Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight

Angelo Sirico; Anke Diemert; Peter Glosemeyer; Kurt Hecher

doi:10.1002/uog.17458

Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight

Standard

Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight. / Sirico, Angelo; Diemert, Anke; Glosemeyer, Peter; Hecher, Kurt.

In: ULTRASOUND OBST GYN, Vol. 51, No. 3, 03.2018, p. 381-386.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Sirico, A, Diemert, A, Glosemeyer, P & Hecher, K 2018, 'Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight', ULTRASOUND OBST GYN, vol. 51, no. 3, pp. 381-386. https://doi.org/10.1002/uog.17458

APA

Sirico, A., Diemert, A., Glosemeyer, P., & Hecher, K. (2018). Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight. ULTRASOUND OBST GYN, 51(3), 381-386. https://doi.org/10.1002/uog.17458

Vancouver

Sirico A, Diemert A, Glosemeyer P, Hecher K. Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight. ULTRASOUND OBST GYN. 2018 Mar;51(3):381-386. https://doi.org/10.1002/uog.17458

Bibtex

@article{c2eb1c394eb846d9be5f280a73a07ac0,

title = "Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight",

abstract = "OBJECTIVES: To evaluate the relationship between cerebroplacental ratio (CPR) and estimated fetal weight (EFW) in low- and high-risk singleton pregnancies. Furthermore, we evaluated the role of CPR in the prediction of adverse perinatal outcome and whether CPR measurements adjusted for EFW improve its predictive value.METHODS: This was a retrospective cohort study including pregnancies in which Doppler investigations of umbilical artery (UA) and fetal middle cerebral artery (MCA) were performed at ≥ 30 weeks' gestation. Pregnancies were allocated to one of three groups according to EFW centile: small-for-gestational age (SGA) with EFW < 10th centile, appropriate-for-gestational age (AGA) and large-for-gestational age (LGA) with EFW > 90th centile. CPR was calculated as the ratio between the UA pulsatility index (PI) and MCA-PI and converted to CPR multiples of the median (MoMs) according to the three EFW groups. Linear regression analysis was performed to evaluate the relationship between CPR-MoMs and EFW centiles in low-risk pregnancies. Furthermore, MoMs of CPR adjusted according to EFW centile (aCPR-MoMs) were calculated. Adverse perinatal outcome was defined as presence of pathological cardiotocography (CTG) trace, arterial cord blood pH < 7.1, 5-min Apgar score < 7 and presence of meconium-stained amniotic fluid (MSAF).RESULTS: A total of 3515 (3016 low risk and 499 high risk) pregnancies, delivered between January 2010 and March 2016, were included. Linear regression analysis revealed a significant positive correlation between EFW centile and CPR-MoM. Receiver-operating characteristics (ROC) curve analysis showed a significant association between CPR-MoM and pathological CTG trace (AUC, 0.539; SD, 0.014; P = 0.005) and low Apgar score (AUC, 0.609; SD, 0.041; P = 0.008), but not with low arterial pH or MSAF. There was a significant association between aCPR-MoM and pathological CTG trace (AUC, 0.540; SD, 0.014; P = 0.003), low arterial cord blood pH (AUC, 0.546; SD, 0.022; P = 0.035) and low Apgar score (AUC, 0.609; SD, 0.044; P = 0.008), but not with MSAF. However, detection rates for adverse perinatal outcomes by CPR-MoM and aCPR-MoM were low, ranging from 6.7% to 28.6% for SGA, 12.1% to 22.2% for AGA and 0% to 33.3% for LGA, for a false-positive rate of 10%. In a subgroup analysis of cases in which ultrasound examination was performed at ≥ 34 weeks of gestation and within 4 weeks of delivery (n = 1439), the ROC curves for aCPR-MoM were significantly associated with all four outcomes evaluated.CONCLUSIONS: CPR-MoM values are dependent on EFW centiles; therefore, we suggest that CPR-MoM should be adjusted for EFW centile. However, both CPR- and aCPR-MoM showed a low prediction rate for adverse perinatal outcome. Copyright {\textcopyright} 2017 ISUOG. Published by John Wiley & Sons Ltd.",

keywords = "Journal Article",

author = "Angelo Sirico and Anke Diemert and Peter Glosemeyer and Kurt Hecher",

year = "2018",

month = mar,

doi = "10.1002/uog.17458",

language = "English",

volume = "51",

pages = "381--386",

journal = "ULTRASOUND OBST GYN",

issn = "0960-7692",

publisher = "John Wiley and Sons Ltd",

number = "3",

}

RIS

TY - JOUR

T1 - Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight

AU - Sirico, Angelo

AU - Diemert, Anke

AU - Glosemeyer, Peter

AU - Hecher, Kurt

PY - 2018/3

Y1 - 2018/3

N2 - OBJECTIVES: To evaluate the relationship between cerebroplacental ratio (CPR) and estimated fetal weight (EFW) in low- and high-risk singleton pregnancies. Furthermore, we evaluated the role of CPR in the prediction of adverse perinatal outcome and whether CPR measurements adjusted for EFW improve its predictive value.METHODS: This was a retrospective cohort study including pregnancies in which Doppler investigations of umbilical artery (UA) and fetal middle cerebral artery (MCA) were performed at ≥ 30 weeks' gestation. Pregnancies were allocated to one of three groups according to EFW centile: small-for-gestational age (SGA) with EFW < 10th centile, appropriate-for-gestational age (AGA) and large-for-gestational age (LGA) with EFW > 90th centile. CPR was calculated as the ratio between the UA pulsatility index (PI) and MCA-PI and converted to CPR multiples of the median (MoMs) according to the three EFW groups. Linear regression analysis was performed to evaluate the relationship between CPR-MoMs and EFW centiles in low-risk pregnancies. Furthermore, MoMs of CPR adjusted according to EFW centile (aCPR-MoMs) were calculated. Adverse perinatal outcome was defined as presence of pathological cardiotocography (CTG) trace, arterial cord blood pH < 7.1, 5-min Apgar score < 7 and presence of meconium-stained amniotic fluid (MSAF).RESULTS: A total of 3515 (3016 low risk and 499 high risk) pregnancies, delivered between January 2010 and March 2016, were included. Linear regression analysis revealed a significant positive correlation between EFW centile and CPR-MoM. Receiver-operating characteristics (ROC) curve analysis showed a significant association between CPR-MoM and pathological CTG trace (AUC, 0.539; SD, 0.014; P = 0.005) and low Apgar score (AUC, 0.609; SD, 0.041; P = 0.008), but not with low arterial pH or MSAF. There was a significant association between aCPR-MoM and pathological CTG trace (AUC, 0.540; SD, 0.014; P = 0.003), low arterial cord blood pH (AUC, 0.546; SD, 0.022; P = 0.035) and low Apgar score (AUC, 0.609; SD, 0.044; P = 0.008), but not with MSAF. However, detection rates for adverse perinatal outcomes by CPR-MoM and aCPR-MoM were low, ranging from 6.7% to 28.6% for SGA, 12.1% to 22.2% for AGA and 0% to 33.3% for LGA, for a false-positive rate of 10%. In a subgroup analysis of cases in which ultrasound examination was performed at ≥ 34 weeks of gestation and within 4 weeks of delivery (n = 1439), the ROC curves for aCPR-MoM were significantly associated with all four outcomes evaluated.CONCLUSIONS: CPR-MoM values are dependent on EFW centiles; therefore, we suggest that CPR-MoM should be adjusted for EFW centile. However, both CPR- and aCPR-MoM showed a low prediction rate for adverse perinatal outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

AB - OBJECTIVES: To evaluate the relationship between cerebroplacental ratio (CPR) and estimated fetal weight (EFW) in low- and high-risk singleton pregnancies. Furthermore, we evaluated the role of CPR in the prediction of adverse perinatal outcome and whether CPR measurements adjusted for EFW improve its predictive value.METHODS: This was a retrospective cohort study including pregnancies in which Doppler investigations of umbilical artery (UA) and fetal middle cerebral artery (MCA) were performed at ≥ 30 weeks' gestation. Pregnancies were allocated to one of three groups according to EFW centile: small-for-gestational age (SGA) with EFW < 10th centile, appropriate-for-gestational age (AGA) and large-for-gestational age (LGA) with EFW > 90th centile. CPR was calculated as the ratio between the UA pulsatility index (PI) and MCA-PI and converted to CPR multiples of the median (MoMs) according to the three EFW groups. Linear regression analysis was performed to evaluate the relationship between CPR-MoMs and EFW centiles in low-risk pregnancies. Furthermore, MoMs of CPR adjusted according to EFW centile (aCPR-MoMs) were calculated. Adverse perinatal outcome was defined as presence of pathological cardiotocography (CTG) trace, arterial cord blood pH < 7.1, 5-min Apgar score < 7 and presence of meconium-stained amniotic fluid (MSAF).RESULTS: A total of 3515 (3016 low risk and 499 high risk) pregnancies, delivered between January 2010 and March 2016, were included. Linear regression analysis revealed a significant positive correlation between EFW centile and CPR-MoM. Receiver-operating characteristics (ROC) curve analysis showed a significant association between CPR-MoM and pathological CTG trace (AUC, 0.539; SD, 0.014; P = 0.005) and low Apgar score (AUC, 0.609; SD, 0.041; P = 0.008), but not with low arterial pH or MSAF. There was a significant association between aCPR-MoM and pathological CTG trace (AUC, 0.540; SD, 0.014; P = 0.003), low arterial cord blood pH (AUC, 0.546; SD, 0.022; P = 0.035) and low Apgar score (AUC, 0.609; SD, 0.044; P = 0.008), but not with MSAF. However, detection rates for adverse perinatal outcomes by CPR-MoM and aCPR-MoM were low, ranging from 6.7% to 28.6% for SGA, 12.1% to 22.2% for AGA and 0% to 33.3% for LGA, for a false-positive rate of 10%. In a subgroup analysis of cases in which ultrasound examination was performed at ≥ 34 weeks of gestation and within 4 weeks of delivery (n = 1439), the ROC curves for aCPR-MoM were significantly associated with all four outcomes evaluated.CONCLUSIONS: CPR-MoM values are dependent on EFW centiles; therefore, we suggest that CPR-MoM should be adjusted for EFW centile. However, both CPR- and aCPR-MoM showed a low prediction rate for adverse perinatal outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

KW - Journal Article

U2 - 10.1002/uog.17458

DO - 10.1002/uog.17458

M3 - SCORING: Journal article

C2 - 28294442

VL - 51

SP - 381

EP - 386

JO - ULTRASOUND OBST GYN

JF - ULTRASOUND OBST GYN

SN - 0960-7692

IS - 3

ER -