A clinical study on Doppler velocimetry of umbilical artery and middle cerebral artery in post-dated pregnancy in the prediction of fetal outcome

Abstract

Background: Doppler ultrasound velocimetry of umbilical and fetal vessels has become established method of antenatal monitoring, allowing non-invasive assessment of fetal circulation. The objective is to study the fetal Doppler indices named umbilical artery (UA) - Pulsatility index (PI), Middle cerebral artery (MCA)-Pulsatility index (PI) and MCA -PI/ UA -PI ratio i.e. Cerebroplacental Ratio (CPR) in post-dated pregnancies and their correlation with perinatal outcome.Methodology: A Prospective observational study conducted on 200 pregnant women having gestational age > 40 weeks in study period from April 2019 to March 2020 at District Hospital, Dharwad. Detailed history of present pregnancy & past obstetric history taken. Thorough examination of patient done. USG Doppler studies were done, above mentioned Doppler parameters were assessed. Apgar score of the neonates were calculated at 1 min and 5 min. They were divided into two groups based on the presence or absence of adverse perinatal outcome.Results: Women with adverse perinatal outcome shows higher UA-PI (> 0.82) with the specificity of 87% and sensitivity of 50%, had higher cases with oligohydroamnios (61%). Adverse neonatal outcome was much higher in the 41-42 weeks of gestation (33.33%) as compared to the 40-41 weeks of gestation (11.18%).MCA - PI with value (< 1.0) shows good ability to predict the mode of delivery with the specificity of 76% and sensitivity of 44.8%. MCA-PI and CPR were not helpful in predicting the adverse perinatal outcome.Conclusion: Doppler indices including MCA-PI, CPR were not useful in predicting adverse neonatal outcome in post-dated pregnancies without any high risk factor. However, UA-PI appears to have good ability to predict adverse neonatal outcome and considered best one of them.