International Journal of Clinical Obstetrics and Gynaecology
2021, Vol. 5, Issue 4, Part C
Predictive value of cerebro-uterine ratio for neonatal outcome in hypertensive disorders of pregnancy
Author(s): Dr. Kanika Sharma, Dr. Bishan Dhiman and Dr. Nishi Sud
Abstract: Hypertensive disorders have a 5-10% incidence in pregnancy and are associated with considerable perinatal morbidity and mortality. It has been hypothesized that, the earliest pathology starts with the impaired conversion of spiral arteries to uteroplacental arteries. The problem starts in uterine circulation and is eventually reflected in the cerebral circulation. Increased blood supply to foetal brain is one of the compensatory mechanisms in cases of decreased placental blood flow. Brain sparing is maximum 2-3 weeks before late decelarations appear on CTG. Hence, patients with high risk of unfavourable outcomes can be identified 2-3 weeks earlier and early intervention may be done. Cerebro-uterine ratio which is the ratio of pulsatility index of Middle cerebral artery and mean pulsatility indices of bilateral uterine arteries decreases with gestational age. A value less than 5th percentile for a gestational age, particularly in third trimester of pregnancy is a marker for poor perinatal outcome. There were 65% patients with pre-eclampsia, and the rest were diagnosed with gestational hypertension. The relationship between CUR and birth weight statistically significant with a p value of 0.04. The relationship between CUR and still birth and that with low APGAR score at 5 minutes of life was also significant with a p-value of 0.01 and 0.009 respectively. It was also found that among the 13 neonatal mortalities in our study group, 69.2% had a Cerebro-uterine ratio of less than 5th percentile for their gestational age at delivery. The p-value was 0.009. Cerebro-uterine ratio has a high sensitivity for predicting neonatal mortality (69.2%) and for predicting low APGAR score at 5 minutes of life. The specificity was highest for the prediction of NICU admissions for more than 2 days (87.7%). Hence, cerebro-uterine ratio can be a good tool in deciding mode and time of termination of hypertensive pregnancies and for appropriate preparation for management of possible neonatal complications.
Dr. Kanika Sharma, Dr. Bishan Dhiman, Dr. Nishi Sud. Predictive value of cerebro-uterine ratio for neonatal outcome in hypertensive disorders of pregnancy. Int J Clin Obstet Gynaecol 2021;5(4):154-159. DOI: 10.33545/gynae.2021.v5.i4c.978