Accepted Article
Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcomes: a systematic review and meta-analysis
Charlotte A. Schreurs MD1, Marjon A. de Boer MD PhD1, Martijn W. Heymans PhD2, Linda J. Schoonmade MA3, Patrick M.M. Bossuyt Prof4, Ben Willem J. Mol Prof5,6, Christianne J.M. de Groot Prof1, Caroline J. Bax MD PhD7
Author affiliations: 1Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; 2Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; 3Department of Medical Library, Vrije Universiteit, Amsterdam, The Netherlands; 4Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands; 5Department of Obstetrics and Gynecology, The Robinson Institute, School of Medicine, University of Adelaide, Adelaide, Australia; 6The South Australian Health and Medical Research Institute, Adelaide, Australia; 7Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
Corresponding author: Charlotte A Schreurs, MD, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail:
[email protected]. Tel: +31 6 12303264
Disclosure: The authors did not report any potential conflicts of interest. Financial Disclosure: No financial support was received for this study. Acknowledgements: The authors thank Katja Jordanova, Marta Jozwiak, and Rui Wang for helping with translations. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.18809
This article is protected by copyright. All rights reserved.
Key words: Cerebroplacental ratio, middle cerebral artery, Doppler, fetal growth restriction, prognostic accuracy
Accepted Article
Running Head: Prognostic accuracy of CPR and MCA Doppler
Summary: Calculating the cerebroplacental ratio with middle cerebral artery Doppler can add value to assessment of umbilical artery Doppler by predicting adverse perinatal outcomes in singleton pregnancies. Clinical trials are needed to evaluate its clinical effectiveness in specific subgroups like late fetal growth restriction.
This article is protected by copyright. All rights reserved.
ABSTRACT
Accepted Article
Objective: Ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) Doppler is widely used as an additional method to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcomes. However, reported estimates of its accuracy vary considerably. We conducted a systematic review with metaanalysis of studies on the prognostic accuracy of CPR and MCA Doppler, and compared this to UA Doppler.
Methods: We queried PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov for studies on the prognostic accuracy of CPR or MCA Doppler for adverse perinatal outcomes in women with a singleton pregnancy of all risk profiles (from inception to June 2016). Risk of bias and concerns about applicability were assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) instrument. Meta-analysis was performed for multiple adverse perinatal outcomes. Hierarchal summary ROC curves were estimated. Prognostic accuracy of the tests was directly compared.
Results: We could include 128 studies (47,748 women). Risk of bias or suboptimal reporting was detected in 120/128 studies (94%) and substantial heterogeneity was found, which limited subgroup analyses for fetal growth and gestational age. Large variation was observed in reported sensitivities and specificities, and in used thresholds. CPR was significantly superior to UA Doppler in predicting composite adverse outcome (as defined in the included studies) (p
