compared to appropriate for gestational age (AGA) infants. The aim of this study was to evaluate the association between the CPR and emergency caesarean for intrapartum fetal compromise (CS IFC) and NICU admission at term after adjusting for estimated fetal weight (EFW) and other confounding factors.Methods: This was a retrospective study of women who birthed at the Mater Mother’s Hospital in Brisbane, Australia between for women who birthed between January 2000 and April 2017. The CPR was measured within 2 weeks of birth in women that delivered at term and assessed for correlation with CS IFC and admission to NICU. The study cohort was also stratified into four categories according to EFW and CPR thresholds. Appropriate for gestational age (EFW ≥10th centile) and normal CPR (≥10th centile), AGA and low CPR (<10th centile), SGA (EFW <10th centile) and normal CPR and SGA and low CPR.Results: Both CPR <10th centile (adjusted odds ratio (aOR) 2.60, 95% CI 1.82–3.71, p < .001) and EFW <10th centile (aOR 2.63, 95% CI 1.85–3.74, p < .001) demonstrated significant associations with CS IFC. EFW <10th centile (aOR 2.23, 95% CI 1.61–3.09, p < .001) but not CPR <10th centile (aOR 1.41, 95% CI 0.99–2.01, p = .06) was predictive of NICU admission. When stratified according to EFW and CPR thresholds, SGA had significant odds ratios for CS IFC and NICU admission regardless of CPR status. However, the AGA and low CPR cohort was only at increased risk of CS IFC (aOR 2.09, 95% CI 1.30–3.34, p = .002) but not of admission to NICU.Conclusions: At term, the CPR is an independent risk factor for CS IFC regardless of fetal weight. However, the CPR was only predictive of NICU admission in an SGA cohort. Overall, our findings suggest that fetal size is a more important variable for both CS IFC and NICU admission.

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

A low fetal cerebroplacental ratio confers a greater risk of intrapartum fetal compromise and adverse neonatal outcomes in low risk multiparous women at term

BackgroundA low fetal cerebroplacental ratio (CPR) and nulliparity have independently been shown to be associated with adverse obstetric and perinatal outcomes. ObjectivesTo assess the effect of parity on the CPR and investigate the utility of a CPR threshold of <10th centile for predicting adverse outcomes. We hypothesised that nulliparous women would have a lower CPR than multiparous women, impacting the diagnostic performance of the <10th centile threshold. This is an important consideration for interpretation of a low CPR in clinical practice. Study DesignThis was a retrospective cohort study of low risk, singleton pregnancies delivering at term in Australia’s largest maternity hospital. The primary outcome was emergency caesarean section for intrapartum fetal compromise (EmCS IFC). Data was dichotomised according to parity and further by CPR <10th centile. Multiple logistic regression was performed. Results4737 women were included for analysis, 2333 were nulliparous and 2404 were multiparous. Overall the z-score (mean [SD])(CPR standardised for gestation) was lower in nulliparous compared to multiparous women (−0.16 [-1.73 – 1.42] vs 0.04 [−1.63 – 1.69], p < 0.001). Multiparous women had a non-significantly lower mean z-score for those who delivered by EmCS IFC than nulliparous women (−0.52 [−2.23 – 2.02] vs −0.45 [−2.22 – 1.1]).Nulliparous women had greater odds of having a CPR <10th centile compared to the multiparous cohort (OR 1.24, 95% CI 1.02–1.5 vs. OR 0.81, 95% CI 0.7–0.98, p < 0.001). A CPR thresholdd <10th centile in nulliparous women was associated with increased odds of intrapartum fetal compromise (IFC), EmCS IFC (aOR 1.72, 95CI 1.2–2.6, p < 0.05) and birthweight <10th centile. A low CPR in multiparous women was associated with increased odds of all adverse perinatal outcomes measured: IFC, meconium stained liquor, EmCS IFC (aOR 4.99, 95%CI 2.5–9.9, p < 0.001), birthweight <10th centile, acidosis, neonatal intensive care admission and severe composite neonatal outcome. These aORs were associated with specificities of >90% and false positive rates of <10% for all outcomes in multiparous women. ConclusionsA CPR <10th centile in multiparous women confers greater odds of adverse perinatal outcomes and as such of the influence of parity should be taken into account when decisions regarding clinical management are made because of a low CPR.

Predicting intrapartum fetal compromise at term using the cerebroplacental ratio and placental growth factor levels (PROMISE) study: randomised controlled trial protocol

IntroductionIntrapartum complications are a major contributor to adverse perinatal outcomes, including stillbirth, hypoxic–ischaemic brain injury and subsequent longer term disability. In many cases, hypoxia develops as a gradual process due...