Karen Flood1, Julia Unterscheider2, Sean Daly3, Michael P Geary4, Mairead M Kennelly5, Fionnuala M McAuliffe6, Keelin O'Donoghue7, Alyson Hunter8, John J Morrison9, Gerard Burke10, Patrick Dicker11, Elizabeth C Tully2, Fergal D Malone2. 1. Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland. Electronic address: karenflood@rcsi.ie. 2. Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Dublin, Ireland. 3. Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland. 4. Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland. 5. Department of Obstetrics and Gynecology, UCD Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland. 6. Department of Obstetrics and Gynecology, UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland. 7. Department of Obstetrics and Gynecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland. 8. Department of Obstetrics and Gynecology, Royal Jubilee Maternity Hospital, Belfast, Ireland. 9. Department of Obstetrics and Gynecology, National University of Ireland, Galway, Ireland. 10. Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 11. Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
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. STUDY DESIGN: 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. CONCLUSION: 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.
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. STUDY DESIGN: 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 ischemicencephalopathy, 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. CONCLUSION: 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: Lindsay S Cahill; Johnathan Hoggarth; Jason P Lerch; Mike Seed; Christopher K Macgowan; John G Sled Journal: J Cereb Blood Flow Metab Date: 2017-12-22 Impact factor: 6.200