Women with severe pre-eclampsia or eclampsia more likely to have abnormal Cerebroplacental Ratio: Study
Hypertensive disorders of pregnancy (HDP) are known causes of placental insufficiency leading to adverse perinatal outcomes-over half (58.9%) of women with HDP at Mbarara Regional Referral Hospital have adverse perinatal outcomes. The cerebroplacental ratio (CPR) is an important noninvasive predictor of adverse perinatal outcomes because it considers both the umbilical artery (UA) and middle cerebral artery (MCA) Doppler velocimetry and provides valuable information about the hemodynamic status of the fetus. It has a high diagnostic accuracy in the detection of abnormal fetal wellbeing and can prevent approximately 30% of adverse perinatal outcomes. An abnormal CPR reflects the redistribution of cardiac output to the cerebral circulation and is predictive of adverse intrapartum and neonatal outcomes.
The cerebroplacental ratio (CPR) is an important predictor and prevents approximately 30% of these adverse perinatal outcomes. Authors determined the prevalence and factors associated with abnormal CPR among women with HDP at MRRH.
Authors conducted a cross-sectional study from December 2022 to May 2023 at the high-risk obstetrics unit of MRRH. They consecutively enrolled all women with hypertensive disorders and gestational ages ≥ 26 weeks and performed obstetric Doppler studies to document the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and then calculated the CPR as a ratio of the MCA-PI and UA-PI. The prevalence of women with an abnormal CPR ≤ 1 0 was expressed as a percentage. They used robust modified Poisson regression analysis to determine the factors associated with abnormal CPR.
Study enrolled 128 women with hypertensive disorders in pregnancy, with a mean age of 28 8±6 3 years. Of these, 67 (52.3%) had abnormal CPR. The factors associated with abnormal CPR were severe pre-eclampsia (adjusted prevalence ratio (aPR): 5.0, 95% CI: 1.28, 29.14) and eclampsia (aPR: 5.27, 95% CI: 1.11, 34.27).
This cross-sectional study determined the prevalence and factors associated with abnormal CPR among pregnant women with hypertensive disorders at a tertiary hospital in a low-resource setting in southwestern Uganda. Authors found that more than half (52.3%) of the women with HDP had abnormal CPR. Additionally, severe pre-eclampsia and eclampsia were independently associated with abnormal CPR by fivefold compared to gestational hypertension. Taken together, these findings build on prior studies in the setting that have documented high rates of adverse perinatal outcomes among women with HDP and highlight the need to implement routine obstetric Doppler studies with CPR assessment among women with HDP. These findings could guide the management of women with these conditions and aid in interventions to optimize perinatal outcomes.
This study highlights a high prevalence of abnormal CPR among women with HDP. Pregnant women with severe pre-eclampsia and eclampsia are more likely to have abnormal CPR. Obstetric Doppler studies with CPR maybe considered for the assessment of pregnant women with HDP, prioritizing those with severe pre-eclampsia and eclampsia. Authors recommend further research to assess perinatal outcomes among those with and without abnormal CPR to profile women with HDP at increased risk of adverse perinatal outcomes, which could aid in early intervention to improve outcomes. A matched case-control study with participants matched especially in terms of gestational age may also be considered to show an association between pre-eclampsia and abnormal CPR.
