Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia.
Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
Ultrasound Obstet Gynecol. 2018 Dec;52(6):750-756. doi: 10.1002/uog.18981.
To determine the screening performance of low fetal cerebroplacental ratio (CPR), a marker of fetal adaptation to suboptimal growth, and maternal placental growth factor (PlGF) level, both in isolation and in combination, for the prediction of Cesarean section (CS) for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (CANO).
This was a prospective cohort study in low-risk women with uncomplicated singleton pregnancy from 36 weeks' gestation to delivery. CPR and PlGF were assessed fortnightly and intrapartum and neonatal outcomes were recorded. CPR and PlGF values from the final assessment for each woman were corrected for gestational age and assessed for screening performance, firstly as continuous variables and then as binary predictors.
Of the 264 women who consented to participate in the study, 207 were included in the final analysis. Seven pregnancies required CS for IFC and 38 had CANO. Pregnancies delivered by CS for IFC had lower CPR and PlGF centiles than those in all other pregnancies. Pregnancies with CANO had a lower PlGF centile. The greatest areas under the receiver-operating characteristics curves (AUCs) for the prediction of CS for IFC (0.92; 95% CI, 0.86-0.97) and CANO (0.64; 95% CI, 0.54-0.74) were achieved by a combination of CPR 20 and PlGF 33 centile thresholds. This produced sensitivities, specificities and positive likelihood ratios for the prediction of CS for IFC of 100%, 86% and 7.14, respectively, and 34.2%, 87.0% and 2.63, respectively, for the prediction of CANO. There was no statistical difference in the AUC for CS for IFC between the combined model and when CPR was used alone, or for CANO between the combined model and CPR or PlGF in isolation.
This pilot proof-of-concept study describes the screening performance of CPR and maternal PlGF level for CS for IFC in low-risk women from 36 weeks' gestation. It was found that CPR and maternal PlGF improved the overall predictive utility for CS for IFC, as well as that for CANO. However, given the lack of significant difference between the combined model and its individual components, it is debatable whether the combined model is a superior screening test. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
评估胎儿脑胎盘比（CPR）和胎盘生长因子（PlGF）这两个胎儿适应不良生长的标志物，在预测因产时胎儿窘迫行剖宫产术（CS）和复合不良新生儿结局（CANO）方面的筛查性能，以及单独和联合使用时的筛查性能。
这是一项前瞻性队列研究，纳入了 36 孕周至分娩的低危、单胎妊娠的女性。每两周评估一次 CPR 和 PlGF，并记录产时和新生儿结局。对每位女性的最后一次评估的 CPR 和 PlGF 值进行了校正，以反映其胎龄，并评估了其作为连续变量和二分类预测指标的筛查性能。
在 264 名同意参与研究的女性中，有 207 名被纳入最终分析。7 例妊娠因产时胎儿窘迫而行 CS，38 例发生复合不良新生儿结局。因产时胎儿窘迫而行 CS 的妊娠，其 CPR 和 PlGF 百分位数均低于其他所有妊娠。发生复合不良新生儿结局的妊娠，其 PlGF 百分位数较低。预测因产时胎儿窘迫行 CS 的最佳受试者工作特征曲线（ROC）曲线下面积（AUC）为 0.92（95%CI，0.86-0.97），预测复合不良新生儿结局的最佳 AUC 为 0.64（95%CI，0.54-0.74），两者均为 CPR 20 与 PlGF 33 百分位界值的联合。由此得出，预测因产时胎儿窘迫行 CS 的敏感性、特异性和阳性似然比分别为 100%、86%和 7.14，预测复合不良新生儿结局的敏感性、特异性和阳性似然比分别为 34.2%、87.0%和 2.63。预测因产时胎儿窘迫行 CS 时，联合模型与单独使用 CPR 的 AUC 之间无统计学差异，预测复合不良新生儿结局时，联合模型与单独使用 CPR 或 PlGF 的 AUC 之间也无统计学差异。
本预试验概念验证研究描述了在 36 孕周时，低危女性的 CPR 和母血 PlGF 水平在预测因产时胎儿窘迫行 CS 方面的筛查性能。研究发现，CPR 和母血 PlGF 提高了预测因产时胎儿窘迫行 CS 的整体预测能力，对预测复合不良新生儿结局也有帮助。然而，鉴于联合模型与其各组成部分之间无显著差异，联合模型是否为一种更优的筛查试验仍存在争议。
