Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction

Evaluating the impact of using gestational age-specific reference values

Anthony O. Odibo, Christopher Riddick, Emmanuelle Pare, David M. Stamilio, George A. Macones

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Objective. The purpose of this study was to compare the impact of using gestational age-specific reference levels of the cerebroplacental Doppler ratio (CPR) with categorical threshold in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. Methods. A retrospective cohort study of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilical artery and middle cerebral artery pulsatility indices were converted to CPRs. The efficacy of using gestational age-specific reference levels of CPRs in predicting adverse outcomes was compared with the use of a CPR of less than 1.08. Adverse perinatal outcomes evaluated included cesarean delivery for nonreassuring fetal heart tones, umbilical artery pH less than 7.0, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage greater than grade 2, periventricular leukomalacia, respiratory distress syndrome, and perinatal death. Results. Of 183 pregnancies meeting our inclusion criteria, there were 70 with at least 1 adverse outcome. With the use of a CPR ratio below the 5th percentile for gestational age, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 65%, 73%, 73%, and 65%, respectively, with an odds ratio (95% confidence interval) of 5.2 (1.4-19.4; area under the receiver operating characteristic curve, 0.69). With a CPR threshold of less than 1.08, the sensitivity, specificity, and positive and negative predictive values were 72%, 62%, 68%, and 67%, with an odds ratio (95% confidence interval) of 4.2 (1.2-15.3; area under the receiver operating characteristic curve, 0.67). Conclusions. An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses. The accuracy of using gestational age-specific reference levels was similar to that of using a categorical threshold.

Original languageEnglish (US)
Pages (from-to)1223-1228
Number of pages6
JournalJournal of Ultrasound in Medicine
Volume24
Issue number9
StatePublished - Sep 2005
Externally publishedYes

Fingerprint

arteries
Gestational Age
constrictions
Reference Values
pregnancy
Umbilical Arteries
thresholds
confidence
Cardiopulmonary Resuscitation
Growth
receivers
ROC Curve
intervals
hemorrhages
sensitivity
Odds Ratio
fetuses
curves
Confidence Intervals
Periventricular Leukomalacia

Keywords

  • Adverse outcomes
  • Cerebral Doppler sonography
  • Fetal growth restriction
  • Umbilical artery Doppler sonography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Acoustics and Ultrasonics

Cite this

Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction : Evaluating the impact of using gestational age-specific reference values. / Odibo, Anthony O.; Riddick, Christopher; Pare, Emmanuelle; Stamilio, David M.; Macones, George A.

In: Journal of Ultrasound in Medicine, Vol. 24, No. 9, 09.2005, p. 1223-1228.

Research output: Contribution to journalArticle

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abstract = "Objective. The purpose of this study was to compare the impact of using gestational age-specific reference levels of the cerebroplacental Doppler ratio (CPR) with categorical threshold in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. Methods. A retrospective cohort study of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilical artery and middle cerebral artery pulsatility indices were converted to CPRs. The efficacy of using gestational age-specific reference levels of CPRs in predicting adverse outcomes was compared with the use of a CPR of less than 1.08. Adverse perinatal outcomes evaluated included cesarean delivery for nonreassuring fetal heart tones, umbilical artery pH less than 7.0, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage greater than grade 2, periventricular leukomalacia, respiratory distress syndrome, and perinatal death. Results. Of 183 pregnancies meeting our inclusion criteria, there were 70 with at least 1 adverse outcome. With the use of a CPR ratio below the 5th percentile for gestational age, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 65{\%}, 73{\%}, 73{\%}, and 65{\%}, respectively, with an odds ratio (95{\%} confidence interval) of 5.2 (1.4-19.4; area under the receiver operating characteristic curve, 0.69). With a CPR threshold of less than 1.08, the sensitivity, specificity, and positive and negative predictive values were 72{\%}, 62{\%}, 68{\%}, and 67{\%}, with an odds ratio (95{\%} confidence interval) of 4.2 (1.2-15.3; area under the receiver operating characteristic curve, 0.67). Conclusions. An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses. The accuracy of using gestational age-specific reference levels was similar to that of using a categorical threshold.",
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N2 - Objective. The purpose of this study was to compare the impact of using gestational age-specific reference levels of the cerebroplacental Doppler ratio (CPR) with categorical threshold in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. Methods. A retrospective cohort study of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilical artery and middle cerebral artery pulsatility indices were converted to CPRs. The efficacy of using gestational age-specific reference levels of CPRs in predicting adverse outcomes was compared with the use of a CPR of less than 1.08. Adverse perinatal outcomes evaluated included cesarean delivery for nonreassuring fetal heart tones, umbilical artery pH less than 7.0, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage greater than grade 2, periventricular leukomalacia, respiratory distress syndrome, and perinatal death. Results. Of 183 pregnancies meeting our inclusion criteria, there were 70 with at least 1 adverse outcome. With the use of a CPR ratio below the 5th percentile for gestational age, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 65%, 73%, 73%, and 65%, respectively, with an odds ratio (95% confidence interval) of 5.2 (1.4-19.4; area under the receiver operating characteristic curve, 0.69). With a CPR threshold of less than 1.08, the sensitivity, specificity, and positive and negative predictive values were 72%, 62%, 68%, and 67%, with an odds ratio (95% confidence interval) of 4.2 (1.2-15.3; area under the receiver operating characteristic curve, 0.67). Conclusions. An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses. The accuracy of using gestational age-specific reference levels was similar to that of using a categorical threshold.

AB - Objective. The purpose of this study was to compare the impact of using gestational age-specific reference levels of the cerebroplacental Doppler ratio (CPR) with categorical threshold in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. Methods. A retrospective cohort study of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilical artery and middle cerebral artery pulsatility indices were converted to CPRs. The efficacy of using gestational age-specific reference levels of CPRs in predicting adverse outcomes was compared with the use of a CPR of less than 1.08. Adverse perinatal outcomes evaluated included cesarean delivery for nonreassuring fetal heart tones, umbilical artery pH less than 7.0, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage greater than grade 2, periventricular leukomalacia, respiratory distress syndrome, and perinatal death. Results. Of 183 pregnancies meeting our inclusion criteria, there were 70 with at least 1 adverse outcome. With the use of a CPR ratio below the 5th percentile for gestational age, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 65%, 73%, 73%, and 65%, respectively, with an odds ratio (95% confidence interval) of 5.2 (1.4-19.4; area under the receiver operating characteristic curve, 0.69). With a CPR threshold of less than 1.08, the sensitivity, specificity, and positive and negative predictive values were 72%, 62%, 68%, and 67%, with an odds ratio (95% confidence interval) of 4.2 (1.2-15.3; area under the receiver operating characteristic curve, 0.67). Conclusions. An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses. The accuracy of using gestational age-specific reference levels was similar to that of using a categorical threshold.

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