Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor

Journal article


Fiolna, M., Kostiv, V., Anthoulakis, C., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor. Ultrasound in Obstetrics and Gynecology. 53 (4), pp. 473-480.
AuthorsFiolna, M., Kostiv, V., Anthoulakis, C., Akolekar, R. and Nicolaides, K.H.
Abstract

Objective: To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 hours of induction of labor.

Methods: This was a prospective observational study in 1,902 singleton pregnancies undergoing induction of labor at ≥ 37 weeks’ gestation. Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) before induction of labor. The measured UA PI and MCA PI and their ratio were converted to multiples of the median (MoM) after adjustment for gestational age. Univariate and multivariate logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome that was provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for cesarean section for presumed fetal distress and neonatal adverse outcome, which included umbilical arterial or venous cord blood pH ≤7 and ≤7.1, respectively, 5-minute Apgar score <7, admission to the neonatal intensive care unit (NICU) for >24 hours, or hypoxic ischemic encephalopathy.

Results: A combination of maternal and pregnancy characteristics, including age, weight, racial origin, previous obstetric history, preeclampsia, gestational age at delivery and amniotic fluid volume, identified 39% of pregnancies requiring cesarean section for fetal distress at FPR of 10%; addition of CPR did not improve the performance of screening. In screening for adverse neonatal outcome by a combination of parity and CPR the DR was 17% at FPR of 10%.

Conclusion: Low CPR, measured within 24 hours of induction of labor, is associated with increased risk of cesarean section for fetal distress and adverse neonatal outcome, but the performance of CPR for such surrogates of adverse perinatal outcome is poor.

KeywordsInduction of labor; Cesarean section; Fetal distress; Doppler ultrasound; Cerebro-placental ratio; Adverse neonatal outcome
Year2019
JournalUltrasound in Obstetrics and Gynecology
Journal citation53 (4), pp. 473-480
PublisherJohn Wiley & Sons Ltd
ISSN1469-0705
0960-7692
Digital Object Identifier (DOI)doi:10.1002/uog.20173
Official URLhttp://doi.org/10.1002/uog.20173
Publication dates
Online13 Nov 2018
Online04 Mar 2019
PrintApr 2019
Publication process dates
Accepted01 Nov 2018
Deposited03 Jun 2020
Accepted author manuscript
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