Study of Cerebro-Placental Ratio in Pregnancies with Abnormal Umbilical Artery Doppler in Predicting Adverse Perinatal Outcome: Are we here yet?

Abstract

Objective: To evaluate the effect of abnormal Umbilical artery Doppler and Cerebro-placental ratio on perinatal outcome in pregnant women between 28-40 weeks of gestation. Methods: It’s a prospective observational study of 139 pregnant women with abnormal umbilical artery Doppler and cerebroplacental ratio from 28-40wks excluding all medical diseases. Doppler was considered abnormal when pulsatality Index (PI) > 95th percentile for gestational age and when Cerebro-placental Ratio is less than 1.08. Results: Abnormal Doppler results are grouped into 3 groups, AEDF (absent end diastolic factor), REDF (reverse end diastolic factor), CPR (cerebro-placental ratio) <1. In AEDF, REDF, CPR groups, respiratory distress syndrome (RDS) was noted in73%, 95%, 37%. Low Apgar (score less than 7), was 4.5%, 35%, 3.1%.FGR was noted in 37%, 81%, 15%. Birth weight < 2.5kg as seen in 32%, 45% whereas in REDF group 95% of babies were <2kg.Sepsis were noted more in REDF 70% whereas none in CPR group. Meconium stained amniotic fluid seen in 13%, 10% and none in CPR group. All babies required NICU stay more than 7 days in REDFcompared to other groups. Perinatal mortality was highest in the REDF (15 %) compared to AEDF (2.29 %) and CPR <1.08 (Zero) [p <0.001]. Conclusion: Abnormal umbilical artery Doppler along with CPR <1 is associated with substantial risk of adverse perinatal outcomes. Abnormal CPR and AEDF are not the indications for immediate delivery. Using Dopplers of other vessels like ductus venosus with UAAEDF could help in deciding the time of delivery and reduce the adverse perinatal outcome.