title: The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study.
abstract: OBJECTIVE
  The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR Study was to evaluate the optimal management of fetuses with an estimated fetal weight less than the 10th centile. The objective of this secondary analysis was to describe the role of the cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome.
  
  
  METHODS
  More than 1100 consecutive singleton pregnancies with intrauterine growth restriction (IUGR) were recruited over 2 years at 7 centers, undergoing serial sonographic evaluation including multivessel Doppler measurement. CPR was calculated using the pulsatility and resistance indices of the middle cerebral and umbilical artery. Adverse perinatal outcome was defined as a composite of intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death.
  
  
  RESULTS
  Data for CPR calculation was available in 881 cases, which was performed at a mean gestational age of 33 weeks (interquarile range, 28.7-35.9). Of the 146 cases with CPR less than 1, 18% (n = 27) had an adverse perinatal outcome. This conferred an 11-fold increased risk (odds ratio, 11.7; P < .0001) when compared with cases with normal CPR (2%; 14 of 735). An abnormal CPR was present in all 3 cases of mortality. Prediction of adverse outcomes was comparable when using all definitions of abnormal CPR.
  
  
  CONCLUSIONS
  Irrespective of the CPR calculation used, brain sparing is significantly associated with an adverse perinatal outcome in IUGR. This adds further weight to integrating CPR evaluation into the clinical assessment of IUGR pregnancies. The impact of this finding on long-term neurodevelopmental outcomes in this patient cohort is underway.
authors.affiliation: Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland. Electronic address: karenflood@rcsi.ie.
authors.forename: Karen
authors.initials: K
authors.lastname: Flood
authors.affiliation: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Julia
authors.initials: J
authors.lastname: Unterscheider
authors.affiliation: Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Daly
authors.affiliation: Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Geary
authors.affiliation: Department of Obstetrics and Gynecology, UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Mairead M
authors.initials: MM
authors.lastname: Kennelly
authors.affiliation: Department of Obstetrics and Gynecology, UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
authors.affiliation: Department of Obstetrics and Gynecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: Department of Obstetrics and Gynecology, Royal Jubilee Maternity Hospital, Belfast, Ireland.
authors.forename: Alyson
authors.initials: A
authors.lastname: Hunter
authors.affiliation: Department of Obstetrics and Gynecology, National University of Ireland, Galway, Ireland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Burke
authors.affiliation: Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dicker
authors.affiliation: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tully
authors.affiliation: Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D002302:Cardiac Output; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
keywords: brain sparing; cerebroplacental ratio; intrauterine growth restriction