Umbilical and Middle Cerebral Artery Doppler Indices at Late Third Trimester in the Prediction of Perinatal Outcome in Growth Restricted Fetuses

Abstract

Background: Intrauterine growth restriction (IUGR) is implied to those fetuses who do not achieve their genetically determined potential size. IUGR being a major complication of pregnancy may result in significant morbidity and mortality. Objective: To evaluate the potential value of (CPR) measured at 34-37 weeks’ gestation in predicting the perinatal outcome of pregnancies with FGR. Patients and Methods: A prospective observational study was conducted in Al-Helal Health Insurance Hospital from October 2018 to September 2019. The target population for this study were pregnant females with gestational age between 34- 37 weeks and with biometrically suspected intrauterine growth-restricted fetuses attending the hospital for antenatal care, and are fulfilling the inclusion and exclusion criteria. Doppler ultrasound evaluation of Umbilical and Middle cerebral arteries was performed and CPR was calculated. At 34-37 weeks’ gestation. Patients characteristics, intrapartum, and neonatal outcomes were recorded. The main outcomes required urgent Cesarean section (CS) due to intrapartum fetal compromise (IFC), 5-minute Apgar score below 7, neonatal death, and admission at neonatal intensive care unit (NICU). Results: A total of 40 women participated in this study with an unfavorable outcome in 20% of newborns. Abnormal CRP was present in 11 cases and was associated with a higher risk of adverse outcomes in terms of the need for urgent CS, lower fetal weight, 5-minute Apgar score under 7, and neonatal death and NICU admission > 10 days., and the diagnostic accuracy of CRP was superior to either umbilical artery pulsitivity index (UA-PI) or middle cerebral artery pulsitivity index (MCA-PI) alone. Conclusion: CPR was more effective, with higher specificity and diagnostic accuracy, in predicting perinatal outcomes compared with the individual Doppler parameters of MCA and UA.