A Prospective Analysis of the Association Between Antepartum Cerebroplacental Ratio and Risk of Adverse Fetal Outcomes in Full-Term Pregnancies at Tertiary Care Setting, Sahiwal, Pakistan

Abstract

Objective: To evaluate the association of cerebroplacental ratio, Doppler ultrasound, and risk of adverse fetal
outcomes in normal-term pregnancies.
Study Design: A prospective cohort study.
Place and Duration of Study: This study was conducted at the Department of Gynecology and Obstetrics and
Radiology, Sahiwal Medical College and Teaching Hospital, Sahiwal, Pakistan from 1^st April 2024 to 30^th March
2025.
Methods: A total of 250 pregnant women with singleton pregnancies and gestation age between 37 and 41
weeks, admitted to the hospital during latent labor, were included in the study. The cerebroplacental ratio was
calculated as the middle cerebral artery pulsatility index divided by the umbilical cord pulsatility index. All
measurements were classified by gestational age percentile into specific groups. Adverse fetal outcomes
included fetal death, meconium-stained amniotic fluid, Apgar score <7 at 5 minutes, stillbirth, NICU admission,
and need for ventilator, sepsis, hypothermia, non-invasive ventilation, hypoglycemia, and necrotizing
enterocolitis.
Results: The incidence of abnormal heart rate was higher in fetuses with cerebroplacental ratio (CPR) <5^th
percentile in comparison with CPR >5^th percentile (54.5% vs 30%). Similar results were recorded in both groups
with CPR <1 (60% vs 30%, P=0.04). A cerebroplacental ratio (CPR) <5^th percentile had a positive predictive value
of 24% and a negative predictive value of 90% for abnormal fetal heart rate. However, the positive predictive
value of cerebroplacental ratio (CPR)<1 and 1.08 for both parameters was 5% and 7%, respectively. The
cerebroplacental ratio (CPR) >95^th percentile had a negative predictive value of 98% and 99%, respectively.
Conclusion: A low cerebroplacental ratio is a predictor of fetal distress requiring operative delivery and
abnormal fetal heart rate, with low positive predictive value and high negative predictive value. A
cerebroplacental ratio (CPR) <5^th percentile, however, was only correlated to abnormal fetal heart rate.

How to cite this: Jamal Y, Shaukat M, Irum R. A Prospective Analysis of the Association Between Antepartum Cerebroplacental Ratio and Risk of Adverse Fetal Outcomes in Full-Term Pregnancies at Tertiary Care Setting, Sahiwal, Pakistan. Life and Science. 2025; 6(4): 547-552. doi: http://doi.org/10.37185/LnS.1.1.943