The Cerebro-placental-uterine Ratio at Gestational Age 28-32 Weeks in Predicting Small for Gestational Age among High-Risk Singleton Pregnancies
Article Sidebar
Main Article Content
Abstract
Objective: The primary aim of this study was to evaluate the performance of the cerebro-placental-uterine ratio (middle cerebral artery PI/umbilical artery PI/ mean uterine artery PI: CPUR) in predicting small for gestational age. The secondary aim was to evaluate pregnancy outcomes in high-risk pregnancies.
Material and Methods: This prospective cross-sectional study included 238 high risk singleton pregnancies at 28-32+6 weeks gestation. The participants received antenatal care and delivered at Rajavithi Hospital between January 2024 and November 2024. The estimated fetal weight (EFW), middle cerebral artery pulsatility index (MCA PI), umbilical artery pulsatility index (UAPI), and uterine artery pulsatility index (UtA PI) were obtained, and the cerebroplacental ratio (CPR) and CPUR were calculated. An adverse pregnancy outcome was defined as fetal small for gestational age(SGA), APGAR score at 5 minutes less than 7, stillbirth, NICU admission within 48 hours of life, preeclampsia, or preterm birth.
Results: Among the 238 non-consecutive pregnant women included in the study, 3.4% had fetuses that were small for gestational age, which constituted the primary outcome. The CPUR was highly reliable in predicting SGA (AUC = 0.827, 95% CI: 0.713–0.942, p = 0.002), a cutoff value of less than 2.355 yielded an sensitivity of 100%, a specificity of 55.7%, a positive predictive value (PPV) of 7.3%, and a negative predictive value (NPV) of 100%. CPUR showed a significant association with preterm delivery (including both early and late preterm). There was no correlation between CPUR and preeclampsia, stillbirth, NICU admission, and APGAR score at 5 minutes less than 7.
Conclusion: CPUR may be a novel indicator for predicting for SGA and preterm delivery in high risk pregnancies.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Nicolaides K, Rizzo G, Hecher K, Ximenes R. Doppler in Obstetrics. Diploma in Fetal Medicine& ISUOG Educational Series. The Fetal Medicine Foundation 2002
Maged AM, Waly M, AbdelHak A, Eissa TS, Osman NK . Correlation of Doppler velocimetry of uterine and umbilical arteries with placental pathology in pregnancy associated with intrauterine growth restriction. J Fetal Med 2019;6:7-16.
DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213:5-15.
Songsathaporn L, Puttanavijarn L, Sudjai D. Normative values of uterine artery Doppler pulsatility index using transvaginal ultrasound in women between 18-24+6 weeks of gestation at Rajavithi hospital. Thai J Obstet Gynaecol 2021;29:227-35
Clark AR, James JL. Stevenson GN, Collins SL. Understanding abnormal uterine artery Doppler waveforms: a novel computational model to explore potential caused within the utero-placental vasculature. Placenta 2015;36:848-52
MacDonald TM, Hui L, Robinson AJ, Dane KM, Middleton AL, Tong S, et al. Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2019;54:367-75.
Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev 2017;6:CD007529.
Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 2005;192:937-44.
Ebbing C, Rasmussen S, Kiserud T. Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements. Ultrasound Obstet Gynecol 2007;30:287-96.
Gomez O, Figueras F, Fernandez S, Bennasar M, Martinez JM, Puerto B, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008;32:128-32
Van den Hof MC, Smith FH, Colman I, Bly S, Johnson J Desilets V, et al. SOGC clinical practice guideline No.359 – The use and abuse of ultrasound in Obstetrics. J Obstet Gynaecol Can 2018;40:984-93.
Wayne WD. Biostatistics: A foundation of analysis in the health sciences. 6th ed New York: John Wiley and Sons 1995
Chate SU, Metgud CS. Pregnancy outcome among high-risk pregnant women in the rural area of Belagavi. J Family Med Prim Care 2022;11:4440-6.
Messawa M, Ma’ajeni E, Daghistani MH, Ayaz A, Farooq MU. The role of Doppler ultrasound in high risk pregnancy: a comparative study. Niger Med J 2012;53:116-20.
Todumrong N, Charoenvidhya D, Uerpairojkit B. Use of placental pulsatility indec in high risk pregnancy to predict fetal growth restriction. Thai J Obstet Gynaecol 2022;30:68-75.
Majmundar S, Gandhi MR , Upadhyay A, Thakkar S, Vidhani D. Prospective study of umbilical and uterine artery Doppler in predicting pregnancy outcome in high-Risk pregnancies. J Cardiovasc Dis Res 2024;15.
Colella M, Frerot A, Novais ARB, Baud O. Neonatal and long term consequences of fetal growth restriction. Curr Pediatr Rev 2018;14:212-8.
Graupner O, Meister M, Lecker L, Karim-Payab S, Franz C, Carow J, et al. Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term. Arch Gynecol Obstet 2023;308:849-55.
Niroomanesh S, Golshahi F, Hessami K, Saleh M, Salari Z, Sahebdel B,et al. Predictive role of Doppler indices of cerebral-placental-uterine ratio and umbilico-cerebral ratio for late-onset fetal growth restriction: a prospective cohort study. J Obstet Gynaecol 2022;42:1882-8.
Smith A, Flatley C, Kumar S. The risk of preterm birth associated with a low cerebroplacental ratio. J Matern Fetal Neonatal Med 2019;32:610-6.
