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.
Tornes, Musa Kayondo; Wiley Journal of Pregnancy Volume 2024, Article ID
8895971, 8 pages https://doi.org/10.1155/2024
