Re-evaluating the role of cerebroplacental ratio in predicting adverse perinatal outcome

Aim: This meta-analysis evaluates the use of cerebroplacental ratio (CPR) in predicting adverse perinatal outcome. Methods: An electronic search of PubMed, Embase, Google scholar, Cochrane Library and Up-to-Date was done using variations of 'cerebroplacental ratio' and 'cerebroumbilical ratio'. We included studies where CPR was measured and postpartum outcomes were available. Selected articles were evaluated for quality of study methodology using the Newcastle-Ottawa Scale, and aggregate statistics for relative risks, odds ratios and 95% confidence interval were calculated. Results: Data from 66,392 patients in 47 studies was extracted. There were 25 prospective, 17 retrospective and 5 case-control studies. Data on each obstetric or perinatal outcome was separately analysed. When analysing the prospective data, it showed abnormal CPR can predict the need for operative delivery due to foetal distress [RR: 2.52, 95%Cl: 2.10-3.02; I-2 = 65.78, P < 0.001], low pH [RR: 2.19, 95%Cl: 1.01-4.75; 1 2 = 70.26, P = 0.005] and low Apgar score [RR: 2.05, 95%Cl: 1.39-3.03; I-2 = 37.15, P = 0.10], foetal or neonatal demise [RR: 2.49, 95%Cl: 1.00-6.20], as well as NICU admission [RR: 2.23, 95% CI: 1.84-2.70; I-2 48.53, P = 0.14].The retrospective data showed a statistically significant correlation in all outcomes but the low pH. Conclusion: Our meta-analysis shows that CPR can be used to identify foetuses with higher risk of operative delivery due to foetal distress, low Apgar score, NICU admission, neonatal morbidity as well as stillbirth and neonatal death rates. (C) 2019 Elsevier B.V. All rights reserved.