The prospective observational study to evaluate the role of uterine artery doppler velocimetry indices for third trimester fetal surveillance in predicting the adverse perinatal outcomes.

To study the association between abnormal uterine artery doppler parameters in the third trimester and adverse perinatal outcomes in high risk as well as low risk pregnancies. • To estimate prognostic value of uterine artery score in predicting and preventing adverse perinatal outcomes. • To study the importance of fetal middle cerebral artery / uterine artery pulsatility index ratio in prediction of preterm labour • To understand the importance of including the uterine artery doppler velocimetry along with umbilical and middle cerebral artery dopplers in third trimester fetal surveillance to get optimal perinatal outcomes. • To compare the predictive values of uterine artery scores, blood flow classes and placental score. MATERIALS & METHODS This study was carried out in patients attending the antenatal outpatient department at The Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Madras Medical College, Chennai during the academic year 2014-2015. The study was done in 120 patients including the 60 high risk patients and the 60 low risk patients. • Group A is a high risk group which is comprised of singleton pregnancies beyond 27 weeks with risk factors like Pre ecclampsia, Small for gestational age, Previous bad obstetric history with recurrent fetal losses and perinatal deaths, Chronic hypentension, Diabetes mellitus, Post-dated pregnancy, Preterm labour and autoimmune diseases. • Group b low risk patients who are singleton pregnancies beyond 27 weeks of gestation without any documented risk factors, to serve as control. • Doppler parameters will be recorded from the uterine artery. • Blood flow classes based on umbilical artery PI, middle cerebral artery/uterine artery pulsatility index ratio, middle cerebral/umbilical ratio, uterine artery scores and the placental score are recorded. • The patients enrolled in the study will be followed up till delivery of the baby. Serial doppler evaluations will be done in the study population depending on the expected level of complications. The doppler parameters which are recorded during the study preceding the delivery will be considered for the statistical analysis. • The mode of delivery, operative delivery for the fetal distress, the gestational age at the delivery, the birth weight, apgar scores at 5 minutes, NICU admissions and perinatal mortality if any will be recorded. RESULTS: The mean uterine artery pulsatility index was the single best indicator of adverse perinatal outcomes, with optimal cutoff for ODFD being 1.07. Uterine artery score of 1 had 70.7%sensitivity and 96.7% specificity for operative delivery for fetal distress. All the scores related to uterine and umbilical artery are more in high risk group, reflecting elevated impedance in the uteroplacental circulation. CONCLUSION: The current study found that uterine artery doppler indices may be included along with umbilical and middle cerebral artery doppler indices to improve fetal surveillance .It helps to predict adverse perinatal outcomes, optimises monitoring and in preventing complications. Scoring system comprising the doppler indices is better than the independent ratios in the third trimester fetal surveillance.