الفهرس 
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Abstract
Doppler velocimetry is the best method of surveillance for fetal hypoxemia during pregnancy. Cerebroplacental ratio (CPR), has been suggested as a useful clinical simplification. It is believed that the CPR better predicts adverse perinatal outcomes than its individual components and better than conventional anthropometric models. Therefore, the aim of this study was to evaluate the significance of the cerebroplacental 10th centile threshold measured weekly from 36 weeks of gestation till delivery as a screening test for prediction of need for Cesarean section for intrapartum fetal compromise and the adverse neonatal outcome in women with normally grown fetuses and uncomplicated pregnancy. This study was carried out on 40 pregnant women who attended to the outpatient or the inpatients wards of the department of obstetrics and Gynecology, Tanta University Hospital from April 2019 to September 2020. All women have uncomplicated, singleton pregnancy with appropriately grown fetuses on clinical assessment. The last Doppler indices including cerebroplacental ratio measurement obtained before labor was reported. CPR Values below 1.1 were reported as abnormal. Various studies have variably defined the threshold of abnormal CPR ratio as <1.08. Among the forty cases included in the study, there were 37 women had age below or equal 30 years, and 3 had age above 30 years. The mean age of the study group was 25.38 with a standard deviation of 3.54. The results showed that there were women of all parity included in this study. Majority of the women were were para 1 or more (72.5%). Moreover, this study showed that 9 out of 15 anemic patients had CPR <1.08. There was statistically significant difference in number of cases who had anemia in both cases who had CPR<1.08 or ≥1.08 (P<0.003). The mean CPR in anemic patients was 1.13 with a standard deviation 0.39. There was significant decrease in the mean of CPR among patients who had anemia (1.13± 0.39) compared to those without anemia (1.53±0.48) with a p-value 0.01. In addition, there was no significant association seen between low CPR and having previous history of abortion or IUGR as well as being smoking (P>0.05). In addition, the mean gestational age in cases with CPR<1.08 was 37.67±0.65 that was lower than that in cases with CPR≥1.08 (38.1±1.07). There was no significant difference between cases who had normal and abnormal CPR regarding gestational age at delivery (P=0.194). In addition, the current study indicated that 58.3% of cases who had cerebroplacental ratio <1.08 delivered by CS compared to 50% of cases who had cerebroplacental ratio > 1.08. There was no difference between cases who had normal and abnormal cerebroplacental ratio regarding mode of delivery (P=0.629). As regard neonatal outcome, our study revealed that there was significant decrease in the prevalence of low birth weight among group who had CPR≥1.08 (P<0.001). The prevalence of adverse neonatal outcome was higher in the women who had CPR <1.08 compared to that in women who had cerebroplacental ratio ≥1.08. The present study showed that CPR <1.08 was significantly associated with neonatal complication like NICU, and neonatal death (P-value<0.05). However, there was no statistically significant relationship between cerebroplacental ratio and neonatal complication like IUFD, and neonatal sepsis (P>0.05). There was no statistically significant association between the mean cerebroplacental ratio and IUFD (P=0.358). There was statistically significant association between the mean cerebroplacental ratio and NICU (P<0.001). There was no statistically significant association between the mean cerebroplacental ratio and neonatal sepsis (P=0.303). The mean cerebroplacental ratio of 0.93± 0.22 has a significant association with neonatal death with a p value 0.025. By comparing the studied group as regard umbilical artery, middle cerebral artery, C/U ratio and cerebroplacental ratio, the results showed that all Doppler indices except umbilical artery RI and umbilical artery-PI were significantly lower in women who had adverse neonatal outcome compared to their levels in women with normal neonatal outcome (P<0.05). Whereas, umbilical artery RI was significantly higher in women who had adverse neonatal outcome compared to their levels in women with normal neonatal outcome (P<0.05).In addition, there was no statistically significant difference in the mean umbilical artery-PI between women who had normal and adverse neonatal outcome (P=0.073). ROC curve analysis showed that that MCA PI and CPR had significantly higher diagnostic accuracy than other indices in predicting outcome of pregnancy. ROC curve showed the optimum cutoff for MCA/UA PI was 1.045 for predicting adverse outcome of pregnancy with sensitivity 76.9% and specificity 85.19%; an area under the ROC curve (AUROC) 0.855(95% CI: 0.719-0.990) (P<0.001). Also, MCA-PI had significantly diagnostic accuracy in predicting adverse outcome of pregnancy. ROC curve showed the optimum cutoff for MCA PI was 1.545 for predicting adverse outcome of pregnancy with sensitivity 84.6% and specificity 81.4%; an area under the ROC curve (AUROC) 0.862(95% CI: 0.745-0.978) (P<0.001). Moreover MCA/UA RI was found better predictor for adverse outcome of pregnancy with an area under the curve 0.752(95% CI: 0.573-0.932) (P=0.011) and at cutoff value of 1.036 the sensitivity was 61.5% and specificity was 77.8%. While the cut off value of umbilical artery-RI was 0.715 for predicting adverse pregnancy outcome, the sensitivity was 69.2%, specificity was 77.8%; .an area under the ROC curve (AUROC) 0.712(95% CI: 0.541-0.884) (P=0.031). Additionally, the optimum cutoff for umbilical artery-PI was 1.26 for predicting adverse outcomes with sensitivity 76.9% and specificity 59.2%; an area under the ROC curve (AUROC) 0.694(95% CI: 0.516-0.871) (P=0.05).However MCA-RI was non-significant in predicting pregnancy outcome (P=0.061).