Predicting pregnancy outcome by Doppler study evaluation of fetal middle cerebral artery, umbilical artery and ductus venosus

Objective: To investigate the sensitivity and specify of MCA, UA  and DV Doppler pulsatility index as a diagnostic value for antepartum assessment of fetal wellbeing and prediction of adverse perinatal out come in both low and high-risk pregnancies.
Patients and methods: Aprospective observational case control study conducted at Mansoura university hospitals from February 2018 through march 2019 and involved 100 pregnant ladies with a singleton pregnan- cy divided into two equal groups, G1 cases with high risk pregnancy, and G2 cases with low risk pregnancy as a control group. Both groups were matched for age, parity and gestational age.
Results: The basic socio-demographic characteristics of the studied cases and controls were similar in age, gravidity, parity and body mass index (p> 0.05) but in G1 cases had significantly higher frequencies  of mean systolic blood pressure, gestational hypertension, gestational DM, mild or severe PET, oligo- hydraminions, IUGR (p <0.001). De- spite there was no significant difference among cases and control as regard mean (SD) of gestational age in weeks, BPD (mm), UA PI (p
>0.05), but there is a highly significant difference as regard FL (mm), AC (mm), MCA PI, DV PI (p values < 0.05). Also; there is a signif- icant difference regarding the reactivity of NST being more reactive  in control than cases (35 vs 2, p <0.001). Again; there is a significant difference between cases and control regarding mean (SD) of gestation- al age at delivery (34±2 vs 39±1 in G2, p <0.001), Fetal weight (gm) (2255±1047 vs 2944±976, p <0.001), Agar score at 5 minutes (4.9±1.1
vs 8.3±1.4, p <0.001), occurrence of hypoxia (68% vs 2%, p <0.001), need for NICU admission (66% vs 2% p <0.001) and acidotic cord blood with PH < 7.2 (33 cases vs 1 case only, p <0.001). Logistic re- gression analysis revealed the cut off value MCA PI (1.62) had high sensitivity (82%), specificity (78%), PV(79%), NPV (81%) and a diag- nostic accuracy of (80%). Also, UA PI cut off value was found (1.12) with sensitivity (60%), specificity (68%), PPV(65%), NPV (63%) with a diagnostic accuracy of (64%). Regarding the best cut off value of DV study by the same method, DVPI cut off value was(0.77), with sensi- tivity (84%), specificity (80%), PPV(80%), NPV(83%) with diagnostic accuracy (82%).
Conclusions: Doppler velocimetry studies of placental and fetal circu- lation can provide important information regarding fetal well-being thus yielding an opportunity to improve fetal and neonatal outcome