الفهرس 
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Abstract
Although the increased fetal morbidity and mortality associated with post-term pregnancy has long been appreciated, most authors have studied gestational age as the only contributing factors. The influence of other factors such as maternal age, parity, maternal smoking, fetal genders or birth weight, past history of post-term has not been adequately evaluated. Additionally the accuracy of earlier studies is limited by the fact that they predate the widespread use of both ultrasonography for accurate gestational dating and intensive fetal testing to establish fetal wellbeing.
The present study was conducted to evaluate the accuracy of cerebroplacental ratios (the middle cerebral artery PI divided by the umbilical artery PI) as detected by color Doppler ultrasonography and amniotic fluid volume as a means of predicting intrauterine fetal distress and adverse perinatal outcome in post-term pregnancies.
The present study included 100 pregnant females which were grouped in two groups:
group 1: This group included 50 pregnant females with gestational age of 40-41 weeks reaching the hospital for antenatal care.
group 2: This group included 50 pregnant females with gestational age of 41-42 weeks reaching the hospital for antenatal care.
All patients were submitted to antenatal fetal surveillance tests including modified biophysical profile (MBPP) which consists of the non-stress test (NST), amniotic fluid index (AFI), and color Doppler velocimetry of fetoplacental and fetal vessels including MCA PI, UA PI, and CPR. The different test results were collected together with the mode of delivery and the perinatal outcome data in table form and were statistically analyzed at the end of the study.
In the present study, there were no statistically significant differences between both groups regarding age and parity while the weight of females who gave birth throughout the period 40-41 weeks was significantly higher than those who deliverd there babies in between 41-42 weeks .
In the current study, normal outcome is associated with higher AFI, MCA-PI, CPR and not significant difference as regard UA-PI compared to adverse outcome group with statistically significant difference between normal and adverse outcome as regard AFI, MCA-PI, CPR .but no significant as regard UA-PI
Cases were classified as having adverse perinatal outcome according to the study protocol criteria: Cesarean delivery for fetal distress, thick meconium stained liquor, meconium aspiration syndrome,
5-min Apgar score less than 7 and admission in neonatal intensive care unit (NICU).
It was proven that the AFI is the most sensitive predictor of thick MSL and MAS where it was the only marker which was highly significant in relation to them.
In the current study, there is highly statistically significant difference between normal and adverse perinatal outcome as regard CPR , AFI, and MCA-PI. On the other hand, there is no statistically significant difference as regard UA-PI between normal and adverse perinatal.outcome.
The studies of amniotic fluid after 40 weeks suggest some association between reduction in volume and adverse outcome, but overall it performs with a poor sensitivity and specificity. There is no evidence to suggest that it can be relied on as a means of monitoring pregnancies after 41 weeks’ gestation.
In the present study by dividing of MCA-PI by its equivalent UA- PI the best cutoff of the ratio is 1.34 where CPR > 1.34 was considered ”normal” and ≤ 1.34 considered ”abnormal” and CPR sensitivity was (92.4%) in comparison with other parameters followed by AFI (81.8%). On the other hand AFI show the highest specificity (76.9%) followed by MCA-PI (61.8%).so comination of all parameters was shown to improve both sensitivity and prediction.