Aim: The aim of our study was to check the appropriability of cerebroplacental ratio (CPR) measured within 48h before delivery in prediction of route of delivery and adverse neonatal outcomes.
Introduction: The cerebroplacental ratio is an important obstetric ultrasound tool used for assessment of foetal oxygenation. It is also a valuable predictor of adverse pregnancy outcomes. CPR is calculated by dividing the Doppler pulsatile indices of the middle cerebral artery (MCA) and the umbilical artery (UA).
Methods: The retrospective study included 1328 pregnant women who gave birth in Department of Obstetrics and Perinatology Jagiellonian University Medical College, Cracow, Poland. Main inclusion criteria were: singleton pregnancy and the interval between ultrasound examination and delivery within 48h. Exclusion criteria consisted: active labour, multiple pregnancy, preeclampsia, foetal growth restriction and evidence of intrauterine infection. CPR value lower than 1.08 was classified as pathological. Participants were divided into 2 groups: control (CPR≥1.08, n=1228) and study (CPR<1.08, n=100). The differences in socio-demographic factors between control and study group were not statistically significant. Data were analysed using chi-squared test, independent sample 2-tailed T-test and logistic regression. p value<0.05 was statistically significant.
Results: In study group was observed statistically significant increased risk of delivery provided by cesarean section (OR=1.8; p=0.015), preterm delivery (OR=2.91; p=0.0001), birth weight<2500g (OR=5.87; p<0.00001) and APGAR score<7 in 1st (OR=6.56; p<0.0001), 3rd (OR=7.04; p<0.0001) and 5th (OR=5.4; p=0.017) minute after delivery, compared to control group. Moreover, low CPR was associated with lower incidence of foetus birth weight within normal limits (OR=0.37; p<0.0001) and on-term delivery (OR=0.61; p<0.0001).
Conclusion: Detection of low value of CPR in every case should be alarming signal for obstetrician. Normal CPR appears to suggest better foetal tolerance to the stress of labour. CPR may be used to stratify the risk of pregnancy before labour.