Utility of doppler derived middle cerebral artery: peak systolic velocity and pulsatility index in prediction of perinatal outcomes of IUGR pregnancies

Surbhi Gupta, Sunita hemani Sharma, Renuka mundliya, Lata Ratanoo


Background: To determine the association of Middle cerebral artery-peak systolic velocity (MCA-PCV) and perinatal outcome among IUGR fetuses. Longitudinal changes occurring in MCA-pulsatality index and MCA-PSV in IUGR fetuses were studied and the performance of MCA-PI, MCA-PSV in IUGR fetuses was compared.

Methods: Hospital based cohort study of 40 IUGR fetuses (gestation age 28-36 weeks, Estimated fetal weight <10th percentile, Umbilical artery PI>95th percentile) in whom MCA-PSV values were obtained on three or more occasions from the time of admission till delivery depending upon period of gestation and severity of IUGR. For analysis purpose two groups were made of twenty patients each depending upon MCA-PSV.

Results: All the fetuses (100%) in group B (i.e. with abnormal MCA-PSV) had adverse perinatal outcome in the form of either mortality or major neonatal complication consisting of Newborn intensive care unit stay ≥14 days, requirement of artificial ventilation or presence of intraventricular hemorrhage, respiratory distress or sepsis. Specificity of abnormal MCA-PSV was found to be 100% in predicting adverse perinatal outcome. When followed longitudinally, in the three fetuses having fetal death, the PSV showed an initial increase in velocity followed by a fall prior to demise, thus suggesting that it could be a pre-terminal event

Conclusions: Fetal MCA-PSV appears to be a reliable indicator of adverse perinatal outcome in growth restricted fetuses thus implying that abnormality in MCA-PSV warrants stringent monitoring. Serial Doppler examinations of fetal MCA-PSV provide better information than does a single measurement.


Intra uterine growth restriction, Middle cerebral artery-peak systolic velocity, Middle cerebral artery-Pulsatility index, Color Doppler, Intra uterine death and Newborn intensive care unit stay

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