Aiob Ala, Toma Ruba, Wolf Maya, Haddad Yosef, Odeh Marwan
Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 22100, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed 52000, Israel.
Eur J Obstet Gynecol Reprod Biol X. 2022 Mar 10;14:100146. doi: 10.1016/j.eurox.2022.100146. eCollection 2022 Apr.
To evaluate the effectiveness of the cerebroplacental ratio (CPR) in predicting poor outcomes in low-risk pregnancies with reduced fetal movements (RFMs).
This prospective study included singleton pregnancies at 28-40 weeks, presenting with RFM but no additional risk factors. Sub analysis was performed for pregnancies between 36 and 40 weeks. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured, and the MCA-PI to UA-PI ratio (CPR) was calculated. Mode of delivery, gestational age, fetal monitoring category, Apgar score at 1 and 5 min, birth weight, presence of meconium, umbilical artery pH, and neonatal intensive care unit (NICU) admission were recorded. Women with good and poor outcomes were compared with doppler indices and pregnancy characteristics.
Of 96 women, 86 had good outcomes. There was no significant difference in UA-PI (0.871 ± 0.171 vs. 0.815 ± 0.179, P = 0.446), MCA-PI (1.778 ± 0.343 vs. 1.685 ± 0.373, P = 0.309), or CPR (2.107 ± 0.635 vs. 2.09 ± 0.597, P = 0.993) between the poor and good outcome groups. No difference was found in the location of the placenta, biophysical profile (BPP) score, fetal sex, or amniotic fluid index (AFI) at the time of presentation. The proportion of nulliparous patients in the poor outcome group was higher than that of multiparous patients. Sub analysis for 36-40 weeks revealed the same results; no significant difference in UA-PI (0.840 ± 0.184 Vs 0.815 ± 0.195, P = 0.599), MCA-PI (1.724 ± 0.403 vs. 1.626 ± 0.382, P = 0.523), or CPR (2.14 ± 0.762 vs. 2.08 ± 0.655, P = 0.931) between poor and good outcome groups.
CPR is not predictive of neonatal outcome in low-risk pregnancies with RFM. However, a higher proportion of poor outcomes in nulliparous women warrants further investigation.
评估脑胎盘比率（CPR）在预测胎动减少（RFM）的低风险妊娠不良结局中的有效性。
这项前瞻性研究纳入了28至40周的单胎妊娠，这些妊娠有RFM但无其他风险因素。对36至40周的妊娠进行了亚组分析。测量脐动脉（UA）和大脑中动脉（MCA）搏动指数（PI），并计算MCA-PI与UA-PI的比值（CPR）。记录分娩方式、孕周、胎儿监护类别、1分钟和5分钟时的阿氏评分、出生体重、有无胎粪、脐动脉pH值以及新生儿重症监护病房（NICU）收治情况。将结局良好和不良的女性在多普勒指数和妊娠特征方面进行比较。
96名女性中，86名结局良好。不良结局组与良好结局组在UA-PI（0.871±0.171对0.815±0.179，P=0.446）、MCA-PI（1.778±0.343对1.685±0.373，P=0.309）或CPR（2.107±0.635对2.09±0.597，P=0.993）方面无显著差异。就诊时在胎盘位置、生物物理评分（BPP）、胎儿性别或羊水指数（AFI）方面未发现差异。不良结局组初产妇的比例高于经产妇。对36至40周的亚组分析得出相同结果；不良结局组与良好结局组在UA-PI（0.840±0.184对0.815±0.195，P=0.599）、MCA-PI（1.724±0.403对1.626±0.382，P=0.523）或CPR（2.14±0.762对2.08±0.655，P=0.931）方面无显著差异。
CPR不能预测有RFM的低风险妊娠的新生儿结局。然而，初产妇中不良结局比例较高值得进一步研究。
