The Role of Cerebroplacental Ratio in Monitoring Fetal Well-Being and Predicting Adverse Outcomes in Healthy and High-Risk Pregnancies in Pakistan

Abstract

Objective: To assess the role of the cerebroplacental ratio (CPR) in determining fetal well-being across healthy and high-risk pregnancies in Pakistan, with a focus on its predictive value for adverse perinatal outcomes such as fetal growth restriction (FGR), preterm birth, and neonatal intensive care unit (NICU) admission.

Study Design: Prospective observational study.

Place and Duration of Study: The study was conducted at the Obstetrics Department of Agha Khan Hospital Hyderabad and Civil Hospital Hyderabad, between July 2024 and December 2024.

Methodology: A total of 64 pregnant women were enrolled and divided equally into four groups of 16 participants: Group 1 (Healthy pregnancies), Group 2 (Pre-eclampsia), Group 3 (Eclampsia), and Group 4 (Diabetes Mellitus). Doppler ultrasound was used to measure the pulsatility indices (PI) of the middle cerebral artery (MCA) and the umbilical artery (UA). The cerebroplacental ratio (CPR) was calculated as the ratio of MCA PI to UA PI. A CPR value of less than 1.0 was considered abnormal and indicative of fetal compromise. Data on perinatal outcomes, including preterm birth, FGR, neonatal Apgar scores, NICU admission, and mode of delivery were collected. Data were analyzed using SPSS Version 25. Statistical significance was defined by a p-value of less than 0.05.

Results: High-risk pregnancies showed significantly lower mean CPR values compared to healthy pregnancies. The mean CPR values were: 1.8 ± 0.3 in the healthy group, 0.85 ± 0.15 in pre-eclampsia, 0.82 ± 0.18 in eclampsia, and 0.95 ± 0.2 in diabetes mellitus (p < 0.001). Adverse perinatal outcomes were more prevalent in high-risk groups. Preterm birth occurred in 37.5% of pre-eclampsia cases, 43.75% of eclampsia cases, and 31.25% of diabetic pregnancies, compared to 6.25% in the healthy group. FGR was observed in 31.25%, 37.5%, and 25% of the pre-eclampsia, eclampsia, and diabetes groups, respectively, while it was absent in the healthy group. NICU admission rates were 25%, 31.25%, and 18.75% in pre-eclampsia, eclampsia, and diabetes groups, respectively, compared to 3.1% in healthy pregnancies. The cesarean delivery rate was highest in eclampsia (62.5%), followed by pre-eclampsia (56.25%) and diabetes mellitus (43.75%), compared to 12.5% in healthy pregnancies. Logistic regression analysis indicated that a CPR below 1.0 was strongly associated with an increased risk of preterm birth (odds ratio: 4.5) and FGR (odds ratio: 3.8).

Conclusion: The cerebroplacental ratio is a crucial tool for predicting adverse perinatal outcomes in high-risk pregnancies. Its integration into routine antenatal care enables early detection of fetal compromise and supports timely clinical interventions, thereby reducing perinatal morbidity and mortality in resource-constrained healthcare settings in Pakistan.