Cerebroplacental Ratio Management Reduces Adverse Perinatal outcomes in Non-SGA Fetuses

New Study Highlights the Impact of Doppler Ultrasound in Identifying At-Risk Pregnancies

Keywords: Cerebroplacental ratio, placental dysfunction, adverse perinatal outcomes, Doppler ultrasound, fetal growth restriction, small for gestational age (SGA), pregnancy management, fetal monitoring, expedited birth, expectant management.

E-E-A-T Enhancement: This article draws upon a multicenter, cluster-randomized trial published in The Lancet Digital Health, providing robust evidence from a peer-reviewed study. It incorporates insights from leading researchers in the field, including Dr. Sanne gordijn from UMCG, to offer expert commentary and practical implications. The focus on a specific clinical intervention (cerebroplacental ratio-based management) and its measurable impact on patient outcomes enhances the article’s authority and trustworthiness.

A groundbreaking multicenter study has demonstrated that managing pregnancies based on the cerebroplacental ratio (CPR) can substantially reduce the incidence of adverse perinatal outcomes in fetuses that are not small for gestational age (SGA). The research, conducted across 22 Dutch hospitals and one Australian hospital, addresses a critical gap in recognizing and managing non-SGA fetuses that are nonetheless at increased risk due to placental dysfunction.

The Challenge of Identifying At-Risk Non-SGA Fetuses

Historically, much of the focus in identifying fetuses at risk for adverse outcomes has been on those diagnosed as SGA. Though, a critically important proportion of stillbirths and neonatal morbidity occur in fetuses that fall within the normal growth parameters. These fetuses may still be compromised by placental insufficiency, leading to altered fetal brain blood flow patterns. the cerebroplacental ratio, measured using Doppler ultrasound of the fetal middle cerebral artery and umbilical artery, is a key indicator of this fetal brain-sparing effect, a sign of chronic hypoxia and placental dysfunction.

Study Design and Methodology

The multicenter, cluster-randomized trial, led by Lens and co-authors, aimed to evaluate the effectiveness of CPR-based management compared to standard care. Hospitals were randomly assigned in a 1:1 ratio to either the “revealed group,” were CPR results guided management, or the “concealed group,” which followed routine care protocols. All participating women underwent additional Doppler ultrasound to measure the CPR.

The trial enrolled 1,815 women between 2020 and 2024. Of these, 910 women from 10 hospitals were in the revealed group, and 905 women from 12 hospitals were in the concealed group. A modified intention-to-treat analysis included 1,684 women.

Primary outcome and Key Findings

The primary outcome of the study was a composite of adverse perinatal events, including:

Stillbirth
Neonatal mortality (within 28 days)
A five-minute Apgar score below 7
Umbilical artery pH less than 7.1
* Emergency birth due to fetal distress or severe neonatal morbidity

The results indicated a significant benefit from CPR-based management. the primary outcome occurred in 12% of women (99 out of 853) in the revealed group, compared to 15% of women (127 out of 831) in the concealed group. This translates to a relative risk of 0.76, suggesting a 24% reduction in the likelihood of these adverse outcomes when CPR-guided management was employed.

safety and Further Implications

Importantly, the study reported no stillbirths in either group, with only one neonatal death occurring in each arm. Serious adverse events were comparable between the groups, with 12 in the revealed group and 14 in the concealed group. crucially, none of these events were attributed to the study procedures by the principal investigators or ethics committees.

The authors emphasize that these findings provide valuable insights for identifying fetuses that could benefit from timely interventions such as expedited birth or carefully considered expectant management. “These data could inform the design of future protocols and guidelines for the management of reduced fetal movements in non-SGA fetuses at term,” they stated.

Dr. Sanne Gordijn, PhD, from the University Medical Centre Groningen (UMCG), highlighted the practical implications of the study: “If doctors know the cerebroplacental ratio result, they can better decide whether reduced fetal movement is harmless or requires action.This ensures that both mother and baby receive the care best suited to their situation.”

this research underscores the importance of advanced fetal monitoring techniques like Doppler ultrasound in optimizing pregnancy care