Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction

Abstract

The purpose of this study was to determine whether gestational age-specific levels of the cerebroplacental ratio (CPR) as a third-trimester ultrasound marker has benefits in the prediction of perinatal morbidity and mortality on foetuses with late-onset foetal growth restriction (FGR). A retrospective study of singleton pregnancies diagnosed with late-onset FGR was performed. Of 407 pregnancies meeting our inclusion criteria, 313 had normal (Group 1) and 94 had abnormal CPR (Group 2). Both groups were similar in age, gestational age at diagnosis, body mass index and parity. There was a significant association between the presence of oligohydramnios and abnormal CPR. Mean gestational age at delivery and mean neonatal birth weight were significantly lower in Group 2. Neonatal intensive care unit admission, foetal distress, low 5–minute Apgar score <7, and low cord pH < 7.1 rates were significantly higher in Group 2. There was one neonatal death in both groups. Multivariable regression analysis demonstrated that, in the prediction of APO, there was a significant contribution from neonatal birth weight <10th percentile, CPR <5th percentile and oligohydramniosis. Our findings revealed that CPR value less than 5th centile can be used as a predictor of APO in late-onset FGR.

IMPACT STATEMENT

• What is already known on this subject? Low cerebroplacetal ratio (CPR) is a marker of failure to reach the growth potential regardless of foetal weight.

• What do the results of this study add? The CPR can be used as an adequate predictor of adverse perinatal outcome in pregnancies with late-onset foetal growth restriction.

• What are the implications of these findings for clinical practice and/or further research? Routine calculation and report of CPR during basic ultrasound examination may help to identify foetuses with FR with a higher risk of adverse perinatal outcome. Future prospective studies on pregnancies with FGR with oligohydroamnios or normal amniotic fluid volume should focus on determining CPR threshold.

Keywords:

• Foetal growth restriction
• cerebroplacental ratio
• adverse outcomes
• Doppler sonography
• umbilical artery
• middle cerebral artery

Acknowledgments

The authors thank Elif Deveci for her assistance and cooperation.

Ethical approval

The Ethics Committee University of Health Science, Zeynep Kamil Women and Children's Diseases Training and Research Hospital approved the study protocol (Approval number: 29.4.20-74).

Disclosure statement

The authors have no conflicts of interest to declare.

Author contributions

Concept: OD, OK. Design: OK, OD, MEO. Materials: OD, AMCR, MA, ASO. Data collecting and processing: OK, HI, GED, AO. Analysis and interpretation: All authors. Literature search: OK, OD; AMCR, MA, HI, AO. Manuscript writing: OK, AO. Critical review: All authors. Approval of submission: All authors.