Citation Information :
Geya G, Singh A, Sattoju N, Gopireddy MM. Role of Cerebro-placental-uterine Ratio in Prediction of Late-onset Fetal Growth Restriction: A Prospective Observational Study. Int J Infertil Fetal Med 2024; 15 (2):93-100.
Background: Late-onset fetal growth restriction (FGR) is the failure to achieve growth potential by the fetus and is diagnosed after 32 weeks of gestation. Majorly, it is associated with stillbirths. Hence, fetuses at risk need to be identified.
Objectives: To evaluate association of cerebro-placental-uterine ratio (CPUR) in predicting late-onset FGR.
Materials and methods: A prospective study was carried out including low-risk nulliparous singleton women after a 32-week period of gestation. Analysis of pulsatility indices of umbilical artery (UA), uterine arteries (UtA), middle cerebral artery (MCA), and estimated fetal weight (EFW) was conducted. The cerebroplacental ratio (CPR) and CPUR were calculated. After adjusting for gestational age, EFW and Doppler indices were converted into centiles and multiples of the median (MoM), respectively. Receiver operating characteristic (ROC) analysis was used to assess predictive value of all Doppler parameters for birth weight <10th, <5th, and <3rd centile as per Gestation Related Optimal Weight (GROW) chart. At ~90% specificity, sensitivity, positive and negative predictive value, and odds ratios (OR) were presented.
Results: A total of 587 participants were included, 169 had birth weight <10th centile and 418 had ≥10th centile. For birth weight <5th and <3rd centiles, the area under the curve (AUC) of CPUR was 0.677 and 0.734, respectively. Low CPUR MoM was associated with birth weight <10th, <5th, and <3rd centile with OR of 3.1, 3.2, and 4.08, respectively, p < 0.001. Higher association with meconium-stained liquor and neonatal intensive care unit (NICU) admission, p < 0.001 was found with low CPUR MoM.
Conclusion: A strong association of uteroplacental insufficiency with CPUR, a novel Doppler ratio, was observed and has higher AUC and OR for identifying low-birth-weight compared to existing Doppler parameters.
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