COMPARATIVE ACCURACY OF UMBILICAL ARTERY DOPPLER AND MIDDLE CEREBRAL ARTERY DOPPLER INDICES FOR PREDICTION OF ADVERSE OUTCOMES IN FETAL GROWTH RESTRICTIONS

Abstract

Background: Fetal growth restriction (FGR) is associated with increased risks of fetal hypoxia, neonatal morbidity, NICU admission, and perinatal mortality. Objective: To compare the diagnostic accuracy of umbilical artery and middle cerebral artery Doppler indices for predicting adverse perinatal outcomes in pregnancies complicated by fetal growth restriction. Methods: This prospective observational diagnostic-accuracy study was conducted at Obstetrics and Gynecology department of Lahore General Hospital from July 2020 to January 2021, included 91 pregnant women with FGR. Maternal characteristics, fetal biometry, UA pulsatility index (UA-PI), UA systolic/diastolic (S/D) ratio, and MCA pulsatility index (MCA-PI) were recorded. Participants were followed until delivery, and neonatal outcomes including birth weight, Apgar score, NICU admission, NICU stay, neonatal complications, and adverse perinatal outcome were assessed. Results: Mean MCA-PI was significantly lower in SGA fetuses than in non-SGA fetuses (1.22±0.50 vs. 1.48±0.49; p=0.017), while mean UA S/D ratio was significantly higher (3.26±1.08 vs. 2.80±0.84; p=0.023). Mean UA-PI did not differ significantly between groups (1.05±0.41 vs. 0.97±0.33; p=0.571). The UA S/D ratio demonstrated the highest sensitivity (50.62%) and overall diagnostic accuracy (54.95%), with 90.00% specificity and 97.62% PPV. MCA-PI showed 35.80% sensitivity but achieved 100.00% specificity and 100.00% PPV. UA PI showed the lowest sensitivity (29.63%) and diagnostic accuracy (36.26%). Conclusion: It is concluded that both UA and MCA Doppler indices are useful in predicting adverse perinatal outcomes in fetal growth restriction. The UA S/D ratio showed the best overall sensitivity and diagnostic accuracy, whereas MCA-PI provided the highest specificity and positive predictive value.