Value of third-trimester cerebroplacental ratio and uterine artery Doppler indices as predictors of stillbirth and perinatal loss.
OBJECTIVE
Placental insufficiency contributes to the risk of stillbirth. Cerebroplacental ratio (CPR) is an emerging marker of placental insufficiency. The aim of this study was to evaluate the association of third-trimester fetal CPR, uterine artery (UtA) Doppler and estimated fetal weight (EFW) with stillbirth and perinatal death.


METHODS
This was a retrospective cohort study including 2812 women with a singleton pregnancy who underwent an ultrasound scan in the third trimester. EFWs were converted into centiles, and Doppler indices (UtA and CPR) were converted into multiples of the median (MoM), adjusting for gestational age. Regression analysis was performed to identify, and adjust for, potential confounders, and receiver-operating characteristics (ROC) curve analysis was used to assess the predictive value.


RESULTS
When adjusting for EFW centile and UtA mean pulsatility index (UtA-PI) MoM, CPR-MoM remained an independent predictor of stillbirth (odds ratio (OR) = 0.003 (95% CI, 0.00-0.11), P = 0.003) and perinatal mortality (OR = 0.001 (95% CI, 0.00-0.03), P < 0.001). UtA-PI ≥ 1.5 MoM was significantly associated with low CPR-MoM, even after adjusting for EFW centile (OR = 5.22 (95% CI, 3.88-7.04), P < 0.001) or small-for-gestational age (SGA; OR = 4.73 (95% CI, 3.49-6.41), P < 0.001). These associations remained significant, even when excluding pregnancies with SGA or including only cases in which Doppler indices were recorded at term (P < 0.01). For prediction of stillbirth, the area under the ROC curve, using a combination of these three parameters, was 0.88 (95% CI, 0.77-0.99) with a sensitivity of 66.7%, specificity of 92.1%, positive likelihood ratio (LR) of 8.46 and negative LR of 0.36.


CONCLUSIONS
Third-trimester CPR is an independent predictor of stillbirth and perinatal mortality. The role of UtA Doppler, CPR and EFW in assessing risk of adverse pregnancy outcome should be evaluated prospectively.
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
A
A
Khalil
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
J
J
Morales-Roselló
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
R
R
Townsend
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
M
M
Morlando
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
A
A
Papageorghiou
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
A
A
Bhide
Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.
B
B
Thilaganathan
D000328:Adult; D015331:Cohort Studies; D005260:Female; D020567:Fetal Weight; D006801:Humans; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D066087:Perinatal Death; D010920:Placenta / Q000000981:diagnostic imaging; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011673:Pulsatile Flow; D012189:Retrospective Studies; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*; D055988:Uterine Artery / Q000000981:diagnostic imaging*
birth weight; cerebroplacental ratio; perinatal death; stillbirth; uterine artery Doppler