{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:55:46Z","timestamp":1788555346498,"version":"build-2803163510"},"reference-count":36,"publisher":"BMJ","issue":"6","funder":[{"name":"Erasmus+ Programme EC"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,2,23]]},"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Fetal growth restriction (FGR) affects 5%\u201310% of all pregnancies, contributing to 30%\u201350% of stillbirths. Unfortunately, growth restriction often is not detected antenatally. The last weeks of pregnancy are critical for preventing stillbirth among babies with FGR because there is a pronounced increase in stillbirths among growth-restricted fetuses after 37\u2009weeks of pregnancy. Here we present a protocol (V.1, 23 May 2016) for the RATIO37 trial, which evaluates an integrated strategy for accurately selecting at-risk fetuses for delivery at term. The protocol is based on the combination of fetal biometry and cerebroplacental ratio (CPR). The primary objective is to reduce stillbirth rates. The secondary aims are to detect low birth weights and adverse perinatal outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>The study is designed as multicentre (Spain, Chile, Mexico,Czech Republic and Israel), open-label, randomised trial with parallel groups. Singleton pregnancies will be invited to participate after routine second-trimester ultrasound scan (19<jats:sup>+0<\/jats:sup>\u201322<jats:sup>+6<\/jats:sup> weeks of gestation), and participants will be randomly allocated to receive revealed or concealed CPR evaluation. Then, a routine ultrasound and Doppler scan will be performed at 36<jats:sup>+0<\/jats:sup>\u201337<jats:sup>+6<\/jats:sup> weeks. Sociodemographic and clinical data will be collected at enrolment. Ultrasound and Doppler variables will be recorded at 36<jats:sup>+0<\/jats:sup>\u201337<jats:sup>+6<\/jats:sup> weeks of pregnancy. Perinatal outcomes will be recorded after delivery. Univariate (with estimated effect size and its 95% CI) and multivariate (mixed-effects logistic regression) comparisons between groups will be performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The study will be conducted in accordance with the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 23May 2016. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>NCT02907242; pre-results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-014835","type":"journal-article","created":{"date-parts":[[2017,6,15]],"date-time":"2017-06-15T20:20:10Z","timestamp":1497558010000},"page":"e014835","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol"],"prefix":"10.1136","volume":"7","author":[{"given":"Francesc","family":"Figueras","sequence":"first","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Gratacos","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Rial","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Gull","sequence":"additional","affiliation":[{"name":"Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladislav","family":"Krofta","sequence":"additional","affiliation":[{"name":"Institute for the care of mother and child, Third Faculty of Medicine, Charles University, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Lubusky","sequence":"additional","affiliation":[{"name":"Departmente of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cruz-Martinez","family":"Rogelio","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n en Medicina y Cirug\u00eda Fetal, Hospital de Especialidades del Ni\u00f1o y la Mujer de Quer\u00e9taro. Unidad de Investigaci\u00f3n en Neurodesarrollo, Instituto de Neurobiolog\u00eda, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM) campus Juriquilla, Quer\u00e9taro, M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cruz-Lemini","family":"M\u00f3nica","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n en Medicina y Cirug\u00eda Fetal, Hospital de Especialidades del Ni\u00f1o y la Mujer de Quer\u00e9taro. Unidad de Investigaci\u00f3n en Neurodesarrollo, Instituto de Neurobiolog\u00eda, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM) campus Juriquilla, Quer\u00e9taro, M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martinez-Rodriguez","family":"Miguel","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n en Medicina y Cirug\u00eda Fetal, Hospital de Especialidades del Ni\u00f1o y la Mujer de Quer\u00e9taro. Unidad de Investigaci\u00f3n en Neurodesarrollo, Instituto de Neurobiolog\u00eda, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM) campus Juriquilla, Quer\u00e9taro, M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Socias","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Chile Hospital, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Aleuanlli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Chile Hospital, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro C Parra","family":"Cordero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Chile Hospital, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,6,15]]},"reference":[{"key":"2025101811153489000_7.6.e014835.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2004.02.009"},{"key":"2025101811153489000_7.6.e014835.2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.116686"},{"key":"2025101811153489000_7.6.e014835.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.937995"},{"key":"2025101811153489000_7.6.e014835.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904223401603"},{"key":"2025101811153489000_7.6.e014835.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f108"},{"key":"2025101811153489000_7.6.e014835.6","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1806"},{"key":"2025101811153489000_7.6.e014835.7","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/j.1471-0528.1986.tb07895.x","article-title":"An audit of the detection and management of small-for-gestational age babies","volume":"93","author":"Hepburn","year":"1986","journal-title":"Br J Obstet Gynaecol"},{"key":"2025101811153489000_7.6.e014835.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.06.039"},{"key":"2025101811153489000_7.6.e014835.9","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1002\/uog.6378","article-title":"Comparison of fundal height measurement and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight at term","volume":"34","author":"Kayem","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025101811153489000_7.6.e014835.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003942","article-title":"Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment","volume":"3","author":"Gardosi","year":"2013","journal-title":"BMJ Open"},{"key":"2025101811153489000_7.6.e014835.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00131-2"},{"key":"2025101811153489000_7.6.e014835.12","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/uog.14915","article-title":"Ultrasound screening for fetal growth restriction at 36 vs 32\u2009weeks' gestation: a randomized trial (ROUTE)","volume":"46","author":"Roma","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025101811153489000_7.6.e014835.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00205.x"},{"key":"2025101811153489000_7.6.e014835.14","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823dc56e"},{"key":"2025101811153489000_7.6.e014835.15","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1999.13020086.x"},{"key":"2025101811153489000_7.6.e014835.16","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/j.1471-0528.1994.tb11916.x","article-title":"Prediction of perinatal morbidity at term in small fetuses: comparison of fetal growth and Doppler ultrasound","volume":"101","author":"Chang","year":"1994","journal-title":"Br J Obstet Gynaecol"},{"key":"2025101811153489000_7.6.e014835.17","first-page":"908","article-title":"Screening for fetal growth restriction: a mathematical model of the effect of time interval and ultrasound error","volume":"92","author":"Mongelli","year":"1998","journal-title":"Obstet Gynecol"},{"key":"2025101811153489000_7.6.e014835.18","first-page":"CD000073","article-title":"Doppler ultrasound for fetal assessment in high risk pregnancies","volume":"2","author":"Neilson","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101811153489000_7.6.e014835.19","doi-asserted-by":"crossref","unstructured":"Parra-Saavedra M , Simeone S , Triunfo S , et al . 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