Is pathological fetal Doppler cerebroplacental ratio (CPR) associated with adverse delivery outcomes in pregnancies complicated by fetal growth restriction undergoing labor induction? A retrospective cohort study.
Nofar Bar Noy-Traub, Eden Friedman, Shaked Yarza, Eynit Grinblatt, Tal Biron-Shental, Shmuel Arnon, Michal Kovo, Dorit Ravid, Sivan Farladansky-Gershnabel
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引用次数: 0
Abstract
Objective: The optimal delivery approach for fetal growth restriction (FGR) with pathological cerebroplacental ratio (CPR) remains uncertain. This study evaluated the association between isolated pathological CPR (<5th percentile) and delivery outcomes, specifically the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate (NRFHR), in FGR cases undergoing induction of labor (IOL).
Methods: In this retrospective cohort study (2014-2023), pregnancies with FGR (estimated fetal weight < 10th percentile) undergoing IOL were stratified by CPR values: pathological (<5th percentile) and normal CPR. Exclusion criteria included multiple gestations, abnormal umbilical artery or ductus venosus Doppler, abnormal non-stress test or biophysical profile, major fetal anomalies, and genetic disorders.
Results: Among 432 FGR, 86 had pathological CPR. This group had higher rates of second-trimester human chorionic gonadotropin (HCG) >2.5 multiples of the median (11.7% vs. 3.8%, P = 0.01) and delivered earlier (37.1 vs. 38.0 weeks, P < 0.01). Overall CD rates and CD due to NRFHR were comparable between groups (19.8% vs. 18.8%, P = 0.84; 14.0% vs. 15.9%, P = 0.66, respectively). Neonates with pathological CPR had lower birthweights (2174 ± 279 g vs. 2279 ± 278 g, P < 0.01) and higher neonatal intensive care unit (NICU) admission rates (17.4% vs. 9.2%, P = 0.03). Logistic regression analysis adjusted for potential confounders showed no independent association between pathological CPR and increased risk of CD due to NRFHR (P = 0.74).
Conclusion: In FGR pregnancies undergoing IOL, isolated pathological CPR is not associated with an increased risk of cesarean delivery for NRFHR. However, these fetuses remain at higher risk for NICU admissions, emphasizing the need for individualized management and close monitoring.
目的：病理性脑胎盘比（CPR）胎儿生长受限（FGR）的最佳分娩方式尚不确定。方法：在这项回顾性队列研究（2014-2023）中，FGR妊娠（估计胎儿体重）结果：在432例FGR中，86例进行了病理性CPR。该组妊娠中期人绒毛膜促性腺激素(HCG) >的发生率较高，为中位数的2.5倍（11.7% vs. 3.8%, P = 0.01），分娩时间较早（37.1 vs. 38.0周，P）。结论：在接受IOL的FGR妊娠中，孤立病理性CPR与NRFHR剖宫产风险增加无关。然而，这些胎儿进入新生儿重症监护病房的风险仍然较高，强调需要个体化管理和密切监测。
期刊介绍：
The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.
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