Cerebroplacental ratio in predicting adverse perinatal outcome: a meta-analysis of individual participant data

C. A. Vollgraff Heidweiller-Schreurs*, I. R. van Osch, M. W. Heymans, W. Ganzevoort, L. J. Schoonmade, C. J. Bax, B. W.J. Mol, C. J.M. de Groot, P. M.M. Bossuyt, M. A. de Boer, CPR IPD Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective: To investigate if cerebroplacental ratio (CPR) adds to the predictive value of umbilical artery pulsatility index (UA PI) alone – standard of practice – for adverse perinatal outcome in singleton pregnancies. Design and setting: Meta-analysis based on individual participant data (IPD). Population or sample: Ten centres provided 17 data sets for 21 661 participants, 18 731 of which could be included. Sample sizes per data set ranged from 207 to 9215 individuals. Patient populations varied from uncomplicated to complicated pregnancies. Methods: In a collaborative, pooled analysis, we compared the prognostic value of combining CPR with UA PI, versus UA PI only and CPR only, with a one-stage IPD approach. After multiple imputation of missing values, we used multilevel multivariable logistic regression to develop prediction models. We evaluated the classification performance of all models with receiver operating characteristics analysis. We performed subgroup analyses according to gestational age, birthweight centile and estimated fetal weight centile. Main outcome measures: Composite adverse perinatal outcome, defined as perinatal death, caesarean section for fetal distress or neonatal unit admission. Results: Adverse outcomes occurred in 3423 (18%) participants. The model with UA PI alone resulted in an area under the curve (AUC) of 0.775 (95% CI 0.709–0.828) and with CPR alone in an AUC of 0.778 (95% CI 0.715–0.831). Addition of CPR to the UA PI model resulted in an increase in the AUC of 0.003 points (0.778, 95% CI 0.714–0.831). These results were consistent across all subgroups. Conclusions: Cerebroplacental ratio added no predictive value for adverse perinatal outcome beyond UA PI, when assessing singleton pregnancies, irrespective of gestational age or fetal size. Tweetable abstract: Doppler measurement of cerebroplacental ratio in clinical practice has limited added predictive value to umbilical artery alone.

Original languageEnglish
Pages (from-to)226-235
Number of pages11
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume128
Issue number2
Early online date8 Jun 2020
DOIs
Publication statusPublished - 1 Jan 2021

Bibliographical note

Acknowledgement
We would like thank Dr F. Figueras, Prof. E. Gratacos, Dr F. Crispi and Dr J. Miranda for sharing data for this project.
The CPR IPD Study Group: Asma Khalil (Fetal Medi- cine Unit, St George’s Hospital Medical School and St George’s University of London, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Lon- don, UK), Basky Thilaganathan (Fetal Medicine Unit, St George’s Hospital Medical School and St George’s Univer- sity of London, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK), Ozhan M Turan (Departments of Obstetrics, Gynecology and Repro- ductive Sciences, University of Maryland School of Medi- cine, Baltimore, MD, USA), Sarah Crimmins (Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA), Chris Harman (Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA), Alis- son M Shannon (Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA), Sailesh Kumar (School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Mater Research Institute – University of Queensland, South Brisbane, QLD, Australia), Patrick Dicker (Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland), Fergal Malone (Departments of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland), Elizabeth C Tully (Departments of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland), Julia Unterscheider (Department of Maternal Fetal Medicine, The Royal Women’s Hospital, Melbourne, VIC, Australia), Isabella Crippa (Department of Obstetrics and Gynaecology, University of Milano-Bicocca, Monza, Italy), Alessandro Ghidini (Department of Obstetrics and Gynae- cology, University of Milano-Bicocca, Monza, Italy), Nadia Roncaglia (Department of Obstetrics and Gynaecology, University of Milano-Bicocca, Monza, Italy), Patrizia Ver- gani (Department of Obstetrics and Gynaecology, Univer- sity of Milano-Bicocca, Monza, Italy), Amarnath Bhide (Fetal Medicine Unit, St George’s Hospital Medical School and St George’s University of London, London, UK), Fran- cesco D’Antonio (Fetal Medicine Unit, St George’s Hospital Medical School and St George’s University of London, London, UK), Gianluigi Pilu (Policlinico S. Orsola-Mal- pighi, University of Bologna, Bologna, Italy), Alberto Galindo (Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Com- plutense University of Madrid, Madrid, Spain), Ignacio Herraiz (Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Com- plutense University of Madrid, Madrid, Spain), Alicia Vazquez-Sarandeses(FetalMedicineUnit-SAMID,Depart- ment of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain), Cath- rine Ebbing (Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway), Synnøve L Johnsen (Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway), Henriette O Karlsen (Research Group for Pregnancy, Fetal Develop- ment and Birth, Department of Clinical Science, University of Bergen, Bergen, Norway).

Keywords

  • Cerebroplacental ratio
  • Doppler
  • fetal growth restriction
  • individual participant data
  • meta-analysis
  • middle cerebral artery
  • prognostic accuracy

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