title: Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study.
abstract: OBJECTIVE
  To investigate the use of the fetal cerebroumbilical ratio to predict intrapartum compromise in appropriately grown fetuses.
  
  
  METHODS
  A prospective observational study set at Queen Charlotte's and Chelsea hospital, London, UK. Fetal biometry and Doppler resistance indices were measured in 400 women immediately before established labor. Labor was then managed according to local protocols and guidelines, and intrapartum and neonatal outcome details recorded.
  
  
  RESULTS
  Infants delivered by cesarean section for fetal compromise had significantly lower cerebroumbilical ratios than those born by spontaneous vaginal delivery (1.52 vs 1.82, P ≤ .001). Infants with a cerebroumbilical ratio <10th percentile were 6 times more likely to be delivered by cesarean section for fetal compromise than those with a cerebroumbilical ratio ≥10th percentile (odds ratio, 6.1; 95% confidence interval, 3.03-12.75). A cerebroumbilical ratio >90th percentile appears protective of cesarean section for fetal compromise (negative predictive value 100%).
  
  
  CONCLUSIONS
  The fetal cerebroumbilical ratio can identify fetuses at high and low risk of a subsequent diagnosis of intrapartum compromise, and may be used to risk stratify pregnancies before labor.
authors.affiliation: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK.
authors.forename: Tomas
authors.initials: T
authors.lastname: Prior
authors.forename: Edward
authors.initials: E
authors.lastname: Mullins
authors.forename: Phillip
authors.initials: P
authors.lastname: Bennett
authors.forename: Sailesh
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000503:physiopathology*; D055815:Young Adult