Elmes Catherine, Phillips Rita
Royal United Hospital Foundation Trust Bath, Combe Park, UK.
HAS Allied Health Professions, University of the West of England Bristol, Bristol, UK.
Ultrasound. 2022 Aug;30(3):184-193. doi: 10.1177/1742271X211048213. Epub 2021 Oct 19.
The aim of this systematic review is to critically assess the efficacy of the cerebroplacental ratio performed in the third trimester at predicting adverse perinatal outcomes and reducing stillbirth rates.
The literature search was performed using CINAHL, EMBASE, EMCARE, MEDLINE and PubMed including systematic reviews, retrospective and prospective studies from inception until July 2020 utilising the PRISMA checklist and flowchart. Data displaying sensitivities, specificity and odds ratios (OR) to include 95% confidence interval (CI) were extracted and synthesised.
Initially, 1226 studies were identified, and nine studies met the inclusion criteria. Sample sizes ranged from 491 to 9772 pregnancies. The cerebroplacental ratio had the strongest diagnostic accuracy of all of the independent variables for detecting fetal demise (mean sensitivity and specificity; 79% and 78%). The cerebroplacental ratio, however, did not perform as favourably at predicting operative delivery (mean sensitivity and specificity; 59% and 82%) or anticipating admission to the neonatal intensive care unit (mean sensitivity and specificity; 55% and 74%).
The results from this study showed that the cerebroplacental ratio within third trimester pregnancies has been proven to have moderate to high diagnostic value when detecting adverse perinatal outcomes, in particular fetal demise.
Cerebroplacental ratio has the potential as a diagnostic tool to reduce adverse perinatal outcomes, in particular fetal demise and help reduce stillbirth rates. The main study limitation involved heterogeneity within the included studies, in particular with a regard to blinding.
本系统评价的目的是严格评估孕晚期进行的脑胎盘比值在预测围产期不良结局和降低死产率方面的有效性。
使用CINAHL、EMBASE、EMCARE、MEDLINE和PubMed进行文献检索，包括从创刊到2020年7月的系统评价、回顾性和前瞻性研究，采用PRISMA清单和流程图。提取并综合显示敏感性、特异性和比值比（OR）的数据，包括95%置信区间（CI）。
最初，共识别出1226项研究，其中9项研究符合纳入标准。样本量从491例到9772例妊娠不等。在所有独立变量中，脑胎盘比值在检测胎儿死亡方面具有最强的诊断准确性（平均敏感性和特异性分别为79%和78%）。然而，脑胎盘比值在预测手术分娩（平均敏感性和特异性分别为59%和82%）或预测新生儿重症监护病房入院方面表现不佳（平均敏感性和特异性分别为55%和74%）。
本研究结果表明，孕晚期妊娠的脑胎盘比值在检测围产期不良结局，尤其是胎儿死亡方面已被证明具有中度至高度诊断价值。
脑胎盘比值有潜力作为一种诊断工具，以减少围产期不良结局，特别是胎儿死亡，并有助于降低死产率。主要研究局限性在于纳入研究中的异质性，特别是在盲法方面。
