Late-Breaking Abstract Presentations
Laura A. Lens, MD (she/her/hers)
PhD candidate
Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Selina Posthuma, MD, MSc
PhD student
Uiversity Medical Center Groningen
University Medical Center Groningen, Groningen, Netherlands
Stefanie E. Damhuis, MD, PhD
MD, PhD, postdoctoral researcher
Amsterdam University Medical Centers
Amsterdam University Medical Centers, Noord-Holland, Netherlands
Renée J. Burger, MD, PhD
Researcher
Amsterdam UMC
Amsterdam, Noord-Holland, Netherlands
Henk Groen, MD, PhD
Assistant Professor in Epidemiology
University Medical Center of Groningen
University Medical Center of Groningen, Groningen, Netherlands
Ruben G. Duijnhoven, PhD
Amsterdam UMC, location University of Amsterdam
Amsterdam, Noord-Holland, Netherlands
Sailesh Kumar, FRCOG, FRCS, MBBS, PhD (he/him/his)
Professor of Obstetrics & Gynaecology
The University of Queensland
Brisbane, Queensland, Australia
.jpg "Alexander E.P Heazell, MD, PhD (he/him/his) photo")
Alexander E.P Heazell, MD, PhD (he/him/his)
Professor of Obstetrics
The University of Manchester
Manchester, England, United Kingdom
.jpg "Asma Khalil, MD, MSc (she/her/hers) photo")
Asma Khalil, MD, MSc (she/her/hers)
Professor of Maternal Fetal Medicine
Fetal Medicine Unit, St George's Hospital, St George's University of London
Fetal Medicine Unit, St George's Hospital, St George's University of London, England, United Kingdom
Wessel Ganzevoort, MD, PhD
Amsterdam University Medical Centers
Amsterdam, Groningen, Netherlands
Sanne J. Gordijn, MD, PhD
Gynecologist perinatologist (MFM)
University Medical Center Groningen
Groningen, Groningen, Netherlands
Routine assessments in near-term pregnancies often fail to accurately detect fetal compromise due to placental insufficiency, especially in non-small for gestational age fetuses. The cerebroplacental ratio (CPR) serves as a potential indicator of placental insufficiency and adverse outcomes. This study aims to evaluate whether expedited birth in women with reduced fetal movements, potentially a sign of placental insufficiency, and low CPR improves neonatal outcomes.
Study Design:
In this international, multicenter, cluster-randomized controlled trial, we randomly assigned 22 Dutch and 1 Australian hospitals to CPR-based management (i.e. expedited birth in case of CPR < 1.1) and concealed CPR measurement with routine clinical care in case of reduced fetal movements at term (37+0 to 40+6 weeks’ gestation). Women were eligible to participate in the trial if the fetus was estimated to be above the 10th percentile, if cardiotocography was normal, and if there were no other reasons necessitating expedited birth within 4 days. Primary outcome was a composite of severe adverse perinatal outcomes: stillbirth, neonatal mortality, 5-minute Apgar score < 7, umbilical artery pH < 7.10, emergency birth for fetal distress and/or severe neonatal morbidity.
Results:
From July 2020 to September 2024, 1816 women participated in the trial. 1676 Women with complete data were included in the intention to treat analysis. In preliminary data, the composite of severe adverse perinatal outcomes occurred in 99 (11.7%) of 849 participants who received CPR-based management versus in 127 (15.4%) of 827 participants in the concealed CPR group (relative risk 0.76; 95% confidence interval 0.58 to 0.99, Figure 1, Table 1). This was mainly driven by a reduction in severe neonatal morbidity, Apgar score < 7, umbilical artery pH < 7.10 and/or emergency birth for fetal distress.
Conclusion:
In women presenting with perceived reduced fetal movements at term in non-small for gestational age fetuses, CPR-based management, i.e. expedited delivery if CPR < 1.1 and expectant management if CPR > 1.1, reduced severe adverse perinatal outcomes.
