Colour Doppler Ultrasound Evaluation Of Umbilical Artery And Middle Cerebral Artery In Suspected IUGR Fetuses

Abstract

The aims and objectives of our study was to study the changes in Umbilical Artery and Middle Cerebral Artery Doppler indices in IUGR pregnancies and correlate with perinatal outcome and to establish the role of doppler ultrasound in the management of IUGR pregnancies.
The present study is a prospective study of Doppler Velocimetry of umbilical artery and Middle cerebral artery in cases with clinical suspicion of IUGR between 24 to 40 weeks of gestation from November 2019 to October 2021. Pregnancies with documented intrauterine death at the time of first Doppler and multiple gestations examination were excluded from the study. The outcome for each pregnancy was obtained by examining the labor ward records and neonatal intensive care unit records wherever appropriate. Findings of Doppler studies were correlated with the following adverse Perinatal outcomes.
The Umbilical artery Pulsatility index and the Middle cerebral artery pulsatility index for the corresponding gestational age were compared with the reference values. The Umbilical artery Pulsatility index was considered abnormal if the value was above the 95th percentile of previously published values for gestational age.
Acceptable wave forms were obtained from MCA and UA in all these cases. All the cases were followed up for the perinatal outcome. It was observed that MCA PI was most sensitive (sensitivity 95.65%). It was more sensitive than either Cerebroplacental Ratio MCA/UA PI (sensitivity 91.3%) or UAPI (sensitivity 91.3%) in predicting any adverse outcome. However, Cerebroplacental Ratio (specificity 81.48%) was more specific compared to UA PI (Specificity 66.6%) and MCA PI (Specificity 63%). Cerebroplacental Ratio (MCA/UA) had highest Positive Predictive Value (PPV=80.8%) compared to UA PI (PPV=70%) and MCA PI (PPV=68.75%) when considered alone. However, UA PI 94.4 has highest Negative Predictive Value followed by Cerebroplacental Ratio 91.66% and MCA PI 90.0.