Stephen Contag1, Silvia Visentin2, Katherine Goetzinger3, Erich Cosmi2. 1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, University of Minnesota, Minneapolis, MN 55455, USA. 2. Department of Women and Child Heath, University of Padua School of Medicine, 35122 Padova, Italy. 3. Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Abstract
OBJECTIVE: To measure the sensitivity and positive predictive value (PPV) for an adverse neonatal outcome among growth-restricted fetuses (FGR) comparing the cerebral-placental ratio (CPR) with the cerebral-renal ratio (CRR). METHODS: Retrospective analysis of 92 women who underwent prenatal ultrasound at the University of Maryland and the University of Padua. Renal, middle cerebral and umbilical artery Doppler waveforms were recorded for all scans during the third trimester. The last scan prior to delivery was included for analysis. We calculated the test characteristics of the pulsatility indices (PI) of the umbilical and renal arteries in addition to the derived CPR and CRR to detect a composite adverse neonatal outcome. RESULTS: The test characteristics of the four Doppler ratios to detect increased risk for the composite neonatal outcome demonstrated that the umbilical artery pulsatility index had the best test performance (sensitivity 64% (95% CI: 47-82%), PPV 24% (95% CI: 21-27), and positive likelihood ratio 2.7 (95% CI: 1.4-5.2)). There was no benefit to using the CRR compared with the CPR. The agreement between tests was moderate to poor (Kappa value CPR compared with CRR: 0.5 (95%CI 0.4-0.70), renal artery PI:-0.1 (95% CI -0.2-0.0), umbilical artery PI: 0.5 (95% CI 0.4-0.7)). Only the umbilical artery had an area under the receiver operating curve that was significantly better compared with the CPR as a reference (p-value < 0.01). CONCLUSIONS: The data that we present do not support the use of renal artery Doppler as a useful clinical test to identify a fetus at risk for an adverse neonatal outcome. Within the various indices applied to this population, umbilical artery Doppler performed the best in identifying the fetuses at risk for an adverse perinatal outcome.
OBJECTIVE: To measure the sensitivity and positive predictive value (PPV) for an adverse neonatal outcome among growth-restricted fetuses (FGR) comparing the cerebral-placental ratio (CPR) with the cerebral-renal ratio (CRR). METHODS: Retrospective analysis of 92 women who underwent prenatal ultrasound at the University of Maryland and the University of Padua. Renal, middle cerebral and umbilical artery Doppler waveforms were recorded for all scans during the third trimester. The last scan prior to delivery was included for analysis. We calculated the test characteristics of the pulsatility indices (PI) of the umbilical and renal arteries in addition to the derived CPR and CRR to detect a composite adverse neonatal outcome. RESULTS: The test characteristics of the four Doppler ratios to detect increased risk for the composite neonatal outcome demonstrated that the umbilical artery pulsatility index had the best test performance (sensitivity 64% (95% CI: 47-82%), PPV 24% (95% CI: 21-27), and positive likelihood ratio 2.7 (95% CI: 1.4-5.2)). There was no benefit to using the CRR compared with the CPR. The agreement between tests was moderate to poor (Kappa value CPR compared with CRR: 0.5 (95%CI 0.4-0.70), renal artery PI:-0.1 (95% CI -0.2-0.0), umbilical artery PI: 0.5 (95% CI 0.4-0.7)). Only the umbilical artery had an area under the receiver operating curve that was significantly better compared with the CPR as a reference (p-value < 0.01). CONCLUSIONS: The data that we present do not support the use of renal artery Doppler as a useful clinical test to identify a fetus at risk for an adverse neonatal outcome. Within the various indices applied to this population, umbilical artery Doppler performed the best in identifying the fetuses at risk for an adverse perinatal outcome.
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