O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 13 O&G Forum 2021; 31: 11 - 14 ORIGINAL RESEARCH Table 4. Major adverse outcomes (stillbirth, the need for a ventilator & preterm birth) of the both groups according to Doppler indices Parameter Sensitivity (95% CI) Specificity (95% CI) Positive Predictive (95% CI Value) Negative Predictive Value (95% CI) Accuracy (95% CI) MCA PI <1.5 85.71 (71.46-94.57) 52.00 (31.31-72.20) 75.00 (66.20-82.13) 68.42 (48.55-83.26) 73.13 (60.90-83.24) CPR PI <1 95.35 (84.19-99.43) 40.00 (21.13-61.33) 73.21 (66.35-79.12) 83.33 (54.33-95.46) 75.00 (63.02-84.81) Table 4. Major adverse outcomes (stillbirth, the need for a ventilator & preterm birth) of the both groups according to Doppler indices Parameter Sensitivity (95% CI) Specificity (95% CI) Positive Predictive (95% CI Value) Negative Predictive Value (95% CI) Accuracy (95% CI) MCA PI <1.5 88.24 (72.55-96.70) 52.94 (35.1-70.22) 65.22 (56.26-73.22) 81.82 (62.96-92.26) 70.59 (58.29-81.02) CPR PI<1 94.12 (80.32-99.28) 29.41 (15.10-47.48) 57.14 (51.37-62.72) 83.33 (54.18-95.48) 61.76 (49.18-73.29) Note: CI: confidence interval, MCA: middle cerebral artery, CPR: cerebroplacental ratio Note: CI: confidence interval, MCA: middle cerebral artery, CPR: cerebroplacental ratio Discussion Various studies have noticed similar poor neonatal outcomes in fetuses with abnormal Doppler velocimetry. Our study revalidates the findings. In a study by Kant et al. (2017) on low-risk and high- risk pregnancies, MCA / UA PI ratio with a single cutoff value \ 1.00 has achieved high specificity and positive predictive value of 100.0 and 100.0% each with relatively low sensitivity. It was concluded from this study that the cerebroplacental ratio is highly sensitive in the diagnosis of hemodynamically impaired fetuses and is useful for predicting perinatal outcomes in these neonates. 6 These results are in line with the results of the present study. In both studies, it was shown that in the group of high-risk pregnancies, the number of pregnancies with CPR <1 was significantly higher than low-risk pregnancies. Both studies showed that CPR < 1 was associated with poor perinatal outcomes; so that the number of neonates with preterm delivery and hospitalization in the NICU in the high-risk group was significantly higher than the low-risk group. In general, both studies showed that CPR could be useful in predicting perinatal outcomes. Unlike Kant’s study, the rate of emergency cesarean section and Apgar score less than 7 was not significantly increase in our study. A retrospective cohort study was performed at a referral center over 14 years between 2000 and 2013 by Khalil to investigate the relationship between cerebroplacental ratio and the need for neonatal hospitalization in term pregnancies. 13 The rates of cesarean delivery and hospitalization in the neonatal ward were 17.2% and 3.9%, respectively. CPR was significantly lower in pregnancies requiring cesarean delivery and hospitalization in the neonatal ward (P <0.01). Multivariate logistic analysis of regression also showed that CPR was an independent predictor of the need for hospitalization in the neonatal ward (P = .021). It was concluded from this study that lower CPR, regardless of fetal size, is independently associated with the need for cesarean delivery and hospitalization in the neonatal ward. (13) Nassr and his colleagues in their study showed that fetuses with abnormal CPR were at higher risk of cesarean delivery for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. 14 Assessment of high-risk pregnancy only by umbilical artery Doppler is usually inadequate for predicting the perinatal outcomes. 15 Also, interpreting fetal MCA Doppler in isolation usually gives limited predictive accuracy for poor perinatal outcomes; as Morris et al. stated in their review, abnormal CPR is associated with high rates of adverse perinatal outcomes and among perinatal adverse events, CPR was more diagnostic for neonatal preterm birth and NICU admission. 16 They have found that abnormal CPR was associated with higher odds of poor perinatal outcomes among the subsets of high-risk pregnant women than those with normal pregnancy and CPR is a potentially useful tool for assessing perinatal outcomes in high-risk pregnancies. As a matter of fact, CPR is especially useful for suggesting poor outcomes in high-risk pregnancies. Conclusion In this study, we used MCA / UA PI ratio as the best Doppler index for predicting adverse perinatal outcomes in women with high-risk pregnancies. Well-timed interventions for those with abnormal Doppler lead to improved perinatal outcomes. Therefore, frequent Doppler studies in these indices can potentially be fruitful for reducing perinatal morbidity and mortality in high-risk cases. Repetitive noninvasive hemodynamic monitoring in pregnancy can significantly identify fetuses at risk and eventually be helpful for improving perinatal outcomes in complicated pregnancies. The results of this study showed that abnormal CPR was associated with adverse pregnancy outcomes, so that low CPR was significantly associated with the need for hospitalization in the NICU and preterm delivery. In general, it can be concluded that CPR can be a predictor of pregnancy outcomes in high-risk pregnancies. Conflict of Interest There is no conflict of interest to be declared. References 1. Soleimanizadeh L, Danesh A, Basri N, Abaszadeh A, Arab M. Assessment of high risk pregnancy in Bam Mahdieh maternity hospital. J. Shahrekord. Univ. Med. Sci. 2004; 6(2):67-73. [Persian] 2. Hasani M, Kermanshahi S. Assessing health care providers' views in health centers about barriers to the implementation of maternal care package in the third trimester: case study. Quarterly Journal of Nursing Management. 2013; 2(3):60-8. [Persian]