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Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study

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Abstract
Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies. Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were converted into centiles correcting for gestational age. These data were not available for the obstetrical team and hence, could not influence management decisions. Primary outcomes were operative delivery for presumed fetal compromise and a composite neonatal outcome (arterial cord Ph < 7.20, Apgar scores at 5 minutes < 7 and neonatal intensive care unit (NICU) admission). Neonates were categorized according to CPR values (<10th centile, between 10th and 90th centile and >90th centile). Results: Three hundred fifteen women were recruited in this study. We ecxluded 32 pregnancies because of small for gestational age babies (SGA), leaving 293 women and 583 CPR values for data-analysis. There were 85 (27%) adverse neonatal outcomes and 29 patients (9%) underwent operative delivery for presumed fetal compromise. Both primary and secondary outcomes were not significant different between the different CPR groups. Furthermore, we examined if individual serial CPR measurements could predict adverse outcome and found no linear correlation between repeated measurements of CPR and adverse outcomes. Conclusion: Our study shows that routine serial screening by CPR measurements provides poor prediction for adverse perinatal outcome in uncomplicated pregnancies.

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Chicago
Page, Ann-Sophie, Geert Page, Isabelle Dehaene, Ellen Roets, and Kristien Roelens. 2017. “Can the Cerebroplacental Ratio (CPR) Predict Intrapartum Fetal Compromise? : a Prospective Observational Study.” Clinical Obstetrics Gynecology and Reproductive Medicine 3 (5): 1–6.
APA
Page, A.-S., Page, G., Dehaene, I., Roets, E., & Roelens, K. (2017). Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study. CLINICAL OBSTETRICS GYNECOLOGY AND REPRODUCTIVE MEDICINE, 3(5), 1–6.
Vancouver
1.
Page A-S, Page G, Dehaene I, Roets E, Roelens K. Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study. CLINICAL OBSTETRICS GYNECOLOGY AND REPRODUCTIVE MEDICINE. 2017;3(5):1–6.
MLA
Page, Ann-Sophie, Geert Page, Isabelle Dehaene, et al. “Can the Cerebroplacental Ratio (CPR) Predict Intrapartum Fetal Compromise? : a Prospective Observational Study.” CLINICAL OBSTETRICS GYNECOLOGY AND REPRODUCTIVE MEDICINE 3.5 (2017): 1–6. Print.
@article{8546144,
  abstract     = {Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies.
Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were converted into centiles correcting for gestational age. These data were not available for the obstetrical team and hence, could not influence management decisions. Primary outcomes were operative delivery for presumed fetal compromise and a composite neonatal outcome (arterial cord Ph {\textlangle} 7.20, Apgar scores at 5 minutes {\textlangle} 7 and neonatal intensive care unit (NICU) admission). Neonates were categorized according to CPR values ({\textlangle}10th centile, between 10th and 90th centile and {\textrangle}90th centile).
Results: Three hundred fifteen women were recruited in this study. We ecxluded 32 pregnancies because of small for gestational age babies (SGA), leaving 293 women and 583 CPR values for data-analysis. There were 85 (27\%) adverse neonatal outcomes and 29 patients (9\%) underwent operative delivery for presumed fetal compromise. Both primary and secondary outcomes were not significant different between the different CPR groups. Furthermore, we examined if individual serial CPR measurements could predict adverse outcome and found no linear correlation between repeated measurements of CPR and adverse outcomes.
Conclusion: Our study shows that routine serial screening by CPR measurements provides poor prediction for adverse perinatal outcome in uncomplicated pregnancies.},
  author       = {Page, Ann-Sophie and Page, Geert and Dehaene, Isabelle and Roets, Ellen and Roelens, Kristien},
  issn         = {2059-4828},
  journal      = {CLINICAL OBSTETRICS GYNECOLOGY AND REPRODUCTIVE MEDICINE},
  language     = {eng},
  number       = {5},
  pages        = {1--6},
  title        = {Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study},
  url          = {http://dx.doi.org/10.15761/COGRM.1000198},
  volume       = {3},
  year         = {2017},
}

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