Value of Cerebroplacental Ratio in Predicting Adverse Perinatal Outcome in Term Pregnancies Complicated by Obesity

Abstract

Objectives

To evaluate the performance of cerebroplacental ratio (CPR) in predicting composite adverse perinatal outcome (CAPO) in women with obesity compared to non-obese women at term.

Methods

This is a retrospective cohort study in a single tertiary referral centre over a 3-year period. All singleton pregnancies with CPR measurements ≥ 37 + 0 weeks and estimated fetal weight ≥ 10^th centile and attempted vaginal delivery were included and divided into two groups defined by pre-pregnancy body mass index (BMI) </≥ 30 kg/m². The presence of at least one of the following outcome parameters was defined as CAPO: operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min Apgar < 7. The prognostic performance of CPR MoM was evaluated using receiver operating characteristic (ROC) analysis.

Results

The study cohort included 1207 pregnancies, of which 112 were women with a BMI ≥ 30 kg/m². In obese women, CAPO occurred in 21 cases (18.8%) compared to 247 (22.6%) cases in women with BMI < 30 kg/m² (p = 0.404). In the entire study cohort, CPR MoM was significantly lower in the CAPO and OD for IFC group. ROC analyses revealed a significant predictive value of low CPR MoM for CAPO in obese women (AUC = 0.64, p = 0.024). Furthermore, CPR was predictive for OD for IFC not only in obese (AUC = 0.72, p = 0.023) but also in non-obese (AUC = 0.61, p = 0.003) women.

Conclusions

Low CPR MoM was predictive for CAPO and OD for IFC in obese women without additional risk factors. However, the overall predictive performance of CPR for CAPO in obese women was poor.

Zusammenfassung

Zielsetzung

Ziel der Studie war es, die Vorhersagekraft der zerebroplazentaren Ratio (CPR) in Bezug auf schlechtes perinatales Outcome (CAPO) bei adipösen Schwangeren in Terminnähe zu beurteilen.

Methoden

Es handelt sich um eine retrospektive monozentrische Kohortenstudie über einen Zeitraum von 3 Jahren in einem Referenzzentrum der Maximalversorgung. Alle Einlingsschwangerschaften mit CPR-Messungen ab 37 + 0 Schwangerschaftswochen, einem fetalen Schätzgewicht ≥ 10. Perzentile und vaginalem Entbindungsversuch wurden gemäß dem mütterlichen Body-Mass-Index (BMI) vor der Schwangerschaft </≥ 30 kg/m² in 2 Gruppen aufgeteilt. Das Vorliegen von mindestens einem der nachfolgenden Outcome-Parameter wurde als ein CAPO definiert: operative Entbindung aufgrund intrapartalem fetalen Distress (OD for IFC); Verlegung auf die neonatale Intensivstation; Nabelschnurarterien-pH ≤ 7,15; 5-Minuten-Apgar-Wert < 7. Die prognostische Aussagekraft des CPR-MoM-Wertes wurde mithilfe einer Receiver-Operating-Characteristic-(ROC-)Analyse untersucht.

Ergebnisse

Die Studienpopulation bestand aus 1207 Schwangerschaften; davon hatten 112 Frauen einen BMI ≥ 30 kg/m². In der Gruppe der übergewichtigen Frauen trat ein CAPO in 21 Fällen auf (18,8%), verglichen mit 247 (22,6%) Fällen in der Gruppe der Frauen mit einem BMI < 30 kg/m² (p = 0,404). In der gesamten Studienpopulation war der CPR-MoM-Wert signifikant niedriger in der CAPO- und OD-for-IFC-Gruppe. Die ROC-Analysen ergaben einen signifikanten Zusammenhang zwischen CPR MoM und CAPO bei adipösen Schwangeren (AUC = 0,64, p = 0,024). Außerdem ließ sich mittels CPR MoM auch ein OD for IFC nicht nur bei adipösen (AUC = 0,72, p = 0,023), sondern auch bei nicht adipösen Schwangeren (AUC = 0,061, p = 0,003) vorhersagen.

Schlussfolgerungen

Ein niedriges CPR MoM sagt CAPO und OD for IFC bei adipösen Schwangeren ohne weitere Risikofaktoren vorher. Jedoch war die Vorhersagekraft der CPR für CAPO bei adipösen Schwangeren niedrig.

Keywords

cerebroplacental ratio - obesity - BMI - adverse perinatal outcome

Schlüsselwörter

CPR - Adipositas - BMI - perinatales Outcome

Publikationsverlauf

Eingereicht: 01. Juni 2024

Angenommen nach Revision: 23. Juli 2024

Artikel online veröffentlicht:
22. August 2024

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