Prediction Of Adverse Perinatal Outcome Research Articles

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.

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.

Doppler Velocimetry of Umbilical Artery in Normal and Growth Restricted Pregnancy

Objectives: To evaluate the umbilical arterial blood flow velocity and its various indices during 3rd trimester of pregnancy and to compare these indices in normal and growth restricted pregnancies.&#x0D; Methods: In this study, 50 women with normal singleton pregnancy and 50 women with intrauterine growth restricted (IUGR) pregnancy with expected birth weight &lt;10th percentile of the normal for the gestational age were studied by Doppler evaluation of their umbilical artery, Pulsality Index (PI), Resistance Index (RI) and S/D ratio of the control group and IUGR group were calculated and reference range constructed. Values of Doppler indices of IUGR group were compared with those of the control group. Perinatal outcome was evaluated in relation to the indices.&#x0D; Results: Doppler velocimetry of umbilical artery showed elevated indices in 33 out of 50 cases of IUGR group showing its high sensitivity in diagnosing haemodynamically compromised growth restricted fetuses. Absent end diastolic velocily (AEDV) and reversed end diastolic velocily (REDV), were seen in 8 and 2 cases respectively and were associated with poor perinatal out come in terms of need for LSCS for fetal distress, Apgar score &lt;7 at 1 minute, admission to NICU (Neonatal Intensive Care Unit) and perinatal death.&#x0D; Conclusion: In normal pregnancy there is gestational age related fall in impedance in Umbilical arteries. Doppler study of umbilical artery is highly sensitive in the detection of IUGR and for the prediction of adverse perinatal outcome in small for gestational age.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 68-73

Predictors of adverse perinatal outcome among women who gave birth at Medical Center of Southwest Ethiopia: a retrospective cohort study

ObjectivesThe aim of this study was to determine predictors of adverse perinatal outcome among women who gave birth at Medical Center of Southwest Ethiopia.SettingInstitutional based retrospective cohort study was conducted...

439 Cpur at labor induction for prediction of adverse perinatal outcome – A pilot study

Introduction and aims of the study: Assessment of the combination of flow indices in the middle cerebral artery, umbilical artery, and uterine arteries (CPUR) is proposed to predict adverse perinatal outcome. An optimal time point to perform this assessment is yet to be found. Our study aimed to check if CPUR would predict adverse perinatal outcome (APO) on the day of labor induction. Methods: This study is planned as a prospective cohort study. Ultrasound is performed directly before initiation of the labor induction procedure. Estimated fetal weight, AFI, and CPUR are measured by certified sonographers on GE Voluson E8 ultrasound machine. Outcomes of interest are cesarean section, operative vaginal delivery, Apgar score, umbilical artery pH, and neonatal complications. Results: We present the results of a pilot study of 43 patients. The study size was not large enough to record significant differences between groups. There was a trend towards higher CPUR among patients with cesarean section or operative vaginal delivery because of fetal distress. No adverse neonatal outcomes were recorded. There were two cases of lower Apgar scores in first minute, both after the cesarean section. Both had higher than average CPUR. Conclusions: The study will be continued to reach a target of 150 patients. The pilot study showed promising results.

Ultrasound prediction of adverse perinatal outcome at diagnosis of late-onset fetal growth restriction.

ABSTRACTObjectiveTo evaluate the relationship between Doppler and biometric ultrasound parameters measured at diagnosis and perinatal adverse outcome in a cohort of late‐onset growth‐restricted (FGR) fetuses.MethodsThis was a multicenter retrospective study of data obtained between 2014 and 2019 including non‐anomalous singleton pregnancies complicated by late‐onset FGR (≥ 32 weeks), which was defined either as abdominal circumference (AC) or estimated fetal weight (EFW) < 10th percentile for gestational age or as reduction of the longitudinal growth of AC by over 50 percentiles compared to ultrasound scan performed between 18 and 32 weeks of gestation. We evaluated the association between sonographic findings at diagnosis of FGR and composite adverse perinatal outcome (CAPO), defined as stillbirth or at least two of the following: obstetric intervention due to intrapartum fetal distress, neonatal acidemia, birth weight < 3rd percentile and transfer to the neonatal intensive care unit (NICU).ResultsOverall, 468 cases with complete biometric and umbilical, fetal middle cerebral and uterine artery (UtA) Doppler data were included, of which 53 (11.3%) had CAPO. On logistic regression analysis, only EFW percentile was associated independently with CAPO (P = 0.01) and NICU admission (P < 0.01), while the mean UtA pulsatility index (PI) multiples of the median (MoM) > 95th percentile at diagnosis was associated independently with obstetric intervention due to intrapartum fetal distress (P = 0.01). The model including baseline pregnancy characteristics and the EFW percentile was associated with an area under the receiver‐operating‐characteristics curve of 0.889 (95% CI, 0.813–0.966) for CAPO (P < 0.001). A cut‐off value for EFW corresponding to the 3.95th percentile was found to discriminate between cases with and those without CAPO, yielding a sensitivity of 58.5% (95% CI, 44.1–71.9%), specificity of 69.6% (95% CI, 65.0–74.0%), positive predictive value of 19.8% (95% CI, 13.8–26.8%) and negative predictive value of 92.9% (95% CI, 89.5–95.5%).ConclusionsRetrospective data from a large cohort of late‐onset FGR fetuses showed that EFW at diagnosis is the only sonographic parameter associated independently with the occurrence of CAPO, while mean UtA‐PI MoM > 95th percentile at diagnosis is associated independently with intrapartum distress leading to obstetric intervention. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The utility of foetal splenic artery Doppler measurement in the diagnosis of late-onset foetal growth restriction

We aimed to examine the contribution of splenic artery (SA) Doppler parameters in the detection of foetuses with late-onset foetal growth restriction (LO-FGR) and to evaluate its power in predicting adverse perinatal outcomes. Within the study's scope, 52 cases in the LO-FGR group and 92 cases in the control group were evaluated. The criteria determined in the Delphi procedure by an international consensus were used to define the LO-FGR. Middle cerebral artery (MCA) pulsatility index (PI) and SA PI were significantly lower in the LO-FGR group (p: .002, p<.001, respectively). Likewise, cerebroplacental ratio (CPR) was significantly lower in the LO-FGR group (p<.001). Decreased CPR and decreased SA PI were significantly and positively associated with an increased likelihood of exhibiting adverse obstetric outcome (p<.001, p: .012, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for SA PI was 1.41 to predict LO-FGR with 70.7% sensitivity and 61.5% specificity (AUC = 0.684; 95% CI, 0.594–0.774). Impact Statement What is already known on this subject? The main clinical difficulty in late-onset foetal growth restriction (LO-FGR) is the detection of the disease. What do the results of this study add? The splenic artery (SA) pulsatility index (PI) may contribute to both diagnostic and the prediction of adverse perinatal outcomes in LO-FGR cases. Our results showed that the SA PI value, as well as cerebroplacental ratio (CPR), can be a useful parameter in predicting negative outcomes. What are the implications of these findings for clinical practice and /or further research? Various degrees of uteroplacental insufficiency in foetuses with LO-FGR may be associated with abnormalities in SA Doppler velocimetry. Splenic artery Doppler velocimetry can be used for the clinical management of LO-FGR.

Vanishing twin after 12 gestational weeks is associated with adverse perinatal outcomes in in vitro fertilization cycles

Background: To assess the associations between vanishing gestational age and the adverse perinatal outcomes following in vitro fertilization cycles. Methods: This is a retrospective cohort study conducted in Guangzhou Women and children hospital from January 2011 to January 2019. We identified 350 vanishing twin pregnancies including 54 secondary fetal deaths and 296 singleton deliveries compared to 2080 infants from single gestations. The children detected by transvaginal ultrasonography in gestational week 6. By linking with the hospital’s registries, the main endpoints were gestational age (weeks), birth weight (g), low birth weight (LBW), preterm birth and neonatal malformation rate. Perinatal outcomes were compared among study groups and controls. Results: Of the 350 vanishing twin, there were 15.4% (54) secondary fetal death. Of the 2376 singleton deliveries, 12.5% (296) originated from a twin gestation. In the assessment of perinatal outcome, there were no significant differences between the singleton cohort and vanishing twin before the presence of fetal cardiac activity cohort (VT before CA) and early vanishing cohort. The late vanishing twin group had a higher risk of preterm delivery (P &lt; 0.001) and LBW (P &lt; 0.001). There were no significant differences between all cohorts in assessing neonatal malformation rate (P &gt; 0.05). Conclusion: Vanishing twin after 12 weeks is a predictor of adverse perinatal outcome. The couples with a viable fetus or a non-viable fetus and an empty gestational sac in early pregnancy (&lt;12 weeks) have a similar outcome as the baby from a singleton delivery without vanishing.

Performance of Six Birth-Weight and Estimated-Fetal-Weight Standards for Predicting Adverse Perinatal Outcome: A 10-Year Nationwide Population-Based Study

(Abstracted from Ultrasound Obstet Gynecol 2021;58:264–277) One of the risk factors for perinatal mortality and morbidity is abnormal fetal growth. The goal of this study was to study the prediction of adverse perinatal outcomes in preterm and term babies based on 3 birth weight (BW) standards (Australian population-based, Fenton, and INTERGROWTH-21st) and 3 estimated fetal weight (EFW) standards (Hadlock, INTERGROWTH-21st, and World Health Organization [WHO]) to classify small-for-gestational age (SGA) and large-for-gestational age (LGA).

Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material&amp; Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Predictors of adverse perinatal outcome up to 34 weeks, a multivariable analysis study

The objective was to evaluate the best predictors of adverse perinatal outcome (APO) in foetuses examined up to 34 weeks and delivered by spontaneous or induced labour. This was a retrospective study of 129 pregnancies that underwent an ultrasound Doppler examination at 23–34 weeks and entered into labour within 30 days. Cerebroplacental ratio (CPR) and mean uterine artery pulsatility index (mUtA PI) were converted into multiples of the median (MoM) and estimated foetal weight (EFW) into centiles to adjust for gestational age (GA). Sonographic and clinical parameters were evaluated using logistic regression analysis. The multivariable model for the prediction of APO presented a notable accuracy: Detection rate (DR) was 39.5% for a false positive rate (FPR) of 5% and 56.8% for a FPR of 10%, AUC 0.82, p < .0001. Significant predictors were GA, EFW centile, and CPR MoM, but not mUtA PI MoM. Moreover, the type of labour onset did not exert any influence on APO. In conclusion, up to 34 weeks, prediction of APO after spontaneous or induced labour may be done measuring CPR and EFW. IMPACT STATEMENT What is already known on this subject? Earlier in pregnancy, foetal growth restriction is caused by placental disease causing progressive hemodynamic changes. These changes have been exhaustively described. Conversely, information about the best predictors of adverse outcome is scarce. What do the results of this study add? The findings of this study show that prior to 34 weeks and up to 1 month before labour, labour outcome might be predicted by gestational age, foetal cerebroplacental ratio (CPR) and estimated foetal weight (EFW). What are the implications of these findings for clinical practice and/or further research? If CPR behaves as a good marker of outcome not only at the end of pregnancy but also earlier in gestation, it might be interrogated along with EFW in foetuses attempting vaginal delivery to determine the risk of adverse outcome.

A Comparison of Amniotic Fluid Index versus Single Deepest Vertical Pocket Measurement at Term as a Predictor of Adverse Perinatal Outcome

Introduction: Oligohydramnios is an important sign of fetal jeopardy and amniotic fluid index (AFI) and single deepest vertical pocket (SDVP) have been used to detect it. Objective: To compare AFI vs. SDVP at term as a predictor of adverse perinatal outcomes. Methods: A prospective observational study was conducted in Teaching Hospital Kandy, Sri Lanka for eight months from July 2015 to March 2016. 448 Singleton pregnancies admitted after 37 completed weeks were included. AFI ≤ 5 cm and SDVP to outcome variables. Results: Mean AFI was 11.35 cm (SD = 5.15) and Mean SDVP was 4.07 cm (SD = 1.88). AFI and SDVP values showed a significant positive correlation (r = 0.954; p Conclusion: AFI better predicted oligohydramnios and subsequent labour induction than SDVP. Low SDVP was a risk factor for adverse perinatal outcomes (such as induction of labour, meconium-stained liquor, operative delivery, 5-minute Apgar less -off values of SDVP and AFI for each perinatal outcome, an in-depth experimental analysis is required in future research.

Maternal risk factors and perinatal outcomes inantenatally diagnosed oligohydramnios

Objective: Our study aims to study the maternal risk factors and perinatal outcomes in antenatally diagnosed oligohydramnios” Study design: Hospital based prospective observational study Methods and materials: The present study was a prospective observational study conducted at Dr L. H. Hiranandani Hospital from 01/09/16 to 30/03/18.This study was carried out after obtaining clearance from the institutional ethical committee. Antenatal women with singleton pregnancy registered / referred to our hospital at or beyond 28 weeks of gestation with clinically suspected oligohydramnios were screened. Thorough history taking, complete examination and baseline investigations were done for all the cases. Ultrasound examination was done for these women and AFI was calculated by four quadrant amniotic fluid volume measurement technique as described by Phelan, et al.1 A curvilinear transducer was used. By marking, the uterus was divided into four quadrants using the maternal sagittal midline vertically and an arbitrary transverse line approximately half way between the symphysis pubis and upper edge of uterine fundus. The transducer was kept parallel to the maternal sagittal plane and perpendicular to the maternal coronal plane throughout. The deepest, unobstructed and clear pocket of amniotic fluid was visualized and the image was frozen. The ultrasound calipers were manipulated in such a way that it measured the pocket in a strictly vertical direction. The process was repeated in each of the four quadrants. AFI was then calculated. Thus, antenatal women with singleton pregnancy at or beyond 28 weeks of gestation with decreased AFI (AFI < / = 8 cm) on ultrasonography were included in the study. Written informed consent was taken after explaining the purpose of the study. The study did not compromise with any treatment/care given routinely to them. Results: It was observed that a higher incidence of antenatal high risk factors and adverse perinatal outcome was seen in higher percentage of patients having severe oligohydramnios than that of borderline oligohydramnios. We observed that decreased AFI (AFI < / = 5 cm) was associated with increased incidence of induction of labour, atypical / abnormal NST, meconium staining of liquor, incidence of LSCS, low APGAR score at 5 minutes and NICU admissions. Amniotic fluid volume measured in terms of AFI is a good predictor of adverse perinatal outcome. Conclusion: Oligohydramnios is as an indicator of the possible presence of maternal factors e.g. gestational hypertension, fetal growth restriction (FGR), abruptio placentae. It is an indicator of poor perinatal outcome. Estimation of amniotic fluid volume should be a part of antenatal fetal surveillance. Amniotic fluid volume measured in terms of amniotic fluid index (AFI) is a helpful tool in determining patients at risk. Severe oligohydramnios, as compared to borderline oligohydramnios is significantly associated with pregnancy complications and perinatal morbidity and mortality such as increased incidence of induction of labour, atypical / abnormal non stress test (NST), Meconium staining of liquor, increased incidence of LSCS, Low APGAR score at 5 minutes, Increased NICU admissions. This highly significant statistical correlation between oligohydramnios and poor perinatal outcome suggests that AFI in adjunct with other methods of fetal surveillance can be used to identify patients at risk. Detailed history taking, experienced clinical judgment, strict antepartum and intrapartum surveillance can reduce perinatal complications.

Association between Irregular Labour Pains and Meconium in Low Risk Pregnancies

Background&#x0D; Meconium stained amniotic fluid (MSAF) is a frequent occurrence seen by health care providers in obstetric and neonatal practice. MSAF is a predictor of adverse perinatal outcome even in low risk pregnancies, so MSAF can be taken as independent marker of fetal distress. MSAF was associated with higher rate of caesarean delivery, meconium aspiration syndrome, hospital admission and perinatal mortality.&#x0D; Objective&#x0D; The objective of this study is to determine the frequency of MSAF in low risk pregnancies presenting with irregular labour pains between 37 to 40 weeks of gestation.&#x0D; Material and Methods&#x0D; This was a Descriptive case series conducted in Gynae / Obs Unit II, Holy Family Hospital, Rawalpindi from December 2020 to May 2021. All patients registered in the labour room of Obs/Gynae Unit-II between 37 to 40 weeks were evaluated for the occurrence of irregular labour pains, with the help of history and clinical examination. Presence of meconium stained amniotic fluid in low risk pregnancies presenting with irregular labour pains was noted. A cutoff value of 12 hours for irregular labour pains was taken and after that elective amniotomy was done to see the colour of liquor and delivery was planned accordingly. Informed written consent was taken from all patients before enrollment in study. All relevant information was recorded on specified proforma.&#x0D; Results&#x0D; Out of 120 low risk pregnant women those presenting with irregular labour pains, meconium was found positive in 77 (64.2%) pregnant women. Out of which majority 45 (37.5%) was 26-30 years old. The mean age of the pregnant women was 28.05 years those fall in the category of low risk pregnancies with irregular labour pains and the standard deviation was 4.354. Among 36 (30.0%) pregnant women who were 19-25 years old, meconium was found positive in 21 (17.5%) pregnant women. Among 45 (37.5%) pregnant women who were 26-30 years old, meconium was found positive in 32 (26.7%) pregnant women. Likewise among 39 (32.5%) pregnant women who were 31-38 years old, meconium was found positive in 24 (20.0%) pregnant women.&#x0D; &#x0D; Conclusion &#x0D; Meconium-stained amniotic fluid was prevalent among majority of the women (64.2%) those presented with irregular labour pains and categorized as low risk. Mean age of the women was 28.05 years. MSAF was found positive among all three age groups but it was more prevalence in age group 26-30 years.

Umbilical artery Doppler assessment in fetuses with a congenital heart disease

Current data is conflicting regarding the utility of umbilical arterial (UA) Doppler assessment as a predictor of adverse perinatal outcomes in fetuses with congenital heart disease (CHD). We describe a cohort of fetuses with CHD who underwent serial UA Doppler surveillance. We performed a retrospective chart review of singleton fetuses with CHD who received prenatal care at our academic center between June 2018 and September 2020. Fetuses with chromosomal abnormality or fetal growth restriction were excluded. Serial UA Doppler data and perinatal outcomes were collected and fetuses with normal versus abnormal UA Doppler assessments were compared. Abnormal UA Doppler assessment was defined as elevated end diastolic flow >95th percentile or absent/reversed end diastolic flow. Of 310 fetuses with CHD identified, 55% (171/310) met inclusion criteria. Of these, 154 (90%) had normal UA Doppler assessment throughout pregnancy, 47% (73/154) of whom had isolated CHD without extracardiac anomalies. Additionally, 17 fetuses had abnormal UA Doppler assessment, 71% (12/17) of whom had isolated CHD. Maternal characteristics did not differ between groups except for maternal race and history of preeclampsia (Table 1). CHD lesions varied, with the most common being isolated VSD (N=39, 23%), hypoplastic left heart syndrome (N=28, 16%), and Tetralogy of Fallot (N=20, 12%), but CHD type did not differ significantly between groups. Of those with normal UA Doppler assessment, 14% (21/154) had an adverse perinatal outcome (defined as fetal demise, neonatal demise, or infant death) compared to 24% (4/17) with abnormal UA Doppler assessment (p=.28, Table 2). We describe UA Doppler and adverse perinatal outcomes in a cohort of normally grown, euploid singleton fetuses with CHD. We did not find a statistically significant difference when comparing those with normal versus abnormal UA Doppler assessment. UA Doppler assessment alone is unlikely to predict adverse perinatal outcome in fetuses with CHD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prediction of Adverse Perinatal Outcomes and Preeclampsia in Pregnant Women with Chronic Arterial Hypertension

The objective of this study was to determine predictors and develop a prognostic model for preeclampsia (PE) and adverse perinatal outcomes in pregnant women with chronic arterial hypertension (CAH). Methods and Results: The study cohort included pregnant women (n=376) with hypertensive disorders: Group 1 –pregnant women with CAH (n=134), Group 2 – with PE on the background of CAH (n=242). Healthy pregnant women made up the control group (n=34). The diagnosis of pregnant women with CAH was made on the basis of existing national and foreign recommendations that an increase in SBP ≥140 mmHg and/or DBP ≥90 mmHg indicates CAH. All patients underwent the following examinations: a survey on a special questionnaire; an anthropometric examination; physical examination; an assessment of the content of uric acid (UA) in the blood serum and microalbuminuria (MAU) in the urine at 6-8 and 16-17 weeks of pregnancy; 12-lead ECG, echocardiography, 24-hour ambulatory blood pressure monitoring, sonography of the uterus, fetus, and placenta at 6-8 and 16-18 weeks. It was found that an inappropriate left ventricular mass (LVM) in pregnant women with CAH, a certain “phenotype” of 24-hour ABPM and indicators of metabolic disorders demonstrate the systemic nature of organ damage and appear to be a predictor of adverse perinatal outcomes and the development of PE. The revealed changes in the LV structure, which are more significant in PE on the background of CAH, suggest the association of concentric left ventricular hypertrophy and disorders of uteroplacental blood flow. Detecting abnormal blood flow from early pregnancy will reduce not only perinatal morbidity and premature birth, but also the probability of organ (LV myocardium, kidney) damage in women with CAH. To predict the risks of adverse perinatal outcomes in pregnant women with CAH and PE, a number of factors were identified that have a statistically significant relationship with the studied complications. The developed model makes it possible to predict the probability of PE and unfavorable perinatal outcomes in pregnant women suffering from CAH with high efficiency (91.1%).

Which is the best ultrasound parameter for the prediction of adverse perinatal outcome within 1 day of delivery?

Objective To compare the accuracies of several sonographic parameters for the prediction of adverse perinatal outcome (APO) prior to delivery. Methods This was a prospective study of fetuses attending the day hospital unit of a tertiary referral hospital that were scanned at 34-41 weeks and gave birth within 24 h of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH < 7.20 requiring urgent cesarean section, neonatal umbilical cord pH < 7.10, 5’ Apgar score <7 and postpartum admission to neonatal or pediatric intensive care units. The accuracies of the middle cerebral, vertebral and umbilical arteries pulsatility index multiples of the median (MoM), the cerebroplacental and vertebroplacental ratios MoM and the EFW in centiles for the prediction of APO was evaluated by means of ROC curves and logistic regression analysis. Results A total of 2140 fetuses were prospectively scanned, however only 182 entered into spontaneous or induced labor and were delivered within 24 h of examination. In this group, MCA PI MoM was the best predictor of APO (AUC = 0.76, 95% CI 0.66–0.85, p < .0001) followed by the CPR MoM (AUC = 0.73, 95% CI 0.63–0.84, p < .0001) and the VPR MoM (AUC = 0.71, 95% CI 0.61–0.81, p < .001). Logistic regression analysis indicated that MCA PI MoM was the only independent determinant for the prediction of APO. Conclusion In a high-risk population of third-trimester fetuses delivering within 24 h of examination, the outcome may be moderately anticipated just with the information provided by the cerebral flow.

Adverse Perinatal Outcomes Among Grand Multiparous and Low Multiparous Women and Its Associated Factors in North Shewa Zone Public Hospitals: The Role of Parity.

BackgroundAdverse perinatal outcomes are the major cause of neonatal morbidity, mortality, and long-term physical and psychological consequences. Contradicting evidence across studies was reported about the impact of grand multiparity on adverse perinatal outcomes. Older literature reported increased incidence of perinatal complications in grand multiparas, but, recent reports failed to support this finding. In addition, there is a paucity of comparative studies on perinatal outcomes. Thus, the study aimed to compare the perinatal outcomes in grand multiparous (GM) and low multiparous (LM) women who give birth in North Shewa Zone Public Hospitals, Ethiopia, 2021.MethodsA comparative cross-sectional study was done among 540 (180 GM and 360 LM) women from January 1 to March 30, 2021. The data were collected using a structured and pre-tested questionnaire through interviews and reviewing patient charts. SPSS version 25 was used for data analysis. The data were entered using Epi-Data version 4.6. The Hosmer–Lemeshow goodness-of-fit was applied to test for model fitness. The statistical significance level was declared at a p-value of ≤0.05.ResultsIn this study, the prevalence of adverse perinatal outcomes was 14.1% (95% CI: 10.9–17.2). Stillbirth/IUFD (33.3%) and low APGAR score (60%) were frequently occurred complications in grand multiparas. Nevertheless, meconium aspiration (26%), admission to NICU (65.2%), macrosomia (61%), and prematurity (52.2%) were higher in low multiparous women. Age above 35 years (AOR (CI) = 2.61 (1.23–5.53)), rural residence (AOR (CI) = 8.31 (3.05–22.6)), being a government employee (AOR (CI) = 0.19 (0.05–0.69)), lack of antenatal care (AOR (CI) = 9.76 (3.03–31.5)), and previous pregnancy complications (AOR (CI) = 3.10 (1.63–5.90)) were significant predictors of adverse perinatal outcomes. However, parity did not show a statistically significant association with perinatal outcomes.ConclusionMaternal age, residence, occupation, lack of antenatal care, and previous pregnancy complications were significant associates of perinatal outcome. There was no statistically significant difference in perinatal outcome between GM and LM women. Socio-economic development, good antenatal care, and early identification and treatment of complications are needed regardless of parity.

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.