The Value Of Cerebro-Placental Ratio In Predicting Fetal Growth Restriction And Perinatal Outcome

Fetal growth restriction(FGR)is still a challenge in clinical practice worldwide,and it is associated with adverse events that occur immediately during the perinatal period and pathological conditions after adulthood.Traditionally,the sensitivity of antenatal diagnosis methods were inefficient,especially in the case of extreme fetal weight,which led to high dismissal rate.Recently,the use of Doppler ultrasound in pregnancy has further improved obstetric outcomes and became a useful tool to reduce prenatal mortality in the fetus.CPR combines UA Doppler and MCA,quantifying the redistribution of cardiac output which called as "blood redistribution" phenomenon.The predictive value of CPR in identifying fetuses that fail to achieve their genetic growth potential and increase the risk of perinatal complications has become a hot topic in many recent studies.Objective:To evaluate the value of CPR in prenatal diagnosis of fetal growth restriction in singleton pregnancies in combination with risk factors associated with fetal growth restriction(FGR);and to compare CPR with UAPI,UAPI in predicting perinatal adverse pregnancy outcomes.Method:Retrospective analysis was performed in natural conception,single pregnancy,gestational age ? 22 weeks and complete medical records of patients undergoing prenatal ultrasound examination in Baoding First Central Hospital from June 2016 to December 2018.All pregnant women were health before pregnancy,no history of smoking,alcohol and drug abuse,no history of infection and genetic disease,no history of taking drugs in the first 3 months of pregnancy or a history of taking high-dose X-ray radiation;all the fetuses had not chromosomal abnormalities and structural abnormalities.The individual patient data,Doppler diagnosis data and clinical diagnosis and prognosis data,and import the data were collected into Excel.The receiver operating characteristic curve(ROC curve)was used to analyze the value of CPR in prenatal diagnosis of fetal growth restriction in singleton pregnancies,and then the value of CPR,MCAPI,UAPI in predicting perinatal adverse pregnancy outcomes compared in pairs?Result:1.A total of 131 pregnant women were enrolled in this study.90 fetuses with FGR were diagnosed after delivery,and 41 were non-FGR.Prenatal diagnosis revealed 73 patients with FGR-related risk factors and 58 patients without relevant risk factors.56 cases of perinatal adverse outcomes occurred,and 75 cases had no adverse perinatal outcomes.71 cases were found CPR<1.08 frenatal by ultrasound examination,in which 64 cases were diagnosed FGR after dilivery;60 cases of CPR?1.08,and 26 cases were diagnosed FGR.2.In all cases included in the study,CPR <1.08 CPR has showed quite high predictive value for FGR.Detailed statistics are as follows:sensitivity 71.1%,specificity 82.9%,positive predictive value 90.1%,and negative predictive value 56.7%,The Youden' s index was 0.54,the area under the ROC curve was 0.792 with a 95% CI [0.712-0.858].3.The predictive value of CPR with or without associated risk factors FGR.Among the patients with FGR-related risk factors(73 cases),the sensitivity was 76.9%,the specificity was 76.2%,the positive predictive value was 88.9%,the negative predictive value was 57.1%,and the Yoden index was 0.52.In the case of no relevant risk factors(58 cases)The sensitivity was 55.3 %,the specificity was 75.0%,the positive predictive value is 80.8%,the negative predictive value was 46.9%,and the Yoden index was 0.30.Combined with the clinical risk factors associated with FGR,the predictive value of CPR is improved.4.The value of CPR,UAPI,and MCAPI in predicting adverse pregnancy outcomes during perinatal period.Prenatal ultrasound examination showed 71 cases of CPR<1.08,78 cases of UAPI>1.42 and 45 cases of MCAPI<1.50.in which there were 49 cases,46 cases and 26 cases showed perinatal adverse outcomesrespectively.The area under the ROC curve of CPR,UAPI and MCAPI were used to predict the circumference.The area under the ROC curve(AUC)of CPR<1.08 was 0.803,95% CI [0.724-0.867];and AUC of UAPI>1.42 was 0.715,95% CI [0.629-0.790];and AUCof MCAPI <1.50 was 0.696,95% CI [0.610-0.773].Comparison of AUC showed CPR and MCAPI,p=0.0004;CPR and MCAPI,p=0.0335;UAPI and MCAPI,p=0.6088.The results showed that CPR would be a better predictor of perinatal adverse outcomes than UAPI and MCAPI alone.5.The composition ratio of various adverse pregnancy outcomes in two groups of CPR<1.08 and CPR?1.08 were analyzed by Chi-square test.The results showed that there were significant statistical differences in emergency caesarean(p=0.003),NICU admission(p=0.006)between the groeps of CPR<1.08 and CPR?1.08.CPR <1.08 may have a certain correlation with the uotcome of caesarean section and NICU admission.Conclusion:The cerebro-placental ratio combined with the clinical risk factors associated with FGR has a high application value for predicting the occurrence of FGR in prenatal ultrasound diagnosis.CPR abnormality in doppler ultrasonography has a high predictive value for adverse perinatal outcomes.Useing CPR to evaluate and guide pregnant women,especially pregnant women with suspected FGR may help reducing the incidence of adverse pregnancy outcomes.