Evaluation of cerebroplacental ratio as a new tool to predict adverse perinatal outcomes in patients with isolated oligohydramnios

Abstract

Aim: There is conflicting information in the literature regarding perinatal outcomes and management of isolated oligohydramniotic (IO) pregnancies. Recent studies show that IO is associated with poor perinatal outcomes. However, there is still no definitive method for deciding the optimal delivery timing for these patients. In this study, we aimed to assess the relationship between Doppler parameters, especially cerebro-placental ratio, and perinatal outcomes in isolated oligohydramnios (IO) patients. Methods: This prospective case control study was conducted between October-November 2018. A total of 98 patients were recruited and divided into two groups, as pregnant women with normal amounts of amniotic volume and the isolated oligohydramnios group. Oligohydramnios diagnosis was made by amniotic fluid index measurement (AFI<5 cm). Pregnancies with hypertension, fetal growth restriction, thrombophilia, preeclampsia, diabetes mellitus, preterm births and chromosomal/structural abnormalities were excluded. Cerebro placental ratios of groups were compared in terms of composite adverse outcomes, low APGAR score in 1st and 5th minutes, C/S operation due to non-reassuring fetal heart rate patterns, admission to neonatal intensive care unit and still births. Results: In the isolated oligohydramnios group (n=45) cerebro-placental ratio (CPR) was lower compared to control group (P<0.001). IO was associated with lower (APGAR score<7) 1st (55.6% vs. 7.5%, P<0.001) and 5th (13.3% vs. 1.9% P=0.028) minute APGAR scores and higher rates of NICU admission (26.7% vs. 3.8% P=0.001). Number of fetal distress cases was higher in patients with low CPR in the IO group (9 vs. 6 P=0.023). Conclusion: Measurement of CPR among IO patients seems useful for detection of fetuses with higher risk for poor neonatal outcomes.

Keywords

• Cerebroplacental ratio
• CPR
• Isolated Oligohydramnios
• Perinatal Outcome
• Fetal Doppler

Serebroplasental oranın izole oligohidroamniyoslu hastalarda kötü perinatal sonuçların öngörülmesindeki yeri

Öz

Amaç: İzole oligohidramniotik (IO) gebeliklerin perinatal sonuçları ve yönetimi ile ilgili literatürde hala çelişkili bilgiler mevcuttur. Son çalışmalarda ise IO’nun kötü perinatal sonuçlar ile ilişkili olduğu yönündedir. Yine de bu hastaların optimal doğum zamanlamasına karar vermek için elimizde hala kesin bir yöntem bulunamamaktadır. Biz de çalışmamızda IO hastalarında Doppler parametreleri, özellikle serebro-plasental oran ve perinatal sonuçlar arasındaki ilişkiyi değerlendirmektir. Yöntemler: Bu prospektif vaka kontrol çalışması Ekim-Kasım 2018 arasında gerçekleştirildi. Çalışmaya 98 hasta dahil edilmiştir. İzole oligohidroamnios ve normal amnion miktarı olan gebeler grubu olmak üzere iki gruba ayrıldı. Oligohidramnios tanısı amniyotik sıvı indeksi ölçümü ile konuldu (AFI <5 cm). Hipertansiyon, intrauterin büyüme kısıtlılığı, trombofili, preeklampsi, diyabet ve kromozomal / yapısal anormallikleri olan gebelikler çalışma dışı bırakıldı. Gruplar cerebroplasental oran (CPR) ölçümleri göz önüne alınarak; kompozit advers sonuçlar, 1. ve 5. dakikalarda düşük APGAR skoru, güven verici olmayan fetal kalp hızı paternlerine bağlı sezaryen (C/S) operasyonu, yenidoğan yoğun bakım ünitesine yatışı ve ölü doğumlar bakımından karşılaştırıldı. Bulgular: CPR <1,08 olan hastalarda fetal distress görülme oranı daha yüksekti (9'a karşı 6 P=0,023). İzole oligohidramnios grubunda (n=45) CPR kontrol grubuna göre daha düşük saptandı. Ayrıca IO, daha düşük (APGAR <7) 1. (%55,6 ve %7,5, P<0.001) ve 5. (%13,3 ve %1,9, P=0,028) dakika APGAR skorları ve daha yüksek YYBÜ kabul oranları ile (%26,7 ve %3,8, P=0,001) ilişkili idi. Sonuç: CPR ölçümü, IO hastalarında kötü neonatal sonuçlar açısından daha yüksek risk taşıyan fetüslerin saptanmasında yararlı görünmektedir.

Anahtar Kelimeler

• Serebroplasental oran
• CPR
• İzole oligohidramnios
• Perinatal sonuç
• Fetal Doppler

Kaynakça

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