Cerebroplacental Ratio in The Prediction of Adverse Perinatlal Outcome in Postdte pregnancy - A prospective study

BACKGROUND: Postdate pregnancies are associated with increased risk of fetal and maternal morbidity and mortality. The cerebroplacental ratio (CPR) is emerging as an important non-invasive tool to assess fetal wellbeing and predict adverse outcome in high risk pregnancies. The aim of this report was to evaluate the value of Doppler CPR in predicting adverse pregnancy outcome in the setting. METHOD: This was a prospective study of 97 pregnant women from 40 weeks of gestation. Fetal Doppler evaluation of the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) were done and the CPR calculated as MCA-PI/UA-PI. The women were followed up until delivery the following data collected: the Apgar score, birth weight and information about SCBU admission.RESULT: The women were aged 19 – 41 years (mean 30.22±4.8years) and the pregnancies were at 40 – 41+3 weeks. The mean UA-PI, MCA-PI and CPR were 0.83 ±0.16, 1.15±0.19 and 1.42 ± 0.31, respectively. Abnormal UA-PI, MCA-PI and CPR were associated with an increased risk of adverse perinatal outcome (relative risk of 4.72, 7.08 and 9.78 respectively). Abnormal UA-PI was associated with fetal distress, abnormal MCA-PI was associated with fetal distress, low Apgar score at 1minute and special care baby unit admission, and abnormal CPR was associated with fetal distress and low Apgar score at 1minute. CONCLUSION: CPR is a good predictor of adverse perinatal outcome in postdate pregnancy and is recommended as an adjunct in evaluation of fetal wellbeing in this setting and similar settings.

[1]  S. Yildirim,et al.  Fetal cerebral and cardiac hemodynamics in postdate pregnancy , 2019, 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.

[2]  Punya Bs,et al.  Study of post dated and term pregnancy with fetomaternal outcome at RRMCH , 2017 .

[3]  Parul T. Shah,et al.  Feto-maternal outcome in pregnancy beyond 40 weeks , 2017 .

[4]  Kate C. Arnold,et al.  Management of Late-Term and Postterm Pregnancies , 2017 .

[5]  P. Modi,et al.  A Study of Maternal and Fetal Outcome in Postdate Pregnancy , 2017 .

[6]  C. Bilardo,et al.  The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. , 2016, American journal of obstetrics and gynecology.

[7]  P. Bennett,et al.  Are fetuses that fail to achieve their growth potential at increased risk of intrapartum compromise? , 2015, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[8]  M. Ropacka-Lesiak,et al.  Cerebroplacental ratio in prediction of adverse perinatal outcome and fetal heart rate disturbances in uncomplicated pregnancy at 40 weeks and beyond , 2015, Archives of medical science : AMS.

[9]  G. Bassey,et al.  Comparison of 25 and 50 microgram of misoprostol for induction of labour in nulliparous women with postdate pregnancy in Port Harcourt. , 2015, Nigerian journal of clinical practice.

[10]  A. Maged,et al.  Fetal middle cerebral and umbilical artery Doppler after 40 weeks gestational age , 2014, 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.

[11]  M. Zugaib,et al.  Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency. , 2013, Revista da Associacao Medica Brasileira.

[12]  El-Sokkary.  Ratio of Middle Cerebral Artery / Umbilical Artery Doppler Velocimetry and Status of Newborn in Postterm Pregnancy , 2011 .

[13]  Yi-Yung Chen,et al.  The effects of absent or reversed end-diastolic umbilical artery Doppler flow velocity. , 2009, Taiwanese journal of obstetrics & gynecology.

[14]  I. Sanusi,et al.  Methods of induction of labour at the University of Maiduguri Teaching Hospital, Maiduguri: a 4-year review. , 2008, Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria.

[15]  G. Usha,et al.  Value of middle cerebral artery to umbilical artery ratio by doppler velocimetry in pregnancies beyond term , 2006 .

[16]  T. Lao,et al.  The use of fetal Doppler cerebroplacental blood flow and amniotic fluid volume measurement in the surveillance of postdated pregnancies , 2005, Acta obstetricia et gynecologica Scandinavica.

[17]  S. Yalti,et al.  Ratio of middle cerebral to umbilical artery blood velocity in preeclamptic & hypertensive women in the prediction of poor perinatal outcome. , 2004, The Indian journal of medical research.

[18]  S. Yagel,et al.  Post-term pregnancies with normal cardiotocographs and amniotic fluid columns: the role of Doppler evaluation in predicting perinatal outcome. , 1994, European journal of obstetrics, gynecology, and reproductive biology.

[19]  S. Sellers,et al.  Fetal cerebral Doppler in the recognition of fetal compromise , 1993, British journal of obstetrics and gynaecology.

[20]  H. S. Brar,et al.  Cerebral, umbilical, and uterine resistance using Doppler velocimetry in postterm pregnancy. , 1989, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[21]  J. Hauth,et al.  Post-Term Pregnancy. I , 1980, Obstetrics and gynecology.