Value of cerebroplacental ratio in predicting adverse perinatal outcome in uncomplicated twin pregnancies: a retrospective study

Abstract

Purpose

To evaluate the performance of the cerebroplacental ratio (CPR) in predicting operative delivery for intrapartum fetal compromise (OD for IFC) and adverse perinatal outcomes in uncomplicated twin pregnancies with attempted vaginal delivery.

Materials and Methods

This was a retrospective cohort study of 72 twin pregnancies in a single tertiary referral center between January 2018 and August 2024. All MCDA and DCDA twin pregnancies with an attempted vaginal delivery after 34+0 weeks were screened for eligibility and those without further risk factors were included in the study. Outcome parameters were OD for IFC and a composite of adverse perinatal outcomes (CAPO) including OD for IFC, 5-minute Apgar score <7, umbilical artery pH <7.10, or admission to the neonatal intensive care unit (NICU). The predictive performance of CPR was evaluated using ROC analyses and multivariable logistic regression.

Results

16 MCDA and 56 DCDA pregnancies met the inclusion criteria. CAPO of at least one of the twins occurred in 27 (37.5%) of the cases. ROC analyses showed that low CPR MoM of neither the presenting twin nor the second twin predicted CAPO. Similarly, the prediction of the need for OD for IFC of twin 2 was not possible using low CPR MoM as the predicting variable. However, logistic regression analyses showed that nulliparity and twin-to-twin delivery time interval were independently associated with CAPO.

Conclusion

Low CPR MoM was not predictive for CAPO or OD for IFC in uncomplicated twin pregnancies after 34 weeks of gestation. However, nulliparity and twin-to-twin delivery time interval were independently associated with CAPO.

Zusammenfassung

Ziel

Untersuchung der Assoziation zwischen der zerebroplazentaren Ratio (CPR) und der Notwendigkeit einer operativen Entbindung aufgrund eines intrapartalen fetalen Distress (OE wegen IFD) sowie schlechtem perinatalen Outcome in unkomplizierten Zwillingsschwangerschaften mit vaginalem Entbindungsversuch.

Material und Methode

Retrospektive Kohortenstudie von 72 Zwillingsschwangerschaften in einem Zentrum der Maximalversorgung zwischen Januar 2018 und August 2024. Es wurden MCDA- und DCDA-Schwangerschaften mit vaginalem Entbindungsversuch nach 34+0 SSW ohne weitere Risikofaktoren eingeschlossen. Outcome-Parameter waren OE wegen IFD oder das Vorliegen mindestens eines der folgenden Parameter (CAPO): OE wegen IFD, 5-Minuten-Apgar <7, Nabelarterien-pH <7,10 oder Aufnahme auf die Neugeborenen-Intensivstation. Die Vorhersagekraft der CPR wurde mittels ROC-Analyse bzw. multivariabler logistischer Regression untersucht.

Ergebnisse

16 MCDA- und 56 DCDA-Schwangerschaften wurden eingeschlossen. CAPO bei mindestens einem der Zwillinge trat in 27 Fällen (37,5%) auf. ROC-Analysen ergaben, dass weder ein niedrige CPR-MoM des führenden noch des zweiten Zwillings für CAPO prädiktiv war. Es zeigte sich ebenfalls keine Assoziation zwischen dem CPR-MoM mit der Notwendigkeit einer OE wegen IFD des zweiten Zwillings. In der logistischen Regression waren Nulliparität und das „Twin-to-twin Delivery Interval unabhängig mit dem Auftreten von CAPO assoziiert.

Schlussfolgerungen

Ein niedriges CPR-MoM war weder für CAPO noch für die Notwendigkeit einer OE wegen IFD prädiktiv. Jedoch waren Nulliparität und ein verlängertes „Twin-to-twin Delivery Interval“ mit dem Auftreten von CAPO assoziiert.

Keywords

Obstetrics - Cerebroplacental Ratio - Twin pregnancy - Adverse outcome - Operative delivery

Publication History

Received: 01 December 2024

Accepted after revision: 24 March 2025

Article published online:
09 April 2025

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