الفهرس 
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Abstract
Fetal growth restriction (FGR) is a condition characterized by the fetus that fails to reach its genetically predetermined growth potential. There are two main phenotypes of FGR: early and late, which are characterized by different clinical, ultrasound and pathological features. However, the distinction is usually based on the diagnosis before or after 32 weeks of gestation. FGR is associated with grievous outcomes like stillbirth, neonatal death, and perinatal morbidity as well as long-term sequelae. In order to improve the perinatal outcome, fetal monitoring and optimal timing of the delivery are of utmost importance. The decision to deliver the fetus has to be based on the appropriate balance between the consequences of prolonged hypoxia and acidosis, and the possible risks of prematurity. However, the optimal methods of fetal surveillance are still the subject of debate. The present study aims to assess and compare the value of placental volume, and Doppler of uterine artery and fetal AoI in the prediction of fetal growth restriction and perinatal outcome. This prospective observational cohort study was carried out up on 100 singleton pregnant women aged 18-38 years old with risk factors for growth restriction. Their gestational age 18-28weeks, assessed by the sure date of first day of last menstrual • period or confirmed by an early ultrasound examination. The participants were subdivided into FGR group (n=31) and normal growth group (n=69). All patients were subjected for history talking, routine antenatal assessment including general, abdominal 2D, and 3D ultrasound by VOCAL. Placental volume, uterine artery and aortic isthmus Doppler indices were detected. Then all patients followed every 2 weeks till 34 weeks. After delivery all neonates assessed by Apgar score at 1and 5minutes, then all were weighted. Summary of our results • The age of the studied patients ranged from 18 to 38 years with a mean value (± SD) of 27.97 (±6.51) years. The BMI of the studied patients ranged from 18.94 to 34.89 Kg/m2 with a mean value (± SD) of 28.38 (±4.07) Kg/m2. Parity was one in 23 (23%) patients, two in 48 (48%) and three in 29 (29%). Gravidity was one in 8 (8%) patients, two in 28 (28%) patients, three in 36 (36%) patients, four in 17 (17%) patients and five in 11 (11%) patients. • Placental volume was significantly lower in IUGR group than normal growh group at 18w and 28w (P value <0.001). • Uterine artery pulsatility indices was significantly higher in IUGR group than no IUGR group at 18w and 28w (P value = 0.028 and <0.001 respectively). • Aortic isthmus Doppler was significantly higher in IUGR group than no IUGR group at 18w and 28w (P value <0.001). • BPD was insignificantly different between both groups at 18w and 28w. FL, AC and fetal weight was significantly lower in IUGR group than no IUGR group at 18w and 28w (P value <0.05). • IUGR was early in 8(8%) patients and late in 23 (23%) patients. • The mode of termination was insignificantly different between both groups. Fetal death was significantly higher in IUGR group than no IUGR group (P value <0.02). • Fetal complications were significantly different as higher in IUGR group than no IUGR group (P value <0.001). • The predictive value regarding placental volume for FGR significantly at 18w at cut-off <106 with 93.55% sensitivity, 98.55% specificity, 96.7% PPV and 97.1% NPV. At 28w at cut-off ≤177.3 with 87.10% sensitivity, 82.61% specificity, 69.2% PPV and 93.4% NPV. • Uterine artery pulsatility indices can significantly predict fetal growth restriction at 18w (P=0.019 and AUC = 0.629) at cut-off >1.14 with 77.42% sensitivity, 47.83% specificity, 40% PPV and 82.8% NPV and at 28w (P=0.006 and AUC = 0.678) at cut-off <0.9 with 70.97% sensitivity, 52.17% specificity, 40% PPV and 80% NPV. • Aortic isthmus Doppler can significantly predict fetal growth restriction at 18w (P<0.001 and AUC = 0.950) at cut-off >0.93 with 80.65% sensitivity, 91.30% specificity, 80.6% PPV and 91.3% NPV and at 28w (P<0.001 and AUC = 0.830) at cut-off >0.86 with 74.19% sensitivity, 60.87% specificity, 46% PPV and 84% NPV.