Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta‐analysis

Journal article

Objective The cerebroplacental ratio (CPR) has been proposed for the routine surveillance of pregnancies with suspected fetal growth restriction (FGR), but the predictive performance of this test is unclear. The aim of this study was to determine the accuracy of the CPR for predicting adverse perinatal and neurodevelopmental outcomes in suspected FGR.

Methods: PubMed, EMBASE, CINAHL, and Lilacs (all from inception to July 31, 2017) were searched for cohort or cross‐sectional studies that reported on the accuracy of the CPR for predicting adverse perinatal and/or neurodevelopmental outcomes in singleton pregnancies with antenatally suspected FGR based on sonographic parameters. Summary receiver operating characteristic (ROC) curves, pooled sensitivities and specificities, and summary likelihood ratios (LRs) were generated.

Results: Twenty‐two studies (4301 women) met the inclusion criteria. Summary ROC curves showed that the best predictive accuracy of the CPR was for perinatal death and the worst was for neonatal acidosis, with areas under the summary ROC curves of 0.83 and 0.57, respectively. The predictive accuracy of the CPR was moderate‐to‐high for perinatal death (pooled sensitivity and specificity of 93% and 76%, respectively, and summary positive and negative LRs of 3.9 and 0.09, respectively), and low for composite of adverse perinatal outcomes, cesarean section for non‐reassuring fetal status, Apgar <7 at 5 minutes, admission to the neonatal intensive care unit, neonatal acidosis, and neonatal morbidities with summary positive and negative LRs ranging from 1.1‐2.5, and 0.3‐0.9, respectively. An abnormal CPR result had moderate accuracy for predicting small for gestational age at birth (summary positive LR of 7.4). The CPR had a higher predictive accuracy in pregnancies with suspected early‐onset FGR. No study provided data for assessing the predictive accuracy of the CPR for adverse neurodevelopmental outcomes.

Conclusion: The CPR appears to be useful in predicting perinatal death in pregnancies with suspected FGR. Nevertheless, before incorporating the CPR into the routine clinical management of suspected FGR, randomized controlled trials should assess whether the use of the CPR reduces perinatal death or other adverse perinatal outcomes.

Authors: Conde‐Agudelo, A; Villar, J; Kennedy, S; Papageorghiou, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Ultrasound in Obstetrics and Gynaecology
• Volume: 52
• Issue: 4
• Pages: 430-441
• Publication date: 2018-06-19
• Acceptance date: 2018-05-23
• DOI: 10.1002/uog.19117
• EISSN: 1469-0705
• Keywords: predictive accuracy; Doppler; fetal growth restriction; cerebroplacental ratio; neurodevelopmental outcomes; perinatal outcomes