Cerebroplacental ratio and neonatal outcome in low-risk pregnancies with reduced fetal movement: A prospective study

Abstract

Cerebroplacental ratio and neonatal outcome in low-risk pregnancies with reduced fetal movement: A prospective study Ala Aiob a,b,*,1, Ruba Toma a, Maya Wolf a,b, Yosef Haddad a, Marwan Odeh a,b a Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya 22100, Israel b Azrieli Faculty of Medicine, Bar Ilan University, Safed 52000, Israel A R T I C L E I N F O Keywords: Reduced fetal movement Doppler Cerebroplacental ratio Neonatal outcome Low-risk pregnancy A B S T R A C T Objective: To evaluate the effectiveness of the cerebroplacental ratio (CPR) in predicting poor outcomes in lowrisk pregnancies with reduced fetal movements (RFMs). Study Design: This prospective study included singleton pregnancies at 28–40 weeks, presenting with RFM but no additional risk factors. Sub analysis was performed for pregnancies between 36 and 40 weeks. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured, and the MCA-PI to UA-PI ratio (CPR) was calculated. Mode of delivery, gestational age, fetal monitoring category, Apgar score at 1 and 5 min, birth weight, presence of meconium, umbilical artery pH, and neonatal intensive care unit (NICU) admission were recorded. Women with good and poor outcomes were compared with doppler indices and pregnancy characteristics. Results: Of 96 women, 86 had good outcomes. There was no significant difference in UA-PI (0.871 ± 0.171 vs. 0.815 ± 0.179, P = 0.446), MCA-PI (1.778 ± 0.343 vs. 1.685 ± 0.373, P = 0.309), or CPR (2.107 ± 0.635 vs. 2.09 ± 0.597, P = 0.993) between the poor and good outcome groups. No difference was found in the location of the placenta, biophysical profile (BPP) score, fetal sex, or amniotic fluid index (AFI) at the time of presentation. The proportion of nulliparous patients in the poor outcome group was higher than that of multiparous patients. Sub analysis for 36–40 weeks revealed the same results; no significant difference in UA-PI (0.840 ± 0.184 Vs 0.815 ± 0.195, P = 0.599), MCA-PI (1.724 ± 0.403 vs. 1.626 ± 0.382, P = 0.523), or CPR (2.14 ± 0.762 vs. 2.08 ± 0.655, P = 0.931) between poor and good outcome groups. Conclusions: CPR is not predictive of neonatal outcome in low-risk pregnancies with RFM. However, a higher proportion of poor outcomes in nulliparous women warrants further investigation.