Abstract
INTRODUCTION: Fetal growth restriction (FGR) is considered a major contributor to perinatal morbidity and mortality. Umbilical artery (UA) Doppler has been widely utilized for assessing FGR. Recent evidence suggests that Doppler assessment of the middle cerebral artery (MCA) may also serve as a valuable tool in predicting perinatal outcomes. OBJECTIVES: The objective of this study is to compare the predictive value of Doppler indices, specifically the MCA pulsatility index (PI), UA PI, and systolic/diastolic (S/D) ratio, in determining adverse perinatal outcomes in pregnancies complicated by FGR. METHODOLOGY: This prospective observational study was conducted on 91 pregnant women with clinically and sonographically diagnosed FGR in the third trimester at a tertiary care center in Delhi. Post-delivery, neonates were categorized into small for gestational age (SGA) and non-SGA groups. Doppler parameters, including UA PI, UA S/D ratio, and MCA PI, along with variables such as age, parity, body mass index (BMI), and neonatal outcomes, were compared between the SGA and non-SGA groups. RESULTS: Among the participants after delivery, 69 mothers had SGA while 22 mothers had non-SGA neonates. MCA PI and UA S/D ratio showed statistically significant differences between the SGA and non-SGA groups (P = 0.017 and P = 0.023, respectively), while UA PI did not show a significant difference (P = 0.57). Abnormal UA S/D ratio were associated with higher rates of cesarean delivery when compared with normal doppler indices (27, 71.05%, vs. 20, 40.82%, P = 0.005), birth weight <10th percentile (33, 86.84%, vs. 32, 65.31%, P = 0.022), Neonatal Intensive Care Unit (NICU) admissions (29, 78.38%, vs. 22, 44.90%, P = 0.002), and neonatal complications (25, 65.79%, vs. 19, 38.78%, P = 0.012). Abnormal UA PI was linked to higher rates of neonatal complications (68.18% vs. 43.94%, P = 0.04). Abnormal MCA PI showed a significant association with birth weight <10th percentile (89.66% vs. 69.35%, P = 0.039). UA S/D demonstrated higher sensitivity (50.62%) and diagnostic accuracy (54.95%), whereas MCA PI showed higher specificity and positive predictive value (100% each) compared to UA PI. CONCLUSIONS: This study's results indicated that abnormal UA S/D was significantly more pronounced than both MCA PI and UA PI. Sensitivity and diagnostic accuracy of UA S/D for SGA prediction were higher, specificity and predictive values of MCA PI were higher than those for UA PI. Thus, MCA PI Doppler indices were a better predictor for fetal outcome in FGR when compared with UA in terms of specificity and predictive value.