Objective  To investigate the impact and predictive value of bilateral umbilical artery (UA) pulsatility index (PI) abnormalities on perinatal outcomes in fetuses with fetal growth restriction (FGR).

Methods  FGR fetuses and their mothers who delivered at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2022 to June 2024 were included in this study. Based on the UA-PI at the last prenatal examination, the mothers were divided into three groups: normal bilateral UA-PI group, abnormal unilateral UA-PI group, and abnormal bilateral UA-PI group. General information, ultrasound characteristics, and neonatal perinatal outcomes were compared among the three groups, and the association between neonatal perinatal outcomes and bilateral UA-PI abnormalities was analyzed.

Results  A total of 516 maternal pairs and FGR fetuses were included. Among them, 91 cases with unilateral abnormal UA-PI (17.64%), 349 cases with normal bilateral UA-PI (67.64%), and 76 cases with abnormal bilateral UA-PI (14.73%). Compared with the group with normal bilateral UA-PI, the groups with abnormal unilateral and bilateral UA-PI had poorer ultrasound parameters and perinatal outcomes, especially the group with abnormal bilateral UA-PI. The predictive AUC values ​​of UA-PI for adverse perinatal outcomes of 8 fetuses ranged from 0.670 to 0.778, with relatively high predictive value for preterm birth <34 weeks of gestation and cesarean section due to fetal distress.

Conclusion  The number of abnormal UA-PI values showed a dose-response relationship with adverse perinatal outcomes and had a certain predictive power for adverse perinatal  outcomes.

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