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The role of the cerebroplacental ratio in predicting pregnancy outcomes at 40–42 gestational weeks: a prospective observational trial

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The cerebroplacental ratio is a sonographic tool used to predict poor pregnancy outcomes. Data are insufficient regarding its use in postdate pregnancy. We evaluated the cerebroplacental ratio’s prediction of unfavorable pregnancy outcomes in women at 40–42 weeks gestation with normal amniotic fluid index.

Methods

This prospective observational study included 101 women with low-risk singleton pregnancy and gestational age > 40 weeks who delivered in a university affiliated hospital during 2020–2021. The middle cerebral artery pulsatility index, the umbilical artery pulsatility index, and the cerebroplacental ratio, which is their quotient, were compared between women with favorable and unfavorable pregnancy outcomes. The latter included: meconium-stained amniotic fluid, cesarean or vacuum-assisted delivery due to pathological cardiotocography (category 2 or 3), 5-min Apgar score < 7, umbilical cord pH < 7.1, neonatal intensive care unit admission, and neonatal death.

Results

Fetal Doppler, performed at a median gestational age of 40.3 (40.0–41.6), did not differ between 75 (74.3%) women with favorable obstetrical outcomes and 26 (25.7%) with unfavorable outcomes. In multivariate analysis, advanced maternal age and a history of a cesarean section were correlated with unfavorable outcomes, while Doppler indices were not found to be predictive. Among women at 41–42 weeks’ gestation, for those with intrapartum fetal monitor category 2–3 vs. category 1, the mean umbilical artery pulsatility index was higher: 0.92 ± 0.34 vs. 0.71 ± 0.11 (p = 0.044).

Conclusion

According to the study results, fetal Doppler indices, including the cerebroplacental ratio, are not predictive of unfavorable outcome in women with pregnancies exceeding 40 weeks. Larger prospective studies are needed.

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Availability of data and materials

Data will be available upon reasonable request to the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

MCA:

Middle cerebral artery

UA:

Umbilical artery

CPR:

Cerebroplacental ratio

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Acknowledgements

The authors declare that no funding was received by any source for this study.

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Author notes

  1. Nadine Ashkar Majadla and Raneen Abu Shqara contributed equally.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, 22100, Nahariyya, Israel

    Nadine Ashkar Majadla, Raneen Abu Shqara, Maya Frank Wolf, Ruba Tuma, Lior Lowenstein & Marwan Odeh

  2. Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel

    Nadine Ashkar Majadla, Raneen Abu Shqara, Maya Frank Wolf, Ruba Tuma, Lior Lowenstein & Marwan Odeh

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  1. Nadine Ashkar Majadla
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  2. Raneen Abu Shqara
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Contributions

NAM: protocol/project development, data collection, data analysis, manuscript writing. RAS: protocol/project development, data collection, data analysis, manuscript writing. MFW: manuscript editing, interpretation of the data. R. Tuma: manuscript editing, interpretation of the data. LL: manuscript editing, interpretation of the data. MO: protocol/project development, data analysis, manuscript editing.

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Correspondence to Maya Frank Wolf.

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Ashkar Majadla, N., Abu Shqara, R., Frank Wolf, M. et al. The role of the cerebroplacental ratio in predicting pregnancy outcomes at 40–42 gestational weeks: a prospective observational trial. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07372-x

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