Morales-Roselló, J; Bhate, R; Eltaweel, N; Khalil, A
(2023)
Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high-risk pregnancies before and after 34 weeks.
Acta Obstet Gynecol Scand, 102 (7).
pp. 891-904.
ISSN 1600-0412
https://doi.org/10.1111/aogs.14570
SGUL Authors: Khalil, Asma
Abstract
INTRODUCTION: The objective of the study was to compare the accuracy of the ductus venosus pulsatility index (DV PI) with that of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome at two gestational ages: <34 and ≥34 weeks' gestation. MATERIAL AND METHODS: This was a retrospective study of 169 high-risk pregnancies (72 < 34 and 97 ≥ 34 weeks) that underwent an ultrasound examination of CPR, DV Doppler and estimated fetal weight at 22-40 weeks. The CPR and DV PI were converted into multiples of the median, and the estimated fetal weight into centiles according to local references. Adverse perinatal outcome was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean delivery, 5' Apgar score <7, neonatal pH <7.10 and admission to neonatal intensive care unit. Values were plotted according to the interval to labor to evaluate progression of abnormal Doppler values, and their accuracy was evaluated at both gestational periods, alone and combined with clinical data, by means of univariable and multivariable models, using the Akaike information criteria (AIC) and the area under the curve (AUC). RESULTS: Prior to 34 weeks' gestation, DV PI was the latest parameter to become abnormal. However, it was a poor predictor of adverse perinatal outcome (AUC 0.56, 95% CI: 0.40-0.71, AIC 76.2, p > 0.05), and did not improve the predictive accuracy of CPR for adverse perinatal outcome (AUC 0.88, 95% CI: 0.79-0.97, AIC 52.9, p < 0.0001). After 34 weeks' gestation, the chronology of the DV PI and CPR anomalies overlapped, but again DV PI was a poor predictor for adverse perinatal outcome (AUC 0.62, 95% CI: 0.49-0.74, AIC 120.6, p > 0.05), that did not improve the CPR ability to predict adverse perinatal outcome (AUC 0.80, 95% CI: 0.67-0.92, AIC 106.8, p < 0.0001). The predictive accuracy of CPR prior to 34 weeks persisted when the gestational age at delivery was included in the model (AUC 0.91, 95% CI: 0.81-1.00, AIC 46.3, p < 0.0001, vs AUC 0.86, 95% CI: 0.72-1, AIC 56.1, p < 0.0001), and therefore was not determined by prematurity. CONCLUSIONS: CPR predicts adverse perinatal outcome better than DV PI, regardless of gestational age. Larger prospective studies are needed to delineate the role of ultrasound tools of fetal wellbeing assessment in predicting and preventing adverse perinatal outcome.
Item Type: |
Article
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Additional Information: |
© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
Keywords: |
adverse perinatal outcome, cerebroplacental ratio, ductus venosus Doppler, fetal Doppler, Pregnancy, Infant, Newborn, Female, Humans, Infant, Pregnancy Outcome, Pregnancy, High-Risk, Retrospective Studies, Fetal Weight, Ultrasonography, Prenatal, Ultrasonography, Doppler, Middle Cerebral Artery, Pulsatile Flow, Umbilical Arteries, Predictive Value of Tests, Middle Cerebral Artery, Umbilical Arteries, Humans, Fetal Weight, Ultrasonography, Doppler, Ultrasonography, Prenatal, Pregnancy Outcome, Retrospective Studies, Predictive Value of Tests, Pregnancy, Pregnancy, High-Risk, Pulsatile Flow, Infant, Infant, Newborn, Female, adverse perinatal outcome, cerebroplacental ratio, ductus venosus Doppler, fetal Doppler, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services, Obstetrics & Reproductive Medicine |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Acta Obstet Gynecol Scand |
ISSN: |
1600-0412 |
Language: |
eng |
Dates: |
Date | Event |
---|
10 July 2023 | Published | 12 May 2002 | Published Online | 21 March 2023 | Accepted |
|
Publisher License: |
Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 |
PubMed ID: |
37173867 |
Web of Science ID: |
WOS:000986365600001 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/115679 |
Publisher's version: |
https://doi.org/10.1111/aogs.14570 |
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