PDF(Pubmed)
Abstract：
OBJECTIVE: Doppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. However, reported estimates of its accuracy vary considerably. The aim of this study was to review systematically the prognostic accuracies of CPR and MCA Doppler in predicting adverse perinatal outcome, and to compare these with UA Doppler, in order to identify whether CPR and MCA Doppler evaluation are of added value to UA Doppler.
METHODS: PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, from inception to June 2016, for studies on the prognostic accuracy of UA Doppler compared with CPR and/or MCA Doppler in the prediction of adverse perinatal outcome in women with a singleton pregnancy of any risk profile. Risk of bias and concerns about applicability were assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Meta-analysis was performed for multiple adverse perinatal outcomes. Using hierarchal summary receiver-operating characteristics meta-regression models, the prognostic accuracy of CPR vs MCA Doppler was compared indirectly, and CPR and MCA Doppler vs UA Doppler compared directly.
RESULTS: The search identified 4693 articles, of which 128 studies (involving 47 748 women) were included. 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. A large variation was observed in reported sensitivities and specificities, and in thresholds used. CPR outperformed UA Doppler in the prediction of composite adverse outcome (as defined in the included studies) (P < 0.001) and emergency delivery for fetal distress (P = 0.003), but was comparable to UA Doppler for the other outcomes. MCA Doppler performed significantly worse than did UA Doppler in the prediction of low Apgar score (P = 0.017) and emergency delivery for fetal distress (P = 0.034). CPR outperformed MCA Doppler in the prediction of composite adverse outcome (P < 0.001) and emergency delivery for fetal distress (P = 0.013).
CONCLUSIONS: Calculating the CPR with MCA Doppler can add value to UA Doppler assessment in the prediction of adverse perinatal outcome in women with a singleton pregnancy. However, it is unclear to which subgroup of pregnant women this applies. The effectiveness of the CPR in guiding clinical management needs to be evaluated in clinical trials. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
METHODS: PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, from inception to June 2016, for studies on the prognostic accuracy of UA Doppler compared with CPR and/or MCA Doppler in the prediction of adverse perinatal outcome in women with a singleton pregnancy of any risk profile. Risk of bias and concerns about applicability were assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Meta-analysis was performed for multiple adverse perinatal outcomes. Using hierarchal summary receiver-operating characteristics meta-regression models, the prognostic accuracy of CPR vs MCA Doppler was compared indirectly, and CPR and MCA Doppler vs UA Doppler compared directly.
RESULTS: The search identified 4693 articles, of which 128 studies (involving 47 748 women) were included. 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. A large variation was observed in reported sensitivities and specificities, and in thresholds used. CPR outperformed UA Doppler in the prediction of composite adverse outcome (as defined in the included studies) (P < 0.001) and emergency delivery for fetal distress (P = 0.003), but was comparable to UA Doppler for the other outcomes. MCA Doppler performed significantly worse than did UA Doppler in the prediction of low Apgar score (P = 0.017) and emergency delivery for fetal distress (P = 0.034). CPR outperformed MCA Doppler in the prediction of composite adverse outcome (P < 0.001) and emergency delivery for fetal distress (P = 0.013).
CONCLUSIONS: Calculating the CPR with MCA Doppler can add value to UA Doppler assessment in the prediction of adverse perinatal outcome in women with a singleton pregnancy. However, it is unclear to which subgroup of pregnant women this applies. The effectiveness of the CPR in guiding clinical management needs to be evaluated in clinical trials. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：多普勒超声评估脑胎盘比率（CPR）和大脑中动脉（MCA）被广泛用作脐动脉（UA）多普勒的辅助检查，以确定有不良围产期结局风险的胎儿。然而,报告的对其准确性的估计差异很大。这项研究的目的是系统地回顾CPR和MCA多普勒在预测不良围产期结局中的预后准确性。并将这些与UA多普勒进行比较，为了确定CPR和MCA多普勒评估是否对UA多普勒具有附加价值。
方法：PubMed，EMBASE,搜索了Cochrane图书馆和ClinicalTrials.gov，从开始到2016年6月，研究UA多普勒与CPR和/或MCA多普勒在预测具有任何风险的单胎妊娠妇女的不良围产期结局方面的预后准确性。使用QUADAS-2（诊断准确性研究质量评估-2）工具评估偏倚风险和对适用性的担忧。对多种不良围产期结局进行Meta分析。使用分层汇总接收者-操作特征元回归模型，间接比较了CPR与MCA多普勒的预后准确性，与CPR和MCA多普勒和UA多普勒直接比较。
结果：搜索确定了4693篇文章，其中包括128项研究(涉及47748名女性)。在120/128项研究（94%）中发现了偏倚或次优报告的风险，并发现了实质性的异质性。这限制了对胎儿生长和胎龄的亚组分析。在报告的敏感性和特异性方面观察到了很大的变化，以及使用的阈值。CPR在预测复合不良结局（如纳入研究中定义的）（P<0.001）和胎儿窘迫紧急分娩（P=0.003）方面优于UA多普勒。但在其他结果方面与UA多普勒相当。MCA多普勒在预测低Apgar评分（P=0.017）和紧急分娩胎儿窘迫（P=0.034）方面的表现明显差于UA多普勒。CPR在预测复合不良结局（P<0.001）和紧急分娩胎儿窘迫（P=0.013）方面优于MCA多普勒。
结论：使用MCA多普勒计算CPR可以为UA多普勒评估增加价值，以预测单胎妊娠妇女的不良围产期结局。然而,目前尚不清楚这适用于孕妇的哪个亚组。CPR在指导临床管理方面的有效性需要在临床试验中进行评估。©2017作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
方法：PubMed，EMBASE,搜索了Cochrane图书馆和ClinicalTrials.gov，从开始到2016年6月，研究UA多普勒与CPR和/或MCA多普勒在预测具有任何风险的单胎妊娠妇女的不良围产期结局方面的预后准确性。使用QUADAS-2（诊断准确性研究质量评估-2）工具评估偏倚风险和对适用性的担忧。对多种不良围产期结局进行Meta分析。使用分层汇总接收者-操作特征元回归模型，间接比较了CPR与MCA多普勒的预后准确性，与CPR和MCA多普勒和UA多普勒直接比较。
结果：搜索确定了4693篇文章，其中包括128项研究(涉及47748名女性)。在120/128项研究（94%）中发现了偏倚或次优报告的风险，并发现了实质性的异质性。这限制了对胎儿生长和胎龄的亚组分析。在报告的敏感性和特异性方面观察到了很大的变化，以及使用的阈值。CPR在预测复合不良结局（如纳入研究中定义的）（P<0.001）和胎儿窘迫紧急分娩（P=0.003）方面优于UA多普勒。但在其他结果方面与UA多普勒相当。MCA多普勒在预测低Apgar评分（P=0.017）和紧急分娩胎儿窘迫（P=0.034）方面的表现明显差于UA多普勒。CPR在预测复合不良结局（P<0.001）和紧急分娩胎儿窘迫（P=0.013）方面优于MCA多普勒。
结论：使用MCA多普勒计算CPR可以为UA多普勒评估增加价值，以预测单胎妊娠妇女的不良围产期结局。然而,目前尚不清楚这适用于孕妇的哪个亚组。CPR在指导临床管理方面的有效性需要在临床试验中进行评估。©2017作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
