Advanced Biomedical Research

Original Article: Predictive value of middle cerebral artery to umbilical artery pulsatility index ratio for neonatal outcomes in hypertensive disorders of pregnancy

Authors

Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Hypertension may lead to notifying adverse perinatal events that should be diagnosed and managed precisely. This study aims to investigate the values of cerebroplacental ration for the prediction of adverse perinatal events in hypertensive disorders of pregnancy. Materials and Methods: The current descriptive-comparative study has been conducted on 100 singleton pregnant women with the diagnosis of preeclampsia or pregnancy-induced hypertension. The Cerebroplacental ratio (CPR) was measured for the included population and divided into normal and abnormal ranges of >1 and ≤1. The adverse perinatal outcomes, including abnormal 5 min APGAR, low birth weight, perinatal death, neonatal intensive care unit (NICU) admission, academia, seizure, emergency cesarean delivery, and Tchirikov index as the general manifestation of adverse perinatal outcomes were compared between the groups. The specificity, sensitivity, positive predictive value, negative predictive value (NPV), and accuracy were measured for the adverse perinatal outcomes. Results: The two groups were remarkably different in terms of 5 min APGAR, low birth weight, cesarean section delivery, and Tchirikov index (P < 0.05). The specificity of CPR for prediction of small-for-gestational age, poor APGAR, requirement of assisted respiration, academia, Tchirikov score and NICU admission was 93.1%, 93.1%, 67.1%, 91.8%, 71.2%, and 63%, and its sensitivity was 26%, 14.8%, 51.8%, 14.8%, 51.8%, and 37%, respectively. Conclusion: CPR seems to be an appropriate means for the prediction of adverse perinatal outcomes with diversity in the prediction values of different determinants of adverse perinatal outcomes; however, in general, it had sensitivity, specificity, PP, NPV, and accuracy of 51.8%, 71.2%, 40%, 80%, and 66%, respectively.

Keywords

1.
Shahinaj R, Manoku N, Kroi E, Tasha I. The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prenat Med 2010;4:17-21.  Back to cited text no. 1
    
2.
Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012;36:56-9.  Back to cited text no. 2
    
3.
Adiga P, Kantharaja I, Hebbar S, Rai L, Guruvare S, Mundkur A. Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in hypertensive disorders of pregnancy. Int J Reprod Med 2015;2015:614747.  Back to cited text no. 3
    
4.
Eslamian ZL, Zarean E, Moshfeghi M, Heidari Z. Evaluation of the predictive value of fetal Doppler ultrasound for neonatal outcome from the 36th week of pregnancy. J Res Med Sci 2018;23:13.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Spinillo A, Gardella B, Bariselli S, Alfei A, Silini EM, Bello BD. Cerebroplacental Doppler ratio and placental histopathological features in pregnancies complicated by fetal growth restriction. J Perinat Med 2014;42:321-8.  Back to cited text no. 5
    
6.
Saber HA, El-Monem A, Mohamed A, Abd El Gaffar HM. Role of middle cerebral artery/umbilical artery pusatility index ratio (cerebro-placental ratio CPR) for prediction of fetal outcome in preeclamptic patients. Sohag Med J 2019;23:177-82.  Back to cited text no. 6
    
7.
Ebrashy A, Azmy O, Ibrahim M, Waly M, Edris A. Middle cerebral/umbilical artery resistance index ratio as sensitive parameter for fetal well-being and neonatal outcome in patients with preeclampsia: Case-control study. Croat Med J 2005;46:821-5.  Back to cited text no. 7
    
8.
Makhseed M, Jirous J, Ahmed MA, Viswanathan DL. Middle cerebral artery to umbilical artery resistance index ratio in the prediction of neonatal outcome. Int J Gynaecol Obstet 2000;71:119-25.  Back to cited text no. 8
    
9.
Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, Thilaganathan B. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015;213:54.e1-54.e10.  Back to cited text no. 9
    
10.
Dunn L, Sherrell H, Kumar S. Review: Systematic review of the utility of the fetal cerebroplacental ratio measured at term for the prediction of adverse perinatal outcome. Placenta 2017;54:68-75.  Back to cited text no. 10
    
11.
Vollgraff Heidweiller-Schreurs C, De Boer M, Heymans M, Schoonmade L, Bossuyt P, Mol B, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: Systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51:313-22.  Back to cited text no. 11
    
12.
Saber HA, El-Monem A, Mohamed A, El Gaffar A, Mohammed H. Role of middle cerebral artery/umbilical artery pusatility index ratio (cerebro-placental ratio CPR) for prediction of fetal outcome in preeclamptic patients. Sohag Med J 2019;23:177-82.  Back to cited text no. 12
    
13.
Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: Executive summary. J Obstet Gynaecol Can 2014;36:416-41.  Back to cited text no. 13
    
14.
Williams KP, Wilson S. Maternal cerebral blood flow changes associated with eclampsia. Am J Perinatol 1995;12:189-91.  Back to cited text no. 14
    
15.
Tchirikov M, Rybakowski C, Hüneke B, Schoder V, Schröder H. Umbilical vein blood volume flow rate and umbilical artery pulsatility as 'venous–arterial index'in the prediction of neonatal compromise. Ultrasound Obstet Gynecol 2002;20:580-5.  Back to cited text no. 15
    
16.
Abdelwahid HH, Wahab BA, Mahmoud MZ, Abukonna A, Saeed Taha EA. Effects of gestational hypertension in the pulsatility index of the middle cerebral and umbilical artery, cerebro-placental ratio, and associated adverse perinatal outcomes. J Radiat Res Appl Sci 2018;11:195-203.  Back to cited text no. 16
    
17.
Patil V, Gowda S, Das S, Suma K, Hiremath R, Shetty S, et al. Cerebro-placental ratio in women with hypertensive disorders of pregnancy: A reliable predictor of neonatal outcome. J Clin Diagn Res 2019;13:6-10.  Back to cited text no. 17
    
18.
Cruz-Martínez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011;117:618-26.  Back to cited text no. 18
    
19.
Prior T, Mullins E, Bennett P, Kumar S. Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: A prospective observational study. Am J Obstet Gynecol 2013;208:124.e1-6.  Back to cited text no. 19
    
20.
Bligh LN, Al Solai A, Greer RM, Kumar S. Diagnostic performance of cerebroplacental ratio thresholds at term for prediction of low birthweight and adverse intrapartum and neonatal outcomes in a term, low-risk population. Fetal Diagn Ther 2018;43:191-8.  Back to cited text no. 20
    
21.
Triunfo S, Crispi F, Gratacos E, Figueras F. Prediction of delivery of small-for-gestational-age neonates and adverse perinatal outcome by fetoplacental Doppler at 37 weeks' gestation. Ultrasound Obstet Gynecol 2017;49:364-71.  Back to cited text no. 21
    
22.
Eser A, Zulfıkaroglu E, Eserdag S, Kılıc S, Danısman N. Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in preeclampsia. Arch Gynecol Obstet 2011;284:307-11.  Back to cited text no. 22
    
23.
El Guindy AE, Nawara M, ElSanter O. Cerebroplacental Ratio and Cerebrouterine Ratio in Predicting Neonatal Outcome in Preeclamptic Pregnant Women. Int J Reprod Med Gynecol. 2018;4: 022-027.  Back to cited text no. 23
    
24.
Alanwar A, El Nour AA, El Mandooh M, Abdelazim IA, Abbas L, Abbas AM, et al. Prognostic accuracy of cerebroplacental ratio for adverse perinatal outcomes in pregnancies complicated with severe pre-eclampsia; a prospective cohort study. Pregnancy Hypertens 2018;14:86-9.  Back to cited text no. 24
    
25.
Garcia-Simon R, Figueras F, Savchev S, Fabre E, Gratacos E, Oros D. Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late-onset small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 2015;46:713-7.  Back to cited text no. 25
    
26.
Bellido-González M, Díaz-López MÁ, López-Criado S, Maldonado-Lozano J. Cognitive functioning and academic achievement in children aged 6-8 years, born at term after intrauterine growth restriction and fetal cerebral redistribution. J Pediatr Psychol 2017;42:345-54.  Back to cited text no. 26
    
27.
Yalti S, Oral O, Gürbüz B, Ozden S, Atar F. Ratio of middle cerebral to umbilical artery blood velocity in preeclamptic & hypertensive women in the prediction of poor perinatal outcome. Indian J Med Res 2004;120:44-50.  Back to cited text no. 27
    
28.
Khalil AA, Morales-Rosello J, Morlando M, Hannan H, Bhide A, Papageorghiou A, Thilaganathan B. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol. 2015;213:54.e1-54.e10.  Back to cited text no. 28
    
29.
Prior T, Paramasivam G, Bennett P, Kumar S. Are fetuses that fail to achieve their growth potential at increased risk of intrapartum compromise? Ultrasound Obstet Gynecol 2015;46:460-4.  Back to cited text no. 29
    
30.
Al-Azad S, Rupa SA, Khan NA. Doppler prediction of perinatal outcome in pregnancy induced hypertension and intrauterine growth retardation. Mymensingh Med J 2010;19:539-42.  Back to cited text no. 30
    
31.
Akolekar R, Sarno L, Wright A, Wright D, Nicolaides KH. Fetal middle cerebral artery and umbilical artery pulsatility index: Effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015;45:402-8. 
Advanced Biomedical Research
Volume 2022, December
December 2022
Pages 1-6