O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 11 O&G Forum 2021; 31: 11 - 14 ORIGINAL RESEARCH Prediction of pregnancy outcomes based on CPR index in normal and high-risk pregnancies Parichehr Pooransari, Nahid Rezaei Ali-abad Department of Gynaecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction E orts to promote the health of pregnant women are among current health priorities in all countries. One of the goals of antenatal care is to identify women at risk. A high-risk pregnancy is an obstetrical problem that a ects pregnancy and its outcome due to various diseases of the mother or fetus. In general, 10-25% of pregnancies can be considered high-risk, with more than half of maternal and infant deaths and prenatal disabilities occurring in these pregnancies. In addition to the adverse health e ects that high-risk pregnancies impose on mothers and infants, the economic e ects of this type of pregnancy should also be considered. 1-4 In general, insu cient placental perfusion leads to fetal hypoxia and symptoms of fetal redistribution along with increased cerebral, adrenal, and myocardial blood ow. Numerous reports have shown that in cases of progressive deterioration of the fetal condition, there is a progressive increase in fetal central blood ow. 5 e increased diastolic ow velocity of the fetal middle cerebral artery is also a sign of brain savings in chronic fetal hypoxia Doppler ultrasound is a non-invasive diagnostic device that can be used in the eld of fetal and prenatal examinations. 6 e use of Doppler ultrasound can probably signi cantly reduce perinatal mortality and morbidity as color Doppler ultrasound provides direct information about vascular resistance and indirect information about blood ow. Fetal Doppler is a valuable tool in the evaluation and management of high-risk pregnancies. As a compensatory mechanism for hypoxia, increased placental resistance and brain retention e ect can cause an abnormality of the CPR, which is the ratio between the MCA pulsatility index (PI) and UMA PI. Abnormal blood ow in UMA, MCA, or both can show normal PI values while CPR can show abnormal values. 7,8 Approximately 10 to 15% of cases of cerebral palsy are due to hypoxia during childbirth. 9 Despite the clinical signi cance of postpartum hypoxia, identifying fetuses at risk for cerebral palsy remains challenging. Extensive use of cardiotocography (CTG) during pregnancy has not reduced the incidence of cerebral palsy. 10 Most cases of cerebral palsy are born with a suitable weight for gestational age. 11 CPR is a unique fetal Doppler parameter for measuring reperfusion that can be associated with increased placental resistance and brain sparing e ect, which occurs as a compensatory mechanism for chronic hypoxia and increases blood ow to the brain. 12 Since color Doppler ultrasound provides information about vascular resistance and blood ow, and may therefore assist in identifying (normal sized) fetuses at risk of cerebral palsy. By conducting this study and con rming the e ectiveness of CPR in predicting perinatal outcomes, it could contribute a novel method to reduce perinatal mortality and morbidity. Martial and methods In this study, 68 patients with a singleton pregnancy between 30 and 36 weeks who referred to the Shohadaye Tajrish Hospital in 2019 to Abstract Background: The use of Doppler ultrasound has significantly reduced perinatal mortality and morbidity. Color Doppler ultrasound provides direct information about vascular resistance and indirect information about blood flow. The Cerebroplacental Ratio (CPR) is a unique fetal Doppler parameter for quantifying reperfusion that can be associated with increased placental resistance and brain sparing effect. Given the importance of this issue in reducing morbidity and perinatal mortality, we decided to conduct a study to evaluate the CPR in predicting perinatal outcomes. Method: In this study, 68 women with pregnancies between 30 and 36 weeks were examined for Doppler parameters. Half of the mothers had high-risk pregnancies (case group) and half had normal pregnancies (control group). Information about Apgar score, NICU hospitalization, the need for a ventilator, emergency cesarean section due to fetal distress, and type of delivery were collected and then the CPR was compared between the control and case groups according to different variables. Results: This study showed that 10 patients in the high-risk group had CPR<1 compared to 2 patients in the low-risk group, which was associated with poor neonatal outcomes, NICU hospitalization, and preterm delivery. Conclusion: Abnormal CPR is associated with adverse pregnancy outcomes and can be a predictor of pregnancy outcomes in high-risk pregnancies. Keywords: Cerebroplacental Ratio (CPR), Pulsatility index (PI), Middle Cerebral Artery, Umbilical Artery Correspondence N Rezael email: n_rezaei@sbmu.ac.ir