Prognostic Value of Cerebroplacental Ratio in Appropriate-for-Gestational-Age Fetuses Before Induction of Labor in Late-Term Pregnancies

Abstract

Purpose To evaluate the relationship between cerebroplacental ratio (CPR) and the need for operative delivery due to intrapartum fetal compromise (IFC) and adverse perinatal outcome (APO) in appropriate-for-gestational-age (AGA) late-term pregnancies undergoing induction of labor. The predictive performance of CPR was also assessed.

Materials and Methods Retrospective study including singleton AGA pregnancies that underwent elective induction of labor between 41 + 0 and 41 + 6 weeks and were delivered before 42 + 0 weeks. IFC was defined as persistent pathological CTG or pathological CTG and fetal scalp pH < 7.20. Operative delivery included instrumental vaginal delivery (IVD) and cesarean section (CS). APO was defined as a composite of umbilical artery pH < 7.20, Apgar score < 7 at 5 minutes, and admission to the neonatal intensive care unit for > 24 hours.

Results The study included 314 women with 32 (10 %) IVDs and 49 (16 %) CSs due to IFC and 85 (27 %) APO cases. Fetuses with CPR < 10^th percentile showed a significantly higher rate of operative delivery for IFC (40 % (21/52) vs. 23 % (60/262); p = 0.008) yet not a significantly higher rate of APO (31 % (16/52) vs. 26 % (69/262); p = 0.511). The predictive values of CPR for operative delivery due to IFC and APO showed sensitivities of 26 % and 19 %, specificities of 87 % and 84 %, positive LRs of 2.0 and 1.2, and negative LRs of 0.85 and 0.96, respectively.

Conclusion Low CPR in AGA late-term pregnancies undergoing elective induction of labor was associated with a higher risk of operative delivery for IFC without increasing the APO rate. However, the predictive value of CPR was poor.

Zusammenfassung

Ziel Auswertung der Assoziation zwischen cerebro-plazentarer Ratio (CPR) und Notwendigkeit einer operativen Entbindung wegen intrapartalem fetalem Distress (IFD) sowie schlechtem perinatalem Outcome bei normalgewichtigen Föten vor Einleitung bei Terminüberschreitung. Die prädiktive Aussagekraft der CPR wurde analysiert.

Material und Methode Retrospektive Studie von Einlingsgraviditäten, die zwischen 41 + 0 und 41 + 6 Schwangerschaftswochen eingeleitet wurden und vor 42 + 0 Schwangerschaftswochen entbunden wurden. IFD wurde als persistierend pathologisches CTG oder pathologisches CTG und Mikroblutuntersuchung < 7,20 definiert. Die operative Entbindung umfasste sowohl vaginal-operative Entbindungen als auch Sectio caesareas. Schlechtes perinatales Outcome wurde als das Vorhandensein eines Nabelschurarterie-pH-Wertes < 7,20, Apgar-Wertes < 7 nach 5 Minuten und/oder eine Aufnahme auf die Neugeborenenstation > 24 Stunden definiert.

Ergebnisse Insgesamt wurden 314 Gebärende eingeschlossen. Von denen hatten 32 (10 %) eine vaginal-operative Entbindung und 49 (16 %) Sectiones, jeweils wegen IFD, sowie 85 (27 %) ein schlechtes perinatales Outcome. Föten mit CPR < 10 Perzentile zeigten einen signifikant höheren Anteil an operativen Entbindungen (40 % (21/52) vs. 23 % (60/262); p = 0,008) sowie einen nicht signifikant höheren Anteil an schlechtem perinatalem Outcome (31 % (16/52) vs. 26 % (69/262); p = 0,511). Die Vorhersagekraft der CPR für operative Entbindung wegen IFD und schlechtes perinatales Outcome zeigte jeweils eine Sensitivität von 26 % und 19 %, eine Spezifität von 87 % und 84 %, ein positives Wahrscheinlichkeitsverhältnis von 2,0 und 1,2 und ein negatives Wahrscheinlichkeitsverhältnis von 0,85 und 0,96.

Schlussfolgerungen Eine niedrige CPR bei normalgewichtigen Föten vor elektiver Einleitung bei Terminüberschreitung war mit einem höheren Risiko für eine operative Entbindung wegen IFD assoziiert. Das Risiko eines schlechten perinatalen Outcomes war nicht signifikant erhöht. Die Vorhersagekraft der CPR war jedoch niedrig.

Key words

appropriate-for-gestational-age - late-term pregnancy - intrapartum fetal compromise - adverse perinatal outcome - cerebroplacental ratio

Publication History

Received: 20 May 2020

Accepted: 15 February 2021

Article published online:
31 May 2021

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