Using estimated fetal weight and cerebroplacental ratio in predicting adverse neonatal outcome in late onset fetal growth restriction

Objective Late onset fetal growth restriction (FGR) with an estimated fetal weight (EFW) below the 10^th percentile are at risk for adverse neonatal outcome, yet clinical management remains a challenge. The cerebroplacental ratio (CPR) can be used to assess the fetal status, however, EFW itself is a predictor of potentially poor outcome. In our study, we examined prenatal paramaters EFW and CPR with regard to their predictive value in outcome of late onset FGR.

Methods In our retrospective study, we included fetuses that were first diagnosed as FGR after 34 weeks of gestation with EFW below the 10^th percentile. CPR was calculated as a ratio of middle cerebral artery and umbilical artery pulsatility indices. Receiver operating characteristic (ROC) curve analysis was used to describe the relationship between sensitivity and false-positive rate for EFW as well as CPR in predicting adverse neonatal outcome.

Results We included a total of 102 cases. Mean gestational age at FGR diagnosis was 36 weeks and FGR confirmed in 92%. A CPR below 1.4 and EFW below 2152g were the best cutoff values in determining adverse fetal outcome, respectively. However, when comparing EFW versus a CPR <  1.4, EFW was better in predicting adverse fetal outcome (p <  0.0001).

Conclusion A combination of EFW and CPR can be useful in determining the optimum time for delivery in order to minimize adverse fetal outcome. CPR should be used as an important additional diagnostic tool for clinical management of this group. Further studies are necessary to confirm our findings.

Publication History

Article published online:
07 October 2020