Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain.
Fetal Diagn Ther. 2022;49(4):196-205. doi: 10.1159/000525162. Epub 2022 Jun 7.
A controversy exists about the accuracy of the cerebroplacental ratio (CPR) for the prediction of cesarean section for intrapartum fetal compromise (CS-IFC). Our aim was to evaluate whether the interval to delivery modifies the accuracy of CPR either as a single marker or combined with estimated fetal weight centile (EFWc), type of labor onset (TLO), and other clinical variables.
This was a multicenter retrospective study of 5,193 women with singleton pregnancies who underwent an ultrasound scan at 35+0-41+0 weeks and gave birth within 1 month of examination, at any of the participating hospitals in Spain, UK, and Italy. CS-IFC was diagnosed in case of an abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20, requiring urgent cesarean section. The diagnostic ability of CPR in multiples of the median (CPR MoM) was evaluated at different intervals to delivery, alone and combined with EFWc, TLO, and other pregnancy data such as maternal age, maternal body mass index, parity, and fetal sex, for the prediction of CS-IFC by means of ROC curves and logistic regression analysis.
The predictive ability of CPR MoM for CS-IFC worsened with the interval to delivery. In general, the best prediction was obtained prior to labor and by adding information related to EFWc and TLO (AUC 0.71 [95% CI: 0.64-0.79], 0.73 [95% CI: 0.66-0.80], and 0.75 [95% CI: 0.69-0.81]; p < 0.0001). Addition of more clinical data did not improve prediction. In addition, results did not vary when only cases with spontaneous onset of labor were studied.
CPR MoM prediction of CS-IFC at the end of pregnancy worsens with the interval to delivery. Accordingly, it should be done in the short term and considering EFWc and TLO.
关于脑-胎盘比值（CPR）预测分娩时胎儿窘迫行剖宫产术（CS-IFC）的准确性存在争议。我们旨在评估分娩间隔是否会改变 CPR 的准确性，无论是作为单一标志物还是与估计胎儿体重百分位数（EFWc）、产程起始类型（TLO）和其他临床变量相结合。
这是一项多中心回顾性研究，纳入了 5193 名单胎妊娠女性，这些女性在 35+0-41+0 周时进行了超声检查，并在检查后 1 个月内在参与研究的西班牙、英国和意大利的任何一家医院分娩。如果出现异常的产时胎儿心率或产时胎儿头皮 pH 值<7.20，需要紧急行剖宫产术，则诊断为 CS-IFC。通过 ROC 曲线和逻辑回归分析，评估 CPR 中位数倍数（CPR MoM）在不同分娩间隔时单独以及与 EFWc、TLO 和其他妊娠数据（如母亲年龄、母亲 BMI、产次和胎儿性别）相结合对 CS-IFC 的预测能力。
CPR MoM 对 CS-IFC 的预测能力随着分娩间隔的延长而恶化。一般来说，在产程前和增加与 EFWc 和 TLO 相关的信息时，预测效果最佳（AUC 0.71[95%CI：0.64-0.79]、0.73[95%CI：0.66-0.80]和 0.75[95%CI：0.69-0.81]；p<0.0001）。增加更多的临床数据并不能改善预测效果。此外，仅研究自然临产的病例时，结果也没有差异。
CPR MoM 预测妊娠末期 CS-IFC 的准确性随着分娩间隔的延长而恶化。因此，应该在短期内进行，并考虑 EFWc 和 TLO。
