The role of the Ratio between Middle Cerebral Artery and Umbilical Artery Doppler in Predicting Neonatal Outcome in Prolonged pregnancies with Oligohydramnious

Abstract

Summary P rolonged pregnancy is defined as pregnancy that continues beyond 40 weeks (280 days) from the first day of last menstrual period or 14 days beyond expected date of delivery. However, recent data have shown that a significant percentage of cases of perinatal asphyxia occur between 40 and 42 weeks of gestation. Post-term pregnancy is associated with significant fetal and maternal risks. Perinatal mortality [still birth plus early neonatal deaths increases about 4 folds in post-term pregnancies. Feto-placental insufficiency, asphyxia (with and without meconium)]. Intra-uterine infections contribute to this excess in perinatal deaths, also macrosomia increases in post-term pregnancies as well as 20-40% of post-term features do have post maturity syndrome. Maternal risk of prolonged pregnancy includes labour dystocia, an increased incidence of perineal injury and a doubling in the rate of caesarean delivery. Morbidity and mortality in post-term pregnancies are thought to be secondary to placental insufficiencies. Resistance index in prolonged pregnancies and adverse perinatal outcome but they failed to demonstrate any relationship. It has been shown that there is a strong correlation between middle cerebral artery blood flow and fetal hypoxia which made assessment of middle cerebral artery blood flow a standard evaluation in cases of features of high risk of hypoxia. However, information in prolonged pregnancy is a scarce. The current study was conducted at Ain shams maternity hospital. 100 patients with prolonged pregnancy (more than or equal 40 weeks) and oligohydraminous were recruited from the causality unit. Patients were divided into two groups (all medically free): - Group (I): 50 patients who delivered by induction - Group (II): 50 patients who delivered by elective caesarean section. The following were done: Informed consent, Full history taking, Complete general and abdominal examination, Ultrasonography to determine fetal life, presence of oligohydramnious, non-stress test, timing of delivery, mode of delivery, indication of delivery. Middle cerebral & umbilical arteries indices were recorded.