ratio of middle cerebral to umbilical artery blood velocity versus biophysical profile in post-term pregnancies for the prediction of perinatal outcome

ABSTRACT

To compare the ratio of middle cerebral artery to umbilical artery blood velocity waveform's systolic/diastolic [MCA/UA] S/D ratio and biophysical profile as regard their ability to predict adverse outcome in post-term pregnancies. A prospective observational study was done in Antenatal clinic and Emergency Department of Obstetrics and Gynecology of Sohag University hospital. Sixty pregnant women were recruited in the study fulfilling the selection criteria of being 42 weeks or more calculated from the first day of the reliable last menstrual period, having a singleton fetus in the vertex presentation. All accepted to participate in the study after explaining its nature. All cases underwent antepartum testing every other day for biophysical profile and Dopplcr ultrasound examination of the fetal middle cerebral artery and umbilical artery. Adverse post-term related outcome was defined as perinatal death, occurrence of mcconium aspiration syndrome, cesarean delivery for fetal distress, admission to the neonatal intensive care unit and low Apgar at 1 and 5 minute. The predictive values of a middle cerebral artery to umbilical artery ratio pregnant women met the inclusion criteria; Post-term related an adverse outcome was [bund in 12 [20% of cases]. Induction of labor was indicated in 34[56.7%] while spontaneous labor occurs in 26[43.3%] of patients. More adverse outcome occurred in the induced group 4[26.5%] versus 3[11.5%], P. value<0.05. Middle cerebral artery to umbilical artery systolic/diastolic ratio <1.05 was found to be the best predictor of adverse outcome, with a sensitivity of 83.3%, specificity of 93.7%, positive predictive value of 78%, and negative predictive value of 95.7%. The biophysical profile was less efficient an antepartum fetal surveillance test with sensitivity 58.3%, specificity of 81.2%, positive predictive value of 43.7%, and negative predictive value of 88.6%. The MCA/UA S/D ratio was better predictor of post-term pregnancies related adverse perinatal outcome than biophysical profile. When the ratio was <1.05 and BPPS <6. fetal prognosis was poor. In post-term pregnancies could he used to identify ictuses at risk of adverse outcome: