MIDDLE CEREBRAL ARTERY AND UMBILICAL ARTERY DOPPLER STUDIES TO PREDICT OUTCOME OF PREGNANCIES.

Abstract

In about 30% of post term pregnancies, the foetuses develop a post maturity syndrome. post term pregnancy is associated with increased risk of both intrauterine and postnatal death. Nowadays, Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become established method of antenatal monitoring, allowing noninvasive assessment of fetal circulation. Circulatory changes, reected in certain fetal Doppler waveforms, predict adverse perinatal outcome. Umbilical arteries are the common vessels assessed by Doppler ultrasound, but recent studies conrm the efcacy of middle cerebral artery (MCA) Doppler assessment for detecting fetal compromise. Objective- To predict outcome of pregnancies by using umbilical artery and Middle cerebral artery doppler ndings. Methodology- Study group consists of 65 pregnant women with gestational age of 40-42 weeks and control groups include the same number of pregnant women with gestational age of 36-40 weeks. All the antenatal women in the subject & control groups were examined by routine ultrasound scan and Doppler subsequently.The peak systolic, end diastolic, and mean velocity were recorded from these vessels, and Umbilical artery S/D ratio, PI and Middle Cerebral Artery PI and CPR were calculated.Comparison of all variables were done using by·a software package Sensitivity, Specicity, Positive predictive value, Negative predictive value of different arterial Doppler indices and cerebroplacental ratio (CPR) were evaluated. ResultNo statistical signicant difference was noted in UA S/D, UAPI, UARI, MCA S/D, MCAPI MCARI in pregnancy with normal and adverse perinatal outcome. Only CPR showed signicant difference for predicting adverse perinatal outcome (p=0.001). Conclusion- None of the Doppler indices except CPR is sensitive enough. Although CPR cut-off value of 1.335 assures the obstetrician of fetal wellbeing, it's low specicity and high false positive results lead to unnecessary tests, undue concern and unnecessary interference.