Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome

Bligh, Larissa N., Alsolai, Amal A., Greer, Ristan M. and Kumar, Sailesh (2017) Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome. Ultrasound in Obstetrics and Gynecology, . doi:10.1002/uog.17542


Author Bligh, Larissa N.
Alsolai, Amal A.
Greer, Ristan M.
Kumar, Sailesh
Title Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome
Journal name Ultrasound in Obstetrics and Gynecology   Check publisher's open access policy
ISSN 1469-0705
0960-7692
Publication date 2017-06-08
Year available 2017
Sub-type Article (original research)
DOI 10.1002/uog.17542
Open Access Status Not yet assessed
Total pages 25
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley & Sons
Language eng
Abstract Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to prospectively evaluate the screening performance of the CPR 10(th) centile for detection of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) in low-risk women from 36 weeks and to determine the best CPR threshold from three previously described in the literature.

In a blinded, prospective, observational, cohort study, 483 women with uncomplicated singleton pregnancies underwent fortnightly CPR measurement from 36 weeks to delivery and intrapartum and neonatal outcomes were recorded. The CPR 10(th) centile threshold screening test performance was calculated for emergency Cesarean section for IFC and composite ANO, incorporating acidosis at birth, Apgar <7 at five minutes or admission to the neonatal intensive care unit. Screening performance evaluation of three previously reported CPR thresholds, CPR ≤1, CPR <5th centile and CPR <10th centile, was also undertaken for these specified outcomes.

Four hundred and fifty eight women were included in the analysis, of which 4.1% had an emergency Cesarean section for IFC and 17.9% had a composite ANO. Sensitivity and specificity for CPR <10th centile were 55.6% and 87.9%, and 28.2% and 88.0%, for Cesarean section IFC and composite ANO, respectively. Comparing the three CPR thresholds, CPR <10(th) centile resulted in the best overall test performance (Cesarean section for IFC area under the receiver operating characteristic curve = 0.72, composite ANO area under the receiver operating characteristic curve = 0.58), although its predictive utility was only fair for Cesarean section for IFC and poor for composite ANO.

The CPR 10(th) centile may be useful as a component of a risk assessment tool for Cesarean section for IFC in low risk pregnancies at term.
Keyword Adverse neonatal outcome
Cerebroplacental ratio
Cerebroumbilical ratio
Cesarean section
Fetal compromise
Hypoxia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
HERDC Pre-Audit
School of Biomedical Sciences Publications
School of Medicine Publications
 
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Created: Wed, 01 Nov 2017, 10:39:34 EST by Johanna Barclay on behalf of Mater Research Institute-UQ