The prediction of perinatal outcome by cerebroplasental ratio in pregnancy with fetal growth restriction

Pregnancies affected by intrauterine growth restriction (IUGR) cause a major public health problem and are associated with increased neonatal morbidity and mortality(71,69) The objective of this study is to describe the importance of cerebroplasental ratio on pregnancy with fetal growth restriction . The Hadlock Formula is the most widely accepted method of estimating fetal weight using a composite sonographic measurement of fetal head, abdomen, and femur.(71,72) IUGR is defined as EFW < 10th centile based on sonographic measurements of fetal biparietal diameter, head circumference, AC, and femur length Ultrasound examination is the primary diagnostic tool for the evaluation of fetal growth. In the presence of risk factors and clinical conditions that are associated with IUGR (75). To approach to the fetus with suspected fetal growth restriction must be used ultrasound examination of fetal anatomy, biometry, and amniotic fluid characteristics. Doppler umbilical artery studies have shown that absence of end diastolic velocities, indicative of IUGR based on severe placental insufficiency is associated with a higher rate of caesarean deliveries and an increased incidence of perinatal and neonatal mortality(73,74) Progressive placental dysfunction there may be an increase in the diastolic velocity resulting in a decrease in the Doppler index (brain sparing). Brain sparing means that Cerebral vasodilatation in response to perceived hypoxemia. MATERİAL AND METHODS 100 high risk pregnant in the third trimester of pregnancy were included from those referred to the antenatal clinic at Sakarya Education and Research Hospital,, after obtaining informed constent. 66 of them is diagnosed with FGR. 34 of them is diagnosed with SGA fetüs. Patients have a singleton pregnancy at 27-40 weeks of gestation diagnosed with FGR. This was defined as the estimated fetal weight below the 10th percentile. Gestational age was assigned from measurement of crown–rump length prior to 14 weeks. Women with a history of , serious congenital structural or chromosomal defects , renal diseases, diabetes mellitus, or positive TORCHES, HCV and HIV serology are excluded. Maternal hypertension was defined as blood pressure > 140/90 mmHg . Hypertensive disorders were defined as chronic if hypertension existed prior to 20 weeks' gestation ; Pre-eclampsia was defined as hypertension and proteinuria. Baseline demographic, past obstetric and medical histories were recorded for all patiens. Pregnancies were assessed by Doppler ultrasound of umbilical (UA) and middle cerebral (MCA) arteries. A cerebroplacental Doppler ratio less than 1 was considered abnormal. Eighty seven (87) women with foetal MCA/UA ratios > 1 and thirteen (13) with ≤ 1 were recruited in two groups. Adverse perinatal outcome for newborn ; abnormal foetal distress, overall caesarean section rate, a 5-minute Apgar score < 7, NICU admission , intraventricular hemorrhage, periventricular leukomalacia, hypoxic ischemic encephalopathy, respiratory distress syndrome necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and death was documented for all cases. Statistical comparisons were performed using the One-way and Anova Test of association. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) was used for data management and statistical analysis. RESULTS The 100 pregnant women were stratified into 2 groups based on the MCA/UA ratio. Group A, MCA/UA ratio>1 (n=87); group B MCA/UA ratio ≤ 1 (n=13). There was statistically significant increase in perinatal morbidity in cases with cerebro-placental ratio <1 Mean ± SD gestational age at diagnosis was 28,22±5,99 Gestational age at delivery was 37,33±2,44 weeks, and birth weight was 2449,79±569,93g. Overall, 56 % of deliveries were indicated by fetal condition and 62 % were by Cesarean section. There were no significant differences in maternal age, gestational age, parity, maternal BMI. systolic and diastolic blood pressure, proteinüria . Amniotic fluid volüm indices were found to be significantly (p=0.001; p<0.01) lower in group with MCA/UA ratio<1 USG measurements Umbilical artery pulsatility indices were found to be significantly (p=0.001; p<0.01) higher in group with MCA/UA ratio<1 Doppler measurements Systolic/diastolic ratios were found to be significantly (p=0.001; p<0.01) higher in group with MCA/UA ratio >1 Doppler measurements Umbilical artery resistance indices ratios were found to be significantly (p=0.001; p<0.01) higher in group with MCA/UA ratio<1 Doppler measurements A significant difference in Rate of caesarean delivery was found between the two groups (P<0.01). Rate of caesarean delivery was higher in group with MCA/UA ratio<1 (13cases ) than group with MCA/UA ratio>1 (87 cases, ) P<0.01 Apgar scores at 1 and 5 min were found to be lower in group with MCA/UA ratio <1 than group with MCA/ UA ratio>1. In foetuses with abnormal CPR, are strongly correlated with worse foetal prognosis. Adverse perinatal outcome for newborn ; abnormal foetal distress, overall caesarean section rate, a 5-minute Apgar score < 7, NICU admission , respiratory distress syndrome , hyperbilirübinemia was worse in group with MCA/UA ratio<1 My results showed that the MCA/UA Doppler ratio of less than 1 was a good predictive tool for neonatal outcome in pregnancy with fetal growth restriction.