DIAGNOSTIC ACCURACY OF COMBINED FETAL BIOPHYSICAL PROFILE AND UTERINE ARTERY DOPPLER IN DETECTING FETAL COMPROMISE IN HIGH-RISK PREGNANCIES

Abstract

Background

High-risk pregnancies are related with increased perinatal morbidity and mortality, largely due to placental insufficiency and fetal hypoxia. Early and accurate identification of fetal compromise is essential to optimize antenatal management and prevent adverse outcomes. A popular ultrasound-based technique called the Biophysical Profile (BPP) measures fetal respiratory movements, gross body movements, fetal tone, amniotic fluid content, and non-stress test to assess fetal well-being. However, BPP primarily reflects established fetal compromise and may fail to detect early placental dysfunction. Uterine artery Doppler ultrasound evaluates uteroplacental circulation and provides indirect information regarding placental resistance. Abnormal uterine artery Doppler indices are recognized markers of impaired placentation and reduced uterine perfusion. Combining fetal physiological assessment with placental hemodynamic evaluation may improve detection of immediate fetal compromise during a single ultrasound encounter.

Objective

To evaluate the diagnostic accuracy of combined fetal Biophysical Profile and uterine artery Doppler in identifying fetal compromise in high risk pregnancies.

Methodology

Biophysical profile (BPP) and uterine artery Doppler ultrasonography were used to evaluate fetal well-being in 96 high-risk pregnancies. The relationship between fetal compromise and BPP components and uterine artery Doppler indices was assessed. Mean, median and standard deviation were used to analyze the data, while sensitivity, specificity, and diagnostic odds ratio (DOR) were used to evaluate diagnostic performance.

Results

Here in this study 96 pregnant women with a mean gestational age of 33.73 ± 2.70 weeks and a mean mother age of 28.27 ± 4.37 years. At a cut-off of ≤6, the whole biophysical profile (BPP) score showed 100% sensitivity and 100% specificity in identifying fetal impairment. Mean UtA PI (≥0.99) and right UtA S/D (≥3.03), two uterine artery Doppler measurements, demonstrated 100% sensitivity but low specificity of 19.0% and 12.7%, respectively. Right and left UtA RI revealed sensitivities of 35.3% and 76.5% with specificities of 78.5% and 25.3%, respectively, whereas right and left UtA PI showed sensitivities of 64.7% and 82.4% with specificities of 53.2% and 32.9%. The left UtA S/D showed 63.3% specificity and 58.8% sensitivity. 100% sensitivity and 97.5% specificity were attained by the combined BPP and mean UtA PI model. Due to the lack of false-positive or false-negative results, the diagnostic odds ratios for BPP, mean UtA PI, right UtA S/D, and the combined model were infinite, whereas the DORs for individual Doppler parameters ranged from 1.102 to 2.463.

Conclusion

When it came to identifying fetal compromise, BPP performed really well. BPP and mean UtA PI together preserved 100% sensitivity and increased specificity, suggesting potential utility as a combined evaluation for fetal compromise.