Objectives: Cerebroplacental ratio (CPR) is emerging as an important predictor of adverse pregnancy outcome. This assessment tool is not routinely used and is mainly performed by fetomaternal specialists. In the management of high risk pregnancies, decision for delivery is compounded by maternal and foetal indications. At times, adverse perinatal outcomes such as stillbirth occur despite close monitoring of the pregnancy. In order to avoid such incidents, iatrogenic premature delivery is carried out. This may result in untoward morbidity due to prematurity, and occasionally mortality. The application of the CPR tool can assist in predicting foetal well-being in terms of hypoxia and cerebral redistribution aiding in decision to deliver.

Methods: For the past 6 months, our unit has applied the CPR in the management of high risk pregnancies. Cases such as severe preeclampsia, insulin dependent diabetes mellitus, intrauterine growth restriction, oligohydramnios and reduced foetal movements were subjected to Doppler assessments of the umbilical artery, middle cerebral artery, ductus venousus, umbilical vein and uterine artery. Only 1 clinician was involved in the usage of this tool. A CPR calculator which is available online was utilised (Fetal Medicine Barcelona).

Results: Usage of the CPR enabled prolongation of gestation of these high risk pregnancies by a few weeks, which would likely have been subjected to earlier delivery by the general obstetricians. Examples of cases managed will be presented. As this is a secondary hospital, high risk cases are not as many as in a tertiary centre.

Conclusion: The CPR is a useful tool in managing high risk pregnancies. It helps prevent inadvertent premature deliveries, thereby reducing adverse neonatal outcomes.