Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study

OBJECTIVE: To investigate the use of the fetal cerebroumbilical ratio to predict intrapartum compromise in appropriately grown fetuses. STUDY DESIGN: A prospective observational study set at Queen Charlotte's and Chelsea hospital, London, UK. Fetal biometry and Doppler resistance indices were measured in 400 women immediately before established labor. Labor was then managed according to local protocols and guidelines, and intrapartum and neonatal outcome details recorded. RESULTS: Infants delivered by cesarean section for fetal compromise had significantly lower cerebroumbilical ratios than those born by spontaneous vaginal delivery (1.52 vs 1.82, P <= .001). Infants with a cerebroumbilical ratio <10th percentile were 6 times more likely to be delivered by cesarean section for fetal compromise than those with a cerebroumbilical ratio >= 10th percentile (odds ratio, 6.1; 95% confidence interval, 3.03-12.75). A cerebroumbilical ratio >90th percentile appears protective of cesarean section for fetal compromise (negative predictive value 100%). CONCLUSION: The fetal cerebroumbilical ratio can identify fetuses at high and low risk of a subsequent diagnosis of intrapartum compromise, and may be used to risk stratify pregnancies before labor.