Magnitude of change in fetal cerebroplacental ratio in third trimester and risk of adverse pregnancy outcome

Flatley, C., Greer, R. M. and Kumar, S. (2017) Magnitude of change in fetal cerebroplacental ratio in third trimester and risk of adverse pregnancy outcome. Ultrasound in Obstetrics and Gynecology, 50 4: 514-519. doi:10.1002/uog.17371

Author Flatley, C.
Greer, R. M.
Kumar, S.
Title Magnitude of change in fetal cerebroplacental ratio in third trimester and risk of adverse pregnancy outcome
Journal name Ultrasound in Obstetrics and Gynecology   Check publisher's open access policy
ISSN 1469-0705
Publication date 2017-10-01
Year available 2017
Sub-type Article (original research)
DOI 10.1002/uog.17371
Open Access Status Not yet assessed
Volume 50
Issue 4
Start page 514
End page 519
Total pages 6
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 3614 Radiological and Ultrasound Technology
2743 Reproductive Medicine
2741 Radiology Nuclear Medicine and imaging
2729 Obstetrics and Gynaecology
Abstract Objectives: To evaluate whether the magnitude of change in the cerebroplacental ratio (CPR) after 30 weeks' gestation is a better predictor of adverse pregnancy outcome compared with a single CPR measurement at 35–37 weeks. A secondary aim was to evaluate whether the utility of CPR at 35–37 weeks was enhanced after adjusting for change in gestational age. Methods: This was a retrospective cohort study of women who had at least two ultrasound scans between 30 and 37 weeks' gestation, with the final scan at 35–37 weeks. Exclusion criteria were major congenital abnormality, aneuploidy, multiple pregnancy and unknown middle cerebral artery pulsatility index or umbilical artery pulsatility index. A normal reference range for CPR was derived from a separate cohort of women with normal outcome and a Generalised Additive Model for Location, Scale and Shape was fitted to derive standardized centiles. These reference centiles were then used to calculate Z-scores for the study cohort. Logistic regression models and receiver–operating characteristics (ROC) curves were used to evaluate the predictive utility of CPR Z-score at last CPR measurement and the change in CPR on mode of delivery, neonatal outcome and composite neonatal outcome. The area under the ROC curve (AUC) for each model was compared before and after adjustment for parity, hypertension, diabetes, body mass index and smoking status. Results: A total of 1860 women met the inclusion criteria. There was no association between the magnitude of change in CPR and composite adverse pregnancy outcome (P = 0.92). Of the outcomes that made up the composite, an increase in CPR Z-score over time was associated with a lower risk for emergency Cesarean delivery (P < 0.001) and emergency Cesarean delivery for non-reassuring fetal status (P = 0.02). It was also associated with a lower risk of birth weight < 10 centile (P = 0.01) and hypoglycemia (P = 0.001). There was no significant difference between the AUCs of last CPR Z-score and last CPR Z-score adjusted for the change in gestational age in predicting pregnancies at risk for adverse outcome. Conclusions: Our results suggest that both the individual CPR Z-score and the magnitude and direction of change in CPR Z-score can identify pregnancies at risk of various adverse perinatal outcomes. However, the CPR Z-score at 35–37 weeks' gestation appears to be a better predictor. Copyright
Keyword adverse perinatal outcome
cerebroplacental ratio
Cesarean section
fetal 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)
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Created: Wed, 01 Nov 2017, 10:43:46 EST by Johanna Barclay on behalf of Mater Research Institute-UQ