Correlation between doppler middle cerebral artery, umbilical and pregnancy outcome in prelabour premature rupture membranes

ABSTRACT

To evaluate to role of middle cerebral and umbilical arteries Doppler in prelabour recently ruptured membranes and pregnancy outcome. One hundred twenty patients; their gestational ages were ranging between 28-37 weeks were in rolled in this study. They were divided into Control group which included 80 patients, and study group which included 40 patients suffering from prelabour rupture membrances; they were further subdivided into two subgroups according to amniotic fluid index into Subgroup IIa [borderline oligohydramnious] which included 20 patients and subgroup IIb [oligohydramnious] which included 60 patients. All patients were subjected to Full present history, clinical examination, lab investigations, and ultrasonographic examinations, colour Doppler examinations of foetal middle cerebral artery and umbilical artery and pregnancy outcome. The amniotic fluid index predicted unfavorable outcome in rupture membranes with sensitivity 88%, specificity 72%, +ve predictive value 59.5% -ve predictive value 93%, Kappa=0.33% p<0.001. Pulsitility index of middle cerebral artery predicted unfavorable outcome with values [72%, 56.4%, 42.9%, 77.8%, 0.21% and 0.048 respectively]. Pulsitility index of umbilical artery predicted unfavorable pregnancy outcome with values [80%, 50.9%, 42.6%, 81.6%, 0.23, and 0.019 respectively]. If all the results of middle cerebral artery Doppler, umbilical artery Doppler and amniotic fluid index were taken in consideration the sensitivity reached 40%, specificity 75%, +ve predictive value reached 53% and -ve predictive value 73%. Based on scoring system of pregnancy outcome: There are good agreements between PI[MCA], PI[UM], Amniotic fluid index and pregnancy outcome in prelabour rupture membranes. Studying Doppler middle cerebral artery, umbilical artery and amniotic fluid index together can help in prediction of pregnancy outcome in prelabour premature rupture membranes