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Martin-Alonso R, Rolle V, Akolekar R, de Paco Matallana C, Fernández-Buhigas I, Sánchez-Camps MI, Giacchino T, Rodríguez-Fernández M, Blanco-Carnero JE, Santacruz B, Gil MM. Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1670. [PMID: 37763790 PMCID: PMC10535994 DOI: 10.3390/medicina59091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.
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Affiliation(s)
- Raquel Martin-Alonso
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Valeria Rolle
- Statistics and Data Management Unit, iMaterna Foundation, Alcalá de Henares, 28806 Madrid, Spain
- Facultad de Estudios Estadísticos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham M75NY, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Chatham CT11QU, UK
| | - Catalina de Paco Matallana
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, 30120 Murcia, Spain
| | - Irene Fernández-Buhigas
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
| | | | - Tara Giacchino
- Facultad de Estudios Estadísticos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Miguel Rodríguez-Fernández
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
| | | | - Belén Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - María M. Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, 28850 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
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Graupner O, Meister M, Lecker L, Karim-Payab S, Franz C, Carow J, Enzensberger C. Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term. Arch Gynecol Obstet 2022:10.1007/s00404-022-06733-8. [PMID: 36038657 DOI: 10.1007/s00404-022-06733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The cerebroplacental ratio (CPR) is associated with adverse perinatal outcome (APO) in low-risk pregnancies near term. A Doppler parameter, which also includes information from the uterine vessels could potentially improve detection of subclinical placental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR) related to APO prediction in low-risk term pregnancies in > 40 + 0 weeks. METHODS This is a retrospective cohort study. All low-risk pregnancies in which feto-maternal Doppler was examined from 40 + 0 weeks and an appropriate for gestational age fetus was present were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min APGAR ≤ 7. RESULTS A total of n = 114 cases were included. Mean gestational age at examination and delivery were 40 + 3 weeks and 40 + 6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC = 0.67, p = 0.004) and CPR (AUC = 0.68, p = 0.002) with CAPO. Additionally, CPUR (AUC = 0.64, p = 0.040) showed a predictive value for OD due to IFC. CONCLUSION The CPUR in > 40 + 0 weeks showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies. However, the extent to which CPUR can be used to optimize delivery management warrants further investigations in prospective interventional studies.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany. .,Department of Obstetrics and Gynecology, University Hospital Rechts Der Isar, Technical University, Munich, Germany.
| | - Markus Meister
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Linda Lecker
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Sepideh Karim-Payab
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Cordula Franz
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Juliane Carow
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany
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