Prediction Of Perinatal Outcome Research Articles

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy. It suggested that the cerebroplacental ratio may be calibrated in the software of the Doppler ultrasonography machine for routine use in high-risk pregnancies.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Raised Serum Uric Acid as a Predictor of Perinatal Outcome in Parturient with Pregnancy Induced Hypertension

Objective: To evaluate the association of increased uric acid in pregnancy-induced hypertension with adverse perinatal outcomes.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Departments of Anesthesia, Gynecology &amp; Obstetrics, Combined Military Hospital, Okara Pakistan, from Mar to Sep 2018.&#x0D; Methodology: After approval of the Hospital Ethical Committee, 106 patients with pregnancy-induced hypertension were included in our study (n=53 in each group). Group-A had patient with raised uric acid, whereas Group-B had normal uric acid. Perinatal outcomes were monitored prospectively.&#x0D; Results: There was no difference in demographic profile of the two study groups. Raised uric acid was shown to be associated with a higher cesarean mode of delivery (p=0.014); preterm delivery (0.001); intrauterine growth retardation (0.038); and low APGAR at 5mintues (0.008). Raised uric had a sensitivity greater than 65% and specificity greater than 50% for perinatal outcomes.&#x0D; Conclusion: Raised uric acid is associated with adverse perinatal outcomes in neonates.

A cross-sectional study on role of labor admission test by CTG as a predictor of perinatal outcome

A cross-sectional study on role of labor admission test by CTG as a predictor of perinatal outcome

Cerebroplacental ratio as a predictor of perinatal outcomes in intrauterine growth restriction

Intrauterine growth restriction (IUGR) complicates 7-15% of pregnancies and is associated with adverse perinatal outcomes. The primary goal of antenatal care is the early detection of such conditions. Doppler studies in fetus are used to predict the morbidity in IUGR. Studies show that cerebroplacental ratio is a better predictor of IUGR babies and adverse perinatal outcome. In this study we compare perinatal outcomes of IUGR babies with a normal CPR and an abnormal CPR. This prospective cohort study was carried out in the Department of Obstetrics and Gynaecology, Amala Institute of Medical Sciences, Thrissur, from January 2018 to June 2019. The study included 170 antenatal mothers diagnosed IUGR sonologically or are at risk of IUGR. CPR was calculated from Doppler parameters as ratio of MCA PI and Umbilical artery PI. CPR more than 1.08 was considered normal. Perinatal outcomes were compared between normal and abnormal CPR group. The incidence of abnormal CPR was found to be 39.4%. An abnormal CPR was associated with an increase in rate of emergency ceaserean rate for fetal distress (76.12%) and 64.18% had an APGAR of &amp;#60;7 at 5 mts of life. 97.02% babies with an abnormal CPR were admitted to NICU for several reasons. Frequency of adverse perinatal outcomes was increased in abnormal CPR group. These differences were statistically highly significant. In patients with IUGR, cerebroplacental ratio is a useful marker in prediction of adverse perinatal outcome. Integrating CPR into routine Doppler studies in clinical practice will help better identify fetuses at risk.

Clinical utility of aortic isthmus Doppler in the prediction of perinatal outcomes

Doppler studies of uteroplacental-fetal circulation have been proven useful in diagnosing fetal growth restriction, appropriately timing delivery, and improving perinatal morbidity and mortality. There has been an extensive search for the ideal means to identify fetuses between the compensatory and acidemic phase (ie, the "preacidemic phase"), and the aortic isthmus Doppler seems to show promise. This study aimed to investigate: (1) the prevalence of abnormal aortic isthmus Dopplers in a cohort of small-for-gestational-age fetuses and their correlation with other conventional Doppler abnormalities, and (2) the predictive ability of abnormal aortic isthmus Dopplers with regard to short-term adverse neonatal outcomes. Fetuses diagnosed as small-for-gestational-age at ≥24 weeks' gestation were included. Management was as per the standard protocol. Aortic isthmus Doppler was performed within a week of delivery with other conventional Dopplers. The adverse perinatal outcomes studied were: requirement of neonatal resuscitation at birth, Apgar score at 5 minutes <7, cord blood pH <7, presence of bronchopulmonary dysplasia, hypoxic-ischemic encephalopathy, grade III/IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal intensive care unit stay longer than 14 days, and stillbirth or neonatal death. Among 121 small-for-gestational-age fetuses, 67 showed Doppler abnormalities in ≥1 vessels. The prevalence of abnormal aortic isthmus Doppler was 14.87%. Analysis was between group 1 with 103 normal aortic isthmus and group 2 with 18 abnormal aortic isthmus fetuses; 41 cases had some form of adverse perinatal outcome, the frequency of which was comparable between the groups. Abnormal aortic isthmus Doppler had a significant correlation with low cerebroplacental ratio, absent or reversed end-diastolic flow in the umbilical artery, and high pulsatility index in the ductus venosus. The positive likelihood ratio for predicting composite adverse perinatal outcome was 10.2 for absent or reversed end-diastolic flow in the umbilical artery, 9.6 for low cerebroplacental ratio, 2.28 for absent or retrograde flow in the aortic isthmus, and 2 for abnormal ductus venosus. Predelivery abnormal aortic isthmus Dopplers performed worse than other conventional Dopplers in predicting abnormal perinatal outcomes.

Role of cerebro-placental ratio in prediction of perinatal outcome in high-risk Pregnancies with intrauterine growth restriction

Background: Antenatal surveillance using Doppler ultrasound velocimetry of the uteroplacental umbilical and fetus arteries has been commonplace. The cerebroplacental ratio has been investigated as a way to predict newborn outcomes. Aim and objectives: In this research, we wanted to see whether the cerebro-placental ratio may help predict perinatal outcomes in high-risk gestation with intrauterine growth restriction. Subjects and methods: This was case-control research done at Al-Hussein University Hospital's Department of Obstetrics and Gynecology; The obstetric color Doppler investigation might be examined in two groups of 100 high-risk pregnant wome: Group Ⅰ - study group: 50 high risk pregnant women with IUGR and Group Ⅱ - control group: 50 high risk pregnant women without IUGR. Results: CPR achieved significance at cutoff point of 1.03 for predicting IUGR with sensitivity of 87.2% and specificity of 71.6% with PPV 83% and NPV 79%. Conclusion: Intrauterine growth restriction in high-risk gestations, the cerebral-placental ratio has a significant prognostic value for perinatal outcome.

Cerebro placental ratio at 30–34 weeks’ gestation in the prediction of perinatal outcome in low-risk and high-risk pregnancy

Doppler ultrasound velocimetry of umbilical and fetal vessels has become an established method of antenatal monitoring, allowing the non-invasive assessment of neonatal circulation. Cerebro placental ratio (CPR) is emerging as a significant predictor of adverse pregnancy outcome. To predict perinatal outcome in low and high-risk pregnancy in early and late-onset FGR using CPR. The study group comprised 410 pregnant women at 30-34 weeks, evaluated with ultrasound Doppler study, and other routine investigations and CPR were calculated. Women were categorized into high-risk and low-risk pregnancies and followed up until delivery, and fetal outcome was noted. Period of prolongation of pregnancy was significantly lower with high-risk patients than low-risk patients (31.09 ± 13.9 vs 37.79 ± 15.1, p=0.0003). NICU admissions significantly increased with high-risk patients than low-risk patients (22.22% vs 9.4%, p=0.002). Low-risk patients underwent significantly more vaginal deliveries as compared to high-risk patients (74.22% vs 44.87%, p &amp;#60; 0.0001). Birth weight, period of prolongation of pregnancy, and gestation period were significantly lower in patients with abnormal CPR than normal CPR group (2.82 Kg vs 1.94 Kg, 37.56 weeks vs 14.64 weeks, 266.47 days vs 245.41 days, respectively). Doppler velocimetry becomes an important tool for high-risk cases and late-onset mild FGR(after 32 weeks). CPR is helpful in high-risk pregnancies and also to predict peripartum fetal distress.

Developing multi-language maternal health education videos for refugee and migrant women in southeast Melbourne

ProblemIn Australia, many women from refugee and migrant backgrounds experience significant health disparities and barriers to care and poor health literacy negatively influences their maternal and infant health outcomes. Improving health literacy improves these outcomes yet can be time consuming and difficult to provide within the confines of current models of maternity care. IntroductionEach year, more than 9000 women give birth across Monash Health’s three maternity sites within one large public health service, located in Melbourne. Almost 60% of these women were born in non-English speaking countries and approximate 10% request the use of an interpreter at some point throughout their maternity experience. This project aimed to co-design animated videos focused on preconception, pregnancy, and postnatal care with women from refugee and migrant backgrounds. MethodsThe authors utilised previously prioritised maternity education needs as a starting point for design workshops undertaken with healthcare staff and women from the end-user communities. Over three workshops, sixteen healthcare staff volunteered to map or provide feedback on key touch points and barriers to quality, respectful care from the preconception period until six months postnatal. Arabic- and Dari-speaking women, led by bicultural educators, were all paid to user test these posters and the subsequently developed videos. ResultsThe process utilised within this project yielded five posters, four videos and four important recommendations in maternity care to incorporate in the education posters and videos, which both healthcare workers and the Arabic- and Dari-speaking women referenced at each mapping and user testing session. These included (1) explaining maternity care (appointment, tests, diet, medications etc.); (2) culturally informed models of care; (3) recognising the role of the support person; and (4) the impact of COVID-19 on health provision and access. DiscussionMaternal health literacy is a known predictor of perinatal outcomes. Globally, women report wanting more guidance and clearer understanding of what is taking place throughout their perinatal journey. This desire for knowledge is no different for women from non-English speaking backgrounds in Australia, though it may require more time and investment by health providers and educators. These posters and videos offer an attempt to support women, particularly women from refugee and migrant backgrounds, who require further healthcare explanations, to complement their current models of care, in a medium that is accessible and appropriate for them.

Does predelivery body mass index really matter in pregnancy?

The aim of the study was to compare the perinatal outcome between the normal weight, overweight and obese pregnant women who delivered in the third-level center of reference. Moreover, the objective was to analyze the usefulness of predelivery body mass index (BMI) in prediction of preterm delivery, prolonged second stage of labor, instrumental vaginal delivery, cesarean section, fetal macrosomia, dystocia and newborn acidosis. The retrospective study included 2104 patients, divided into three groups, with BMI between 18.5 and 24.9; 25.0 and 29.9; higher than or equal 30.0 kg/m2, respectively. The data were assessed from the medical history. The predelivery obesity increases the risk of cesarean section (aOR 1.63), macrosomia (aOR 8.89) and dystocia (aOR 3.40) in comparison to normal weight women. Moreover, the obese females had three times greater risk of having a macrosomic child (aOR 3.57) and 1.5 times greater risk of cesarean section (aOR 1.52) than overweight group. The role of predelivery BMI in the prediction of cesarean delivery (AUC 0.550; sensitivity 0.39; specificity 0.71, p < 0.001, cut-off value 28.7 kg/m2), macrosomia (AUC 0.714; sensitivity 0.66; specificity 0.70; p < 0.001, cut-off value 29.0 kg/m2) and dystocia (AUC 0.658; sensitivity 0.77; specificity 0.53, p < 0.001, cut-off value 27.0 kg/m2) was significant. The predelivery obesity increases the risk of cesarean section, macrosomia and shoulder dystocia and is a useful parameter in the prediction of perinatal outcomes. The establishing cut-off value for predelivery BMI was the lowest in prediction of shoulder dystocia.

Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study.

Birth asphyxia is a common cause of perinatal morbidity, mortality. To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.

Relationship of cystatin C, Hs-CRP, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with isolated oligohydramnios.

We evaluated inflammatory parameters in pregnant women with isolated oligohydramnios. This prospective cross-sectional study enrolled 54 pregnant with isolated oligohydramnios (IO) and 54 matched by gestational week, healthy pregnant with normal amniotic fluid. Maternal plasma levels of cystatin C, hs-CRP, neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), and pregnancy outcomes were compared between two groups. Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than that in the control group (p < 0.05). In the IO group, the rate of primary cesarean section, fetal distress, neonates with meconium-stained, and need for neonatal intensive care unit was higher, and Apgar scores were significantly lower than those in the control group (p < 0.05). There was no significant difference between the groups for meconium-stained neonate rates and the intensive care unit's need in the late-term (410/7-416/7 weeks). Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than the control group (p < 0.05). Cystatin C was positively correlated with the need for neonatal intensive care and negatively correlated with Apgar scores. The PLR was positively correlated with the rate of meconium-stained neonates (p < 0.05). Cystatin C and hs-CRP had significant value in predicting IO (p < 0.05). Maternal serum levels of Cystatin C and hs-CRP may support the diagnosis and prediction of perinatal outcomes as possible biochemical markers in IO cases. In particular, a high level of cystatin C may indicate the need for neonatal intensive care and low Apgar scores. In addition, late-term IO may show similar results in meconium and neonatal intensive care needs compared to without oligohydramnios.

Premature rupture of membranes in preterm pregnancy: prediction of perinatal outcomes

AIM: This study was aimed to determine predictors of severe lesions of the central nervous system in newborns from mothers with preterm labor complicated by premature rupture of membranes, and to develop a model for predicting adverse outcomes based on clinical data and biochemical markers.&#x0D; MATERIALS AND METHODS: At the first, retrospective, stage of the study, in order to determine clinical predictors of severe cerebral injury, we studied anamnesis data and features of pregnancy and delivery in 101 patients with premature rupture of membranes, expectant management tactics and subsequent delivery at 2633.6 weeks of gestation. At the second stage, in the prospective study, which included 33 patients, we evaluated the level of neuron-specific enolase in the amniotic fluid and determined its diagnostic significance as a predictor of severe lesions of the nervous system.&#x0D; RESULTS: The following factors were determined as clinical predictors of severe cerebral ischemia in premature infants: delivery time, duration of the latency period, the proportion of stab leukocytes in the leukocyte formula, and the presence of funiculitis in the histological examination of the placenta. A prognostic model with sensitivity of 98% and specificity of 80%, including clinical predictors and neuron-specific enolase, was developed.&#x0D; CONCLUSIONS: Prediction of severe cerebral ischemia and correction of the latency period allows for improving perinatal outcomes in premature infants and starting rehabilitation measures after birth in a timely manner.

Прогнозирование перинатального исхода при преэклампсии на основании доплерометрических показателей

Objective of the Review: To present current literature data on the prediction of perinatal outcomes in pregnant women with preeclampsia and on potential strategies for improving the prediction of outcomes of pregnancy complicated by preeclampsia based on Doppler parameters. Key points. The results of studies devoted to the choice of the most optimal Doppler indicators that can be used to predict perinatal outcome are presented. This review presents an analysis of the accuracy of Doppler parameters (pulsation index in the middle cerebral and umbilical arteries, resistance index, cerebroplacental ratio) in predicting adverse perinatal outcomes in pregnancy complicated by preeclampsia. A review of the current literature on the prediction of perinatal outcomes and management of pregnant women with preeclampsia and potential strategies improving the prediction of outcomes of pregnancy complicated by preeclampsia. Conclusion. Currently, dopplerometry in obstetric practice is a highly accurate prognostic method for determining the perinatal outcome in complicated pregnancy. This method allows to predict the actual risk to the fetus, monitor and evaluate its degree along with other methods of antenatal care, and also allows you to choose the time and method of delivery if the risk of intrauterine death of the fetus is high. Keywords: parameters of fetal cerebral hemodynamics, velocity and pulsation of blood flow in the middle cerebral artery, cerebroplacental ratio, gestational period, Doppler parameters, preeclampsia.

Umbilical Artery Systolic/Diastolic Ratio and Amniotic Fluid Index in Prediction of Adverse Perinatal Outcome in Term Pregnancies.

Background:Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. It is based on fetal heart rate monitoring using nonstress test and contraction stress test, ultrasound biometry and amniotic fluid assessment, Doppler blood flow studies of fetal and uteroplacental circulation, and an evaluation of biophysical fetal parameters. The combination of these methods leads to improvements in fetal morbidity and mortality.Aim:The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of umbilical artery (UA) systolic/diastolic (S/D) ratio, and amniotic fluid index (AFI) in term pregnancies for the prediction of perinatal outcome and their relation with perinatal outcome.Methods:This study was conducted at a tertiary care hospital on 100 pregnant women where all the term singleton pregnancies (37–42 weeks) admitted in maternity were subjected to color Doppler for UA S/D ratio assessment and AFI estimation. Further, management of patients was done according to color Doppler findings and their relation with perinatal outcome.Results:Out of 100 pregnant women, 68% had AFI >8 (normal), while 32% of women had AFI <8 (abnormal), with the mean AFI being 9.39 ± 2.55 cm, whereas70% had S/D ratio <3 (normal) and 30% of women had S/D ratio >3 (abnormal), with the mean S/D ratio of 2.61 ± 0.450. UA S/D ratio had better performance values (i.e., sensitivity, specificity, and positive and negative predictive value) than AFI in predicting adverse perinatal outcomes.Conclusion:AFI and UA S/D ratio are important for predicting low appearance, pulse, grimace, activity, and respiration score, meconium, respiratory complications, and perinatal mortality in high as well as low-risk pregnancy cases. However, UA S/D ratio is a better predictor of perinatal outcome in high-risk pregnancies.

Bradycardia-to-Delivery Interval and Fetal Outcomes in Umbilical Cord Prolapse

(Acta Obstet Gynecol Scand. 2021;100:170–177) Umbilical cord prolapse is an emergency with risk for significant complications, including prematurity and birth asphyxia. As cord compression and umbilical arterial vasospasm can lead to fetal hypoxia and birth asphyxia, rapid delivery is required to prevent fetal brain injury, cerebral palsy and death. However, studies have found improved Apgar scores associated with longer decision-to-delivery intervals in some cases of umbilical cord prolapse. Bradycardia-to-delivery interval may be a better predictor of perinatal outcomes because cord prolapse and onset of fetal hypoxia may occur before the decision to deliver. This study aimed to investigate the relationship between bradycardia-to-delivery interval or decision-to-delivery interval and adverse neonatal outcomes, specifically focusing on the range of fetal heart rate abnormalities in cases of umbilical cord prolapse.

Prediction of perinatal outcomes in pregnant women with fetal growth retardation

Introduction. An important problem of modern obstetrics is the development and improvement of methods for predicting fetal growth retardation (FGR) and pregnancy outcomes in this pathology, since there are no proven effective treatments for FGR. Purpose of the study — to develop prediction criteria for newborn hypotrophy and cumulative adverse perinatal outcome in pregnant women with FGR. Objective. To identify key predictive factors for adverse perinatal outcomes in pregnancy complicated by FGR. Material and methods. A case-control, cohort-based study was conducted that included 155 pregnant women with FGR, who were divided into two groups after delivery: Group 1 included 90 patients with neonatal hypotrophy and Group 2 included 65 patients without neonatal hypotrophy. A comprehensive analysis of clinical and anamnestic, laboratory and instrumental data, peculiarities of the course of pregnancy and perinatal outcomes was performed. FGR was determined on the basis of ultrasound fetometry. Results. Factors associated with neonatal hypotrophy and unfavorable perinatal outcome were: impaired blood flow in the uterine arteries and/or umbilical artery, early preeclampsia and scarcity of water. Protective factors were antibacterial therapy for intrauterine infection, administration of low-molecular-weight heparin in the first trimester, and acetylsalicylic acid starting from the 12th to 16th weeks of gestation. Conclusion. The most promising measures in the prevention of FGR and adverse perinatal outcomes in this pathology may be timely prescription of antithrombotic correction and treatment of genital infections.

Role of Cerebro-Placental Ratio in Prediction of Perinatal Outcome in Preeclamptic Patients with Intrauterine Growth Restriction

Background: The assessment of fetal hemodynamic status via Doppler flow is increasingly regarded as likely to aid in the detection of pregnancies at risk of developing adverse fetal outcomes. Doppler flow provides useful information beyond the ultrasound-based assessment of fetal growth alone. Objective: This study aimed to evaluate the role of cerebro-placental ratio (CPR) in prediction of perinatal outcome in preeclamptic patients with intrauterine growth restriction (IUGR). Patients and methods: This case-control study was conducted at Obstetrics and Gynecology Department, Zagazig University, on 50 pregnant women divided in to two groups: Group I (study group) that included 25 high risk pregnant women with IUGR. Group II (control group) included 25 high risk pregnant women without IUGR. The study was conducted during the period from December 2020 till July 2021. Results: The current study showed that CPR had 90.9% sensitivity, 78.6% specificity and 84 % diagnostic accuracy to predict newborns with low Apgar score, with statistically significant positive correlation. CPR also had 100% sensitivity, 100% specificity and 100 % diagnostic accuracy to predict stillbirth, with highly statistically significant positive correlation. The CPR had 100% sensitivity, 83.3% specificity and 92 % diagnostic accuracy to predict newborns with NICU admission, with statistically significant positive correlation. Other complications as meconium aspiration and neonatal death had no statistically significant to be predicted by low CPR. Conclusion: This study concluded that the Cerebro-Placental Ratio had high predictive value of perinatal out come in preeclamptic patients.

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.