Prescriptive Reference Standards of Third-Trimester Cerebroplacental Ratio and Its Physiological Determinants

Objective: To construct valid reference standards reflecting optimal cerebroplacental ratio and to explore its physiological determinants. Methods: A cohort of 391 low-risk pregnancies of singleton pregnancies of nonmalformed fetuses without maternal medical conditions and with normal perinatal outcomes was created. Doppler measurements of the middle cerebral artery and umbilical artery were performed at 24–42 weeks. Reference standards were produced, and the influence of physiological determinants was explored by nonparametric quantile regression. The derived standards were validated in a cohort of 200 low-risk pregnancies. Results: Maternal body mass index was significantly associated with the 5th centile of the cerebroplacental ratio. For each additional unit of body mass index, the 5th centile was on average 0.014 lower. The derived 5th, 10th, and 50th centiles selected in the validation cohort were 5, 9.5, and 51% of the measurements. Conclusions: This study provides methodologically sound prescriptive standards and suggests that maternal body mass index is a determinant of a cutoff commonly used for decision-making.

[1]  D J Torgerson,et al.  Pragmatic trials: lab meets bedside , 2019, The British journal of dermatology.

[2]  A. Papageorghiou,et al.  Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review , 2019, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[3]  D. Wright,et al.  Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio , 2019, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[4]  M. Heymans,et al.  Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis , 2018, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[5]  F. Figueras,et al.  Evidence‐based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy , 2018, American journal of obstetrics and gynecology.

[6]  E. Gratacós,et al.  Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol , 2017, BMJ Open.

[7]  T. Powell,et al.  Effects of maternal obesity on placental function and fetal development. , 2017, Reproduction.

[8]  Sailesh Kumar,et al.  Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. , 2017, Placenta.

[9]  C. Schalkwijk,et al.  Maternal diet, gestational weight gain, and inflammatory markers during pregnancy , 2016, Obesity.

[10]  A. Nassr,et al.  Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance , 2016, Journal of perinatal medicine.

[11]  A. Papageorghiou,et al.  Consensus definition of fetal growth restriction: a Delphi procedure , 2016, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[12]  N. Shvalb,et al.  The Effect of the Pressure Exerted on the Maternal Abdominal Wall by the US Probe on Fetal MCA Peak Systolic Velocity , 2015, Ultraschall in der Medizin - European Journal of Ultrasound.

[13]  K. Nicolaides,et al.  Fetal middle cerebral artery and umbilical artery pulsatility index: effects of maternal characteristics and medical history , 2015, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[14]  L. Sarno,et al.  Maternal body mass index influences umbilical artery Doppler velocimetry in physiologic pregnancies , 2015, Prenatal diagnosis.

[15]  A. Khalil,et al.  Doppler reference values of the fetal vertebral and middle cerebral arteries, at 19–41 weeks gestation , 2015, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[16]  G. Pilu,et al.  Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability , 2013, BJOG : an international journal of obstetrics and gynaecology.

[17]  K. Kalache,et al.  ISUOG Practice Guidelines: use of Doppler ultrasonography in obstetrics , 2013, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[18]  R. Cruz‐Martínez,et al.  Can anomalies of fetal brain circulation be useful in the management of growth restricted fetuses? , 2012, Prenatal diagnosis.

[19]  Francesc Figueras,et al.  Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. , 2011, American journal of obstetrics and gynecology.

[20]  T. Kiserud,et al.  Middle cerebral artery blood flow velocities and pulsatility index and the cerebroplacental pulsatility ratio: longitudinal reference ranges and terms for serial measurements , 2007, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[21]  J. Hanley,et al.  A method is presented to plan the required sample size when estimating regression-based reference limits. , 2007, Journal of clinical epidemiology.

[22]  R. Koenker,et al.  Quantile regression methods for reference growth charts , 2006, Statistics in medicine.

[23]  A. Baschat,et al.  The cerebroplacental Doppler ratio revisited , 2003, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[24]  R. Huch,et al.  Reference resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24–42 weeks of gestation , 1997, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[25]  J. Fleming,et al.  A CRITICAL EVALUATION OF SONAR “CROWN‐RUMP LENGTH” MEASUREMENTS , 1975, British journal of obstetrics and gynaecology.

[26]  J Figueras,et al.  Customized birthweight standards for a Spanish population. , 2008, European journal of obstetrics, gynecology, and reproductive biology.

[27]  D. Maulik,et al.  Assessment of the fetal PO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia. , 1995, Ultrasound in medicine & biology.