Relationship Between Adverse Neonatal Outcomes and Diastolic Deceleration Area on Fetal MCA Doppler in Patients with Late Fetal Growth Restriction.

Objectives: This study aimed to assess the predictive value of the Diastolic Deceleration Area (DDA), a novel Doppler ultrasound parameter, in detecting adverse neonatal outcomes in fetuses with late-onset fetal growth restriction (FGR). While Doppler parameters such as cerebroplacental ratio (CPR), umbilicocerebral ratio (UCR), and cerebralplacentaluterine ratio (CPUR) are commonly used for fetal monitoring, their predictive power varies. Given the importance of cerebral blood flow redistribution in fetal adaptation to hypoxia, we investigated whether DDA could serve as a reliable indicator of fetal distress and adverse perinatal outcomes. Methods: This prospective case-control study was conducted between January 2024 and July 2024, including 90 pregnant women: 45 diagnosed with late-onset FGR and 45 gestational age-matched healthy controls. Doppler ultrasound measurements, including umbilical artery, uterine artery, middle cerebral artery Doppler indices, CPR, UCR, CPUR, and DDA, were performed. The primary outcome was the prediction of adverse neonatal events, such as neonatal intensive care unit (NICU) admission, neonatal sepsis, respiratory distress, low APGAR scores, and low cord blood pH. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive ability of the Doppler indices. Results: DDA values were significantly higher in the FGR group compared to controls (p<0.001). At a cut-off value of >7.23, DDA demonstrated 50% sensitivity and 88% specificity, making it the most specific Doppler parameter for predicting adverse neonatal outcomes. In comparison, CPR (cut-off ≤2.11), UCR (cut-off >0.46) and CPUR (cut-off ≤1.36) had higher sensitivity (96%, 96%, 54%) but lower specificity (32%, 31% and 85% respectively). Conclusion: DDA is a promising Doppler parameter for identifying fetuses at risk in late-onset FGR. Its high specificity suggests it could be a valuable supplementary tool alongside traditional Doppler indices for better risk assessment and clinical decision-making. Further studies are needed to validate its role in perinatal care.