School of Biomedical Science, University of Queensland, St Lucia, Queensland, Australia.
Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
Ultrasound Obstet Gynecol. 2018 Sep;52(3):340-346. doi: 10.1002/uog.17542. Epub 2018 Aug 5.
Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to evaluate prospectively the screening performance of the CPR 10 centile threshold for prediction of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) after 36 weeks' gestation in low-risk women, and to compare this with CPR ≤ 1 and < 5 centile thresholds described previously in the literature.
This was a blinded, prospective, observational, cohort study of 483 women with uncomplicated singleton pregnancy who underwent fortnightly CPR measurements from 36 weeks to delivery, and their intrapartum and neonatal outcomes were recorded. The CPR 10 centile threshold screening performance was calculated for emergency Cesarean section for IFC and composite ANO (defined as acidosis at birth, 5-min Apgar score < 7 and/or admission to the neonatal intensive care unit). Comparison of screening performance of CPR ≤ 1 and < 5 and < 10 centile thresholds was also undertaken for these specified outcomes.
In total, 437 women were included in the analysis, of whom 4.1% had an emergency Cesarean section for IFC and 17.8% had a composite ANO. Sensitivity and specificity for CPR < 10 centile were, respectively, 55.6% and 87.9% for prediction of Cesarean section for IFC, and 28.2% and 88.0% for composite ANO. Compared with CPR ≤ 1 and < 5 centile, CPR < 10 centile yielded the best overall test performance for detection of Cesarean section for IFC and composite ANO, although its predictive value was only fair for Cesarean section for IFC (area under the receiver-operating characteristics curve (AUC) = 0.72) and poor for composite ANO (AUC = 0.58).
The CPR 10 centile threshold may be useful as a component of a risk assessment tool for Cesarean section for IFC in low-risk pregnancies at term. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
预测无并发症、足月妊娠中的产时胎儿窘迫是全球产科面临的挑战。目前，尚无被广泛接受的此类疾病筛查检测手段，尽管脑-胎盘比值（CPR）显示出一定的前景。我们旨在前瞻性评估 CPR 第 10 百分位界值预测剖宫产术治疗产时胎儿窘迫（IFC）和 36 孕周后复合不良新生儿结局（ANO）的筛查性能，并且与之前文献中描述的 CPR≤1 和<5 百分位界值进行比较。
这是一项盲法、前瞻性、观察性队列研究，纳入了 483 例无并发症的单胎妊娠妇女，她们从 36 孕周开始每两周进行一次 CPR 测量，直至分娩，并记录其产时和新生儿结局。计算了 CPR 第 10 百分位界值用于预测 IFC 和复合 ANO（定义为出生时酸中毒、5 分钟 Apgar 评分<7 分和/或转入新生儿重症监护病房）的紧急剖宫产术的筛查性能。还比较了 CPR≤1 和<5 和<10 百分位界值对这些特定结局的筛查性能。
共有 437 例妇女纳入分析，其中 4.1%因 IFC 行紧急剖宫产术，17.8%发生复合 ANO。CPR<10 百分位预测 IFC 剖宫产术的敏感性和特异性分别为 55.6%和 87.9%，预测复合 ANO 的敏感性和特异性分别为 28.2%和 88.0%。与 CPR≤1 和<5 百分位相比，CPR<10 百分位对检测 IFC 和复合 ANO 剖宫产术的整体检测性能最佳，尽管其对 IFC 剖宫产术的预测价值仅为中等（受试者工作特征曲线下面积（AUC）=0.72），对复合 ANO 的预测价值较差（AUC=0.58）。
CPR 第 10 百分位界值可能可作为低危足月妊娠 IFC 剖宫产术风险评估工具的组成部分。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
