Cerebroplacental-uterine ratio combined with ultrasound parameters for predicting perinatal outcomes in late-onset FGR.

OBJECTIVE

To investigate the predictive value of the cerebroplacental-uterine ratio (CPUR) combined with multiple ultrasound parameters for adverse perinatal outcomes (APOs) in late-onset fetal growth restriction (FGR).

METHODS

This retrospective study included 149 singleton pregnant women diagnosed with suspected late-onset FGR at our hospital from August 2023 to January 2025. Based on perinatal outcomes, they were divided into a non-adverse outcome group (105 cases) and an adverse outcome group (44 cases). Ultrasound parameters including umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), uterine artery pulsatility index (UtA-PI), cerebroplacental ratio (CPR), CPUR, aortic isthmus pulsatility index (AoI-PI), and estimated fetal weight (EFW) percentile were measured and compared between the two groups. Univariate analysis was used to screen significant variables, followed by binary logistic regression analysis to identify independent predictors. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of individual indicators and combined models.

RESULTS

The adverse outcome group had significantly higher levels of UA-PI, UtA-PI, AoI-PI, and a higher proportion of EFW <5th percentile compared to the non-adverse outcome group, while MCA-PI, CPR, and CPUR levels were significantly lower (all p < 0.001). Multivariate regression analysis showed that CPUR (OR = 0.061, 95% CI: 0.021-0.172), AoI-PI (OR = 14.003, 95% CI: 3.928-49.925), and EFW <5th percentile (OR = 3.386, 95% CI: 1.124-10.193) were independent predictors of APOs in late-onset FGR. ROC curve analysis revealed that the combined prediction model incorporating CPUR, AoI-PI, and EFW (<5th) had the best predictive performance, with an AUC of 0.932 (95% CI: 0.890-0.974), sensitivity of 84.1%, and specificity of 86.7%, outperforming any single indicator.

CONCLUSION

CPUR, AoI-PI, and EFW (<5th) are independent predictors of APOs in late-onset FGR. The combined prediction model constructed from these three parameters demonstrates high predictive value and may provide a reference for early identification of high-risk fetuses and optimization of perinatal management.