5 years ago

Cerebroplacental Ratio in Reduced Fetal Movements: Evidence for Worsening Fetal Hypoxemia

Asma Khalil, José Morales-Roselló, Julia Binder, Caitriona Monaghan, Baskaran Thilaganathan
Objective To investigate the fetal cerebroplacental ratio (CPR) in women presenting with reduced fetal movements (RFM). Methods This is a retrospective cohort study conducted over a 7-year period at a Fetal Medicine Unit at a tertiary referral centre. 4500 singleton pregnancies presenting with RFM after 36 weeks' gestation and 1527 control pregnancies at a similar gestation without RFM were analysed. Fetal biometry and Doppler parameters were recorded and converted into centiles and multiples of the median (MoM). The CPR was defined as the ratio between the middle cerebral artery (MCA) pulsatility index (PI) and the umbilical artery (UA) PI. Maternal and pregnancy characteristics were obtained from hospital records. Results The MCA PI MoM (median 0.95; IQR 0.84-1.09 vs 0.97; 0.86-1.11, p<0.001) and the CPR PI MoM (median 0.97; IQR 0.83-1.15 vs 0.99; 0.85-1.16, p=0.018) were significantly lower in pregnancies with RFM when compared to controls. Women presenting with multiple episodes of RFM, defined as ≥ 2 episodes, demonstrated significantly lower CPR PI MoM (median 0.90; IQR 0.81-1.12 vs 0.96; 0.84-1.08, p=0.021) compared to single episodes. Logistic regression analysis demonstrated a significant association between maternal age (OR 0.96, 95%CI 0.93-0.99), non-Caucasian ethnicity (OR 0.72; 95% CI 0.53- 0.97), estimated fetal weight (EFW) (OR 1.01; CI 1.00-1.02), CPR PI MoM (OR 0.24; 95% CI 0.12-0.47) and the risk of recurrent RFM. Conclusion Pregnancies complicated by multiple episodes of RFM show significantly lower CPR PI MoM and MCA PI MoM when compared to single episodes and controls. This is likely to represent evidence of worsening fetal hypoxemia in women presenting with recurrent RFM.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18830

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