Systematic review evaluating the efficacy of the cerebroplacental ratio (CPR) in saving babies lives.

Introduction: The aim of this systematic review is to critically assess the efficacy of the cerebroplacental ratio performed in the third trimester at predicting adverse perinatal outcomes and reducing stillbirth rates. Method: The literature search was performed using CINAHL, EMBASE, EMCARE, MEDLINE and PubMed including systematic reviews, retrospective and prospective studies from inception until July 2020 utilising the PRISMA checklist and flowchart. Data displaying sensitivities, specificity and odds ratios (OR) to include 95% confidence interval (CI) were extracted and synthesised. Findings: Initially, 1226 studies were identified, and nine studies met the inclusion criteria. Sample sizes ranged from 491 to 9772 pregnancies. The cerebroplacental ratio had the strongest diagnostic accuracy of all of the independent variables for detecting fetal demise (mean sensitivity and specificity; 79% and 78%). The cerebroplacental ratio, however, did not perform as favourably at predicting operative delivery (mean sensitivity and specificity; 59% and 82%) or anticipating admission to the neonatal intensive care unit (mean sensitivity and specificity; 55% and 74%). Discussion: The results from this study showed that the cerebroplacental ratio within third trimester pregnancies has been proven to have moderate to high diagnostic value when detecting adverse perinatal outcomes, in particular fetal demise. Conclusion: Cerebroplacental ratio has the potential as a diagnostic tool to reduce adverse perinatal outcomes, in particular fetal demise and help reduce stillbirth rates. The main study limitation involved heterogeneity within the included studies, in particular with a regard to blinding.