Abstract: Background and Aim:
Diabetes mellitus is one of common disease which is complicating pregnancy worldwide. Adverse neonatal outcomes associated with diabetes are of wide range. Cerebroplacental ratio (CPR) is a simple tool that can be calculated by Doppler hence using CPR as tool to predict neonatal outcome would be great scope in future. Hence present study aimed at to evaluate the cerebroplacental ratio (CPR) as a predictor of neonatal outcomes in pregnancies complicated by diabetes mellitus.
Materials and Methods: It’s a prospective observational study at our tertiary care centre of 100 pregnant women who are diagnosed with overt or gestational diabetes mellitus. Cerebroplacental ratio is calculated. 100 cases were subdivided into 2 groups by calculating CPR Z score.
i) Z score positive group with individual CPR ratio greater than mean (70 cases)
ii) Z score negative group with individual CPR ratio
Results: Cerebroplacental ratio less than 1.3 (negative Z score) is associated with bad neonatal outcome. Mean gestational age of delivery is lower (less than 37 weeks) in negative CPR Z score group in compared to more than 38 weeks in positive CPR Z score group. Pulsatility index of MCA is significantly lower in negative group than positive group with mean index of 1.23 in negative group and 1.55 in positive group. Pulsatility UA index is significantly higher in negative group than positive group with mean index 0.978 in negative group and 0.62 in positive group. Mean CPR z score is 1.224 for negative group and 2.57 score for positive group. Negative Z score group falls below 11th percentile and positive z score group falls above 86th percentile. Antenatal complications is significantly higher in negative group especially IUGR and oligohydramnios than positive group. Intrapartum complications are also significantly higher in negative group especially fetal distress. Bad neonatal outcomes are less in positive CPR Z score group like admission to Nicu, low Apgar, and low birth weight.
Conclusion: Doppler cerebroplacental ratio is a better predictor of adverse perinatal outcome compared to Pulsatility index of umbilical artery or Pulsatility index of middle cerebral artery in singleton high risk pregnancy. There is no significant association between cerebroplacental ratio and pregnancy complicated by overt or gestational diabetes mellitus but CPR ratio less than 1.3 is associated with worse neonatal outcome. CPR ratio is less in pregnancy complicated by overt diabetes compared to gestational diabetes. Patients treated with insulin had less CPR ratio compared to patients on oral hypoglycaemic agents than on medical nutrition therapy. A less CPR ratio is associated with early gestational age of delivery. Ante partum complications like IUGR, oligohydramnios, Intrapartum fetal distress and postpartum complications like NICU admission, low birth weight and low Apgar are associated with low CPR ratio.