VP54.05: Cerebroplacental ratio during labour

Le résumé fourni par la source

In order to decrease the perinatal mortality rate in South Africa risk stratification of pregnant women must improve. Inaccurate dating affects the ability to detect growth restriction. Patients requiring referral may go undetected and deliver with the inappropriate level of care. Doppler studies can assist in detecting at-risk fetuses. We aimed to describe the short-term outcomes of fetuses with a normal or abnormal cerebroplacental ratio (CPR) in early labour in a heterogenous population. A cohort of 200 women were prospectively recruited while in early labour. History was obtained including previous ultrasounds. Ultrasound was done for biometry, umbilical artery (UA), middle cerebral artery (MCA) and uterine Dopplers, the CPR was calculated. Labour and delivery details were recorded. An association was looked for between an abnormal CPR and adverse outcomes or Prior's score. 15 (7.7%) participants had a CPR <1.08, 31 (16.0%) were <5th centile and 46 (23.7%) <10th centile. Prior's composite score was not significant (p = 0.737) for a CPR cut-off of the 5th centile. There was no association for any variable (fetal compromise, Apgar at 5min <7, arterial cord ph. <7, small for gestational age, admission, any respiaratory support), having an adverse outcome (p = 0.179) or Prior's composite score (p = 0.237) for a CPR cut-off of the 10th centile. The PPV was only high (0.70) for the need for respiratory support – bag mask ventilation and resuscitation. It did have a very good negative predictive value (0.92). Adjusting for confounders, there was no association between an abnormal CPR and an adverse outcome. There were no cases of perinatal death or neonatal encephalopathy. An abnormal CPR was not clinically useful in detecting fetuses at risk in early labour regardless of the cut off examined. It is reassuring when normal and may if combined with other parameters still prove useful.

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