To Estimate the Role of Fetal Umbilical Artery, Middle Cerebral Artery Pulsatality Index and Their Ratio in Predicting Adverse Perinatal Outcome in Foetuses with Growth Restriction: A Prospective Observational Pilot Study

Abstract

Abstract Objective: To estimate the role of fetal umbilical artery (UA), middle cerebral artery (MCA) pulsatality index (PI) and their ratio in predicting adverse perinatal outcome in foetuses with growth restriction (FGR). Methodology: It is a prospective observational pilot study done at a tertiary care hospital among the study population of singleton pregnancies between 28 and 36 weeks of gestation that were diagnosed with FGR by USG (estimated fetal weight <10th centile, abdominal circumference <10th centile). The correlation of fetal color Doppler assessment using UA PI, MCA PI, and MCA:UA PI and the adverse perinatal outcome in terms of preterm/term delivery or emergency cesarean delivery for fetal indication, low birth weight, APGAR <7 at 1 or 5 min, neonatal intensive care unit stay >24 h, and perinatal death were studied prospectively. Descriptive analysis of quantitative data was expressed and cross tables were generated to compare the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MCA PI, UA PI, and MCA:UA PI and any one adverse perinatal outcome if present or absent. Results: A total of 30 pregnancies were studied prospectively from April 2018 to April 2019. The UA, MCA Doppler PI, and MCA:UA PI have a sensitivity and specificity of 90%, 90%, and 95% and 55%, 67%, and 77%, respectively, for adverse perinatal outcomes. Conclusion: In the detection of FGR, best results are obtained when we use MCA:UA PI ratio, which is more sensitive and specific in detecting adverse perinatal outcomes, especially in later weeks of gestation from 31 to 36 weeks rather than UA PI or middle cerebral artery PI alone.