Preeclampsia is a hypertensive pregnancy illness linked to poor outcomes for the unborn child. While the “cerebrouterine ratio (CU)” is a new measure that represents both the uterine circulation of the mother and the cerebral circulation of the foetus, the “cerebroplacental ratio (CP)” is a well-established Doppler parameter for foetal assessment. The purpose of this research was to assess how well preeclamptic pregnancies' diagnostic features for CP and CU predicted unfavourable newborn outcomes. A prospective cohort research comprising 300 pregnant women at risk of preeclampsia. Doppler ultrasonography was used to calculate CP and CU. Preterm birth, IUGR, and perinatal mortality were examples of adverse neonatal outcomes. Diagnostic features were evaluated, and receiver operating characteristic (ROC) curves were produced. When the threshold was set at 0.85, CP showed excellent sensitivity and specificity, with an AUC of 0.82. CU demonstrated great specificity (91.3%) at the 0.80 threshold. Combining CP and CU improved risk categorization by offering a thorough evaluation of foetal well-being. CP and CU are useful instruments for evaluating risk in preeclampsia. With its high specificity, CU detects high-risk cases, whereas CP's sensitivity makes it a useful screening tool. Their complementary qualities improve risk assessment, supporting clinical judgment. More research is necessary to validate these results and determine the best cutoff values for various clinical settings. In preeclampsia, CP, and CU show promise as indicators of unfavourable neonatal outcomes. When used singly or in combination, they can enhance clinical management and risk assessment, which may improve outcomes for mothers and newborns in preeclamptic pregnancies.
TopIntroduction
Preeclampsia is a multisystem illness that causes end-organ failure and new-onset hypertension after 20 weeks of gestation. It is a major cause of morbidity and mortality in newborns and mothers globally (Bhide et al., 2013). Maternal-fetal medicine faces a difficult problem because it impacts 2-8% of pregnancies and is a major cause of preterm birth, IUGR, and stillbirth (Valensise et al., 2008; Lees et al., 2020). It is critical to find trustworthy indicators of poor newborn outcomes in preeclampsia in order to enhance care for both mothers and foetuses (Elaiyaraja et al., 2023).
An increased maternal inflammatory response, aberrant placental growth and function, and endothelial dysfunction are all components of the complex and multifactorial syndrome known as preeclampsia (Hasan Talukder et al., 2023). The varied clinical manifestations and consequences linked to preeclampsia are influenced by these underlying pathophysiological pathways (Gómez et al., 2008). Thus, in order to maximise the management of both the mother and the foetus in preeclamptic pregnancies, it is imperative to find and apply efficient risk classification strategies (Tak & Sundararajan, 2023).
Doppler sonography has become a useful method for evaluating the health of the foetus throughout pregnancy and may be able to identify preeclampsia-related problems early on. The CU ratio and the CP have drawn more attention recently as possible indicators of poor infant outcomes in preeclamptic pregnancies. CP evaluates the blood flow in the UA, which represents the placental circulation, and the foetal MCA, which represents the cerebral circulation. Contrarily, CU assesses the foetal MCA blood flow with respect to the uterine artery, which represents the uterine or maternal circulation. These ratios shed light on foetal hemodynamics and, consequently, overall health.
The goal of this research is to understand better how CU and CP work together to predict unfavourable outcomes for neonates born to preeclamptic mothers. It is crucial to comprehend the diagnostic properties of these ratios and how they predict perinatal outcomes in order to direct clinical practise and improve treatment for both mothers and foetuses. This research will examine the comparative diagnostic capabilities of CP and CU in the context of preeclampsia, as well as the scientific justification for their usage and their benefits. Preeclampsia is a severe manifestation of hypertensive problems during pregnancy, which is a serious global health concern. Maternal hypertension, proteinuria, and organ failure are linked to preeclampsia. It is a major source of illness and mortality in both mothers and perinatals, and it typically manifests itself in the second part of pregnancy, though it can happen earlier (Oloyede & Iketubosin, 2013). Preeclampsia can cause poor growth, preterm birth, stillbirth, and liver dysfunction in the mother as well as renal failure, stroke, and disseminated intravascular coagulation in the foetus (Gómez et al., 2005; Uzan et al., 2011).
Even with continued investigation, the exact cause of preeclampsia is still unknown. Most people agree that the illness progresses in two stages: aberrant placentation occurs in the first stage, and systemic inflammation and maternal endothelium dysfunction occur in the second stage (Alfirevic et al., 2017). Reduced placental perfusion, hypoxia, and the release of proinflammatory cytokines and antiangiogenic proteins (such as soluble fms-like tyrosine kinase-1) into the maternal circulation are caused by the shallow invasion of trophoblast cells into the maternal uterine spiral arteries during the early stages of pregnancy (Stampalija et al., 2010). The clinical signs of preeclampsia are exacerbated by these circulating substances, which also harm several organs and produce broad maternal endothelial dysfunction (Mol et al., 2016).