الفهرس 
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Abstract
Postterm-pregnancy refers to a pregnancy that has ≥42 weeks of gestation or ≥294 days from the first day of the last menstrual period Accurate pregnancy dating is critical to the diagnosis.
The incidence of postdating varies according to the definition used, & more important to the dating criteria.
The prolonged pregnancy occurs in 2.5 – 12 % of pregnancies depending upon the method used for measurements.
Prolonged pregnancy is associated with increased risk of perinatal morbidity & mortality. Assessment of fetal wellbeing is a corner stone in the management of prolonged pregnancy. Antepartum detection of fetus at risk in utero remains a major challenge in modern obstetric practice.
Investigation of the fetal cardiovascular & hemodynamic system has become a clinical reliability with the advent of advanced ultrasound technology & the fetal Doppler velocimetry studies enabling precise evaluation of patterns of blood flow with the feto-placental unit
The present study was conducted to evaluate the accuracy of cerebro-placental ratio (the middle cerebral artery PI divided by the umbilical artery PI) as detected by color Doppler ultrasonography in cases of uncomplicated prolonged pregnancy & compare it with amniotic fluid volume measurement in order to evaluate the efficacy of each test in assessment of fetal wellbeing & to predict intrauterine fetal distress & adverse perinatal outcome in post-term pregnancies.
This study was carried out on 100 pregnant women with uncomplicated prolonged pregnancies beyond or at 40 weeks gestation attending at Beni-Suef
Summary and conclusions
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University Hospitals, Obstetrics and Gynecology Clinic.for antepartum assessment of fetal well being.
All patients were submitted to antenatal fetal surveillance tests including biophysical profile, amniotic fluid volume measurement & color Doppler velocimetry of fetoplacental& fetal vessels including MCA PI, UA PI & CPR. Different standardized cutoff points of the Doppler indices were utilized & evaluated.
In each case the mode of the delivery & Apgar scoring of neonatal outcome were recorded.
For the purpose of analysis of results, the study population was divided into two groups based on the presence or absence ofadverse perinatal outcome. Then the results will be tabulated & statistically analyzed.
In the present study, there is no statistically significant difference among both groups as regard maternal age, height, weight, parity & gravidity.
Results of the present study showed that prolonged pregnancy was associated with increased incidence of cesarean section. Also, there was increased incidence of cesarean delivery for fetal distress among the group of adverse perinatal outcome.
In the current study, normal perinatal outcome is associated with higher amniotic fluid volume, MCA-PI, CPR, BPP & lower UA-PI compared to adverse outcome group.
In the present study, there is highly statistically significant difference between normal & adverse perinatal outcome as regard amniotic fluid volume, CPR, MCA-PI, UA-PI & BPP.
In the present study, there is no statistically significant difference among both groups as regard maternal age, height, weight, parity & gravidity.
Summary and conclusions
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Results of the present study showed that prolonged pregnancy was associated with increased incidence of cesarean section. Also, there was increased incidence of cesarean delivery for fetal distress among the group of adverse perinatal outcome.
In the current study, normal perinatal outcome is associated with higher amniotic fluid volume, MCA-PI, CPR, BPP & lower UA-PI compared to adverse outcome group.
In the present study, there is highly statistically significant difference between normal & adverse perinatal outcome as regard amniotic fluid volume, CPR, MCA-PI, UA-PI & BPP.
The studies of amniotic fluid after 40 weeks suggest some association between reduction in volume & adverse outcome.
There is no evidence to suggest that it can be relied on amniotic fluid volume as a mean of monitoring of pregnancies after 4o weeks’ gestation.
Regarding Doppler velocimetry study, absent end diastolic flow has not been recorded.
On comparing between the groups of normal & adverse perinatal outcome regarding the mean of UA-PI, MCA-PI & CPR, significant differences were found between both groups as follows: the mean value of UA-PI was 0.72 in the group of normal outcome versus 0.89 in the group of adverse outcome. Also, the mean value of MCA-PI was 1.29 in the group of normal outcome versus 0.92 in the other group. As well, the mean value of CPR in the normal outcome was 1.83 versus 1.04 in the other group.
In the present study, CPR shows highest specificity (98%) in comparison with other parameters & its sensitivity is (75%).
On the other hand, the specificity & sensitivity of MCA-PI is (88%) & (81%) respectively. Also the specificity & sensitivity of UA-PI is & (77%) & (61%) respectively.