Department of Obstetrics and Gynecology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße, 30 52074, Aachen, Germany.
Department of Obstetrics and Gynecology, University Hospital Rechts Der Isar, Technical University, Munich, Germany.
Arch Gynecol Obstet. 2023 Sep;308(3):849-855. doi: 10.1007/s00404-022-06733-8. Epub 2022 Aug 30.
The cerebroplacental ratio (CPR) is associated with adverse perinatal outcome (APO) in low-risk pregnancies near term. A Doppler parameter, which also includes information from the uterine vessels could potentially improve detection of subclinical placental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR) related to APO prediction in low-risk term pregnancies in > 40 + 0 weeks.
This is a retrospective cohort study. All low-risk pregnancies in which feto-maternal Doppler was examined from 40 + 0 weeks and an appropriate for gestational age fetus was present were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min APGAR ≤ 7.
A total of n = 114 cases were included. Mean gestational age at examination and delivery were 40 + 3 weeks and 40 + 6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC = 0.67, p = 0.004) and CPR (AUC = 0.68, p = 0.002) with CAPO. Additionally, CPUR (AUC = 0.64, p = 0.040) showed a predictive value for OD due to IFC.
The CPUR in > 40 + 0 weeks showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies. However, the extent to which CPUR can be used to optimize delivery management warrants further investigations in prospective interventional studies.
在接近足月的低危妊娠中，脑胎盘比（CPR）与不良围产期结局（APO）相关。一种多普勒参数，它还包括来自子宫血管的信息，有可能改善对亚临床胎盘功能障碍的检测。本研究的目的是探讨在>40+0 周的低危足月妊娠中与 APO 预测相关的脑-胎盘-子宫比（CPUR）的性能。
这是一项回顾性队列研究。所有在 40+0 周时进行胎儿-产妇多普勒检查且存在适当胎龄胎儿的低危妊娠均被纳入研究。进行了 ROC（受试者工作特征曲线）分析以评估 CPUR 的预测价值。至少存在以下一种结局参数被定义为复合 APO（CAPO）：因产时胎儿窘迫（IFC）而行剖宫产术（OD）、新生儿重症监护病房入院、脐动脉 pH 值≤7.15、5 分钟 Apgar 评分≤7。
共纳入 n=114 例病例。检查和分娩时的平均孕周分别为 40+3 周和 40+6 周。总体而言，114 例中有 38 例（33.3%）发生 CAPO。ROC 分析显示 CPUR（AUC=0.67，p=0.004）和 CPR（AUC=0.68，p=0.002）与 CAPO 有显著相关性。此外，CPUR（AUC=0.64，p=0.040）对 IFC 所致 OD 具有预测价值。
在>40+0 周时的 CPUR 对低危妊娠中的 CAPO 和 IFC 所致 OD 具有预测价值。然而，CPUR 在多大程度上可以用于优化分娩管理，需要进一步在前瞻性干预研究中进行研究。
