Exploratory Fetal Doppler Thresholds for Predicting Composite Fetal Compromise in Preeclampsia: A Single-Centre Prospective Diagnostic Accuracy Study
DOI:
https://doi.org/10.33192/smj.v78i9.281484Keywords:
Preeclampsia, Cerebroplacental ratio, Doppler ultrasonography, Fetal distres, Adverse perinatal outcome, Umbilical artery, Middle cerebral artery, Diagnostic accuracyAbstract
Objective: To assess the diagnostic accuracy of umbilical artery (UA), middle cerebral artery (MCA), and cerebroplacental ratio (CPR) Doppler indices for composite fetal compromise in preeclampsia and derive exploratory cut-offs.
Materials and Methods: This prospective study included 77 women with preeclampsia at one Vietnamese centre (June 2021–June 2023). UA and MCA Doppler were performed within 48 hours before delivery; CPR was MCA pulsatility index divided by UA pulsatility index. The prespecified reference standard was at least one of category III cardiotocography (CTG), thick meconium-stained amniotic fluid, or umbilical arterial pH <7.10. CTG classification was blinded, ascertainment was complete, and delivery decisions did not use Doppler thresholds. Analyses were prespecified for <37 and ≥37 weeks. Cut-offs maximised the Youden index; optimism was assessed using 2,000 bootstrap replicates, and gestational-age interaction was tested.
Results: Fetal compromise occurred in 35/77 women (45.5%): 18/40 before 37 weeks and 17/37 thereafter. All components were strictly nested; thus, the composite identified the same 35 women as category III CTG. Cord acidaemia occurred in five women, all before 37 weeks. CPR provided the best discrimination (AUC 0.78; 95% CI 0.65–0.87). CPR <1.10 yielded 74.3% sensitivity and 78.6% specificity, decreasing to 71.3% and 76.5% after optimism correction. Gestational-age interactions were non-significant (p=0.22 and p=0.46), but stratum-specific thresholds differed (<1.08 versus <1.22); gestational-age independence was not established.
Conclusion: CPR outperformed single-vessel indices, but estimates were imprecise and internally derived. These thresholds are hypothesis-generating and require external validation before clinical use.
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