Role of cerebroplacental ratio at 35 to 36 weeks of gestational age in prediction of perinatal out come in asymptomatic pregnant Indian women: a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263048Keywords:
Cerebroplacental ratio, Doppler ultrasonography, Foetal hypoxia, Perinatal outcome, NICU, Brain-sparing effectAbstract
Background: Foetal hypoxia and adverse perinatal outcomes remain significant challenges in obstetrics. The cerebroplacental ratio (CPR)-calculated as middle cerebral artery pulsatility index (MCA PI) divided by umbilical artery pulsatility index (UA-PI)-reflects both placental vascular resistance and brain-sparing foetal adaptation. This study evaluated the predictive value of CPR for adverse perinatal outcomes in low-risk pregnancies.
Methods: A prospective cohort study was conducted at Sparsh Hospital, Kannauj, from October 2024 to March 2026, enrolling 100 asymptomatic, low-risk singleton pregnant women at 35 to 36 weeks of gestation. Participants underwent Doppler ultrasonography to measure UA-PI, MCA PI, and CPR. Participants were followed prospectively to evaluate neonatal outcomes, including Apgar scores and Neonatal Intensive Care Unit (NICU) admissions. Spearman’s rho correlation was used for statistical analysis.
Results: The mean Apgar score was 9.41±1.61. Mean Doppler values were: UA-PI 1.00±0.334, MCA PI 1.49±0.513, and CPR 1.59±0.601. No statistically significant correlation was observed between Apgar scores and UA PI (rho=-0.058, p=0.568), MCA PI (rho=0.107, p=0.296), or CPR (rho=0.174, p=0.087). However, among 9 patients with CPR <1, 8 babies (88.9%) required NICU admission. Conversely, only 2 of the 91 patients with normal CPR required NICU admission.
Conclusions: Although Doppler indices showed no linear correlation with routine Apgar scores, a threshold of CPR <1 at 35-36 weeks was strongly associated with poor perinatal outcomes and NICU admission in low-risk pregnancies. CPR assessment enables early identification of vulnerable foetuses, supporting closer surveillance and timely delivery.
References
Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol. 1992;79(3):416-20.
Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol. 2003;21(2):124-7.
Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, et al. The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol. 1999;180(3 Pt 1):750-6.
Figueras F, Gratacos E. Stage-based approach to the management of fetal growth restriction. Prenat Diagn. 2014;34(7):655-9.
Khalil A, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, Thilaganathan B. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol. 2015;213(1):54.
Odibo AO, Riddick C, Pare E, Stamilio DM, Macones GA. Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: evaluating the impact of using gestational age-specific reference values. J Ultrasound Med. 2005;24(9):1223-8.
Bonnevier A, Maršál K, Brodszki J, Thuring A, Källén K. Cerebroplacental ratio as predictor of adverse perinatal outcome in the third trimester. Acta Obstet Gynecol Scand. 2020;100(3):497-503.
Ozeren M, Dinç H, Ekmen U, Senekayli C, Aydemir V. Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur J Obstet Gynecol Reprod Biol. 1999;82(1):11-6.
Alkmark M, Wennerholm U, Saltvedt S, Bergh C, Carlsson Y, Elden H, et al. Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: A cost-effectiveness analysis. BJOG. 2022;129(13):2157-65.
Keulen JK, Bruinsma A, Kortekaas JC, Dillen JV, Bossuyt PM, Oudijk MA, et al. Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): multicentre, randomised non-inferiority trial. BMJ. 2019:364:l344.
Hussain AA, Yakoob MY, Imdad A, Bhutta ZA. Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis. BMC Public Health. 2011;11(3):5.
Kaimal AJ, Little SE, Odibo AO, Stamilio DM, Grobman WA, Long EF, et al. Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. Am J Obstet Gynecol. 2011;204(2):137.
Lausman A, Kingdom J. How and when to recommend delivery of a growth-restricted fetus: A review. Best Pract Res Clin Obstet Gynaecol. 2021;77:119-28.
Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98.
Rabinovich A, Tsemach T, Novack L, Mazor M, Rafaeli-Yehudai T, Staretz-Chacham O, et al. Late preterm and early term: when to induce a growth restricted fetus? A population-based study. J Matern Fetal Neonatal Med. 2018;31(7):926-32.
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