Comparison of three Doppler ratio indices for predicting adverse perinatal outcomes in late-onset fetal growth restriction

OBJECTIVE: To compare the predictive performance of three Doppler ratio indices-cerebroplacental ratio (CPR), cerebral-placental-uterine ratio (CPUR), and uteroplacental-cerebral ratio (UCPR)-for adverse perinatal outcomes in late-onset fetal growth restriction (FGR). METHODS: = 1000). AUC pairwise comparisons employed the DeLong test, and decision curve analysis (DCA) evaluated clinical utility. DCA demonstrated clinical benefit across threshold probabilities of 15-50%. CONCLUSIONS: In late-onset FGR, CPR, CPUR, and UCPR showed comparable predictive accuracy for adverse perinatal outcomes, each maintaining independent predictive value after adjustment for disease severity and gestational age. Statistically non-significant pairwise differences should not be interpreted as clinical equivalence; multicenter prospective studies are warranted. These indices may assist clinical decision-making in late-onset FGR management.