EVALUATING CEREBROPLACENTAL RATIO AND UTERINE ARTERIES DOPPLER IN LOW-RISK SINGLETON TERM PREGNANCIES

Abstract

Accurate identification of pregnancies at risk for intrapartum hypoxia is pivotal for effective obstetric management. Nevertheless, prevailing strategies often fall short in precisely predicting hypoxic-related complications in low-risk singleton term pregnancies. This study scrutinizes the efficacy of amalgamating the cerebroplacental ratio (CPR) and uterine artery Doppler in forecasting obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) among low-risk singleton term pregnancies in early labor. A prospective observational study spanning maternity units at Krishna Hospital, karad was conducted from January 2021 to September 2023. Enrolled were low-risk term pregnancies with spontaneous labor onset. A two-step multivariable model was crafted to assess the OI risk for suspected IFC. The baseline model encompassed antenatal and intrapartum characteristics, while the combined model integrated these aspects with abnormal CPR and mean uterine artery pulsatility index (UtA PI). Receiver-operating characteristics (ROC) curve analysis unveiled that the combined model, entailing antenatal characteristics along with abnormal CPR and mean UtA PI, yielded a significantly elevated area under the curve (AUC) in contrast to the baseline model. The combined model showcased a sensitivity of 0.80 (95 % CI 0.68–0.90), specificity of 0.70 (95 % CI 0.67–0.74), positive predictive value (PPV) of 0.18 (95 % CI 0.14–0.22), negative predictive value (NPV) of 0.97 (0.95–0.98), likelihood ratio positive (LR+) of 2.38 (95 % CI 1.98–2.86), and likelihood ratio negative (LR-) of 0.40 (95 % CI 0.24–0.64) for OI due to suspected IFC. The predictive model, amalgamating antenatal and intrapartum characteristics with abnormal CPR and mean UtA PI, exhibits a commendable capability to rule out and a moderate capability to rule in OI due to IFC, albeit with suboptimal predictive value. This integrated assessment methodology shows promise in refining the antepartum identification of pregnancies at risk for intrapartum fetal compromise among low-risk singleton term pregnancies.