Myocardial Performance Index Versus Umbilical Artery Doppler in Growth-Restricted Fetuses for Prediction of Neonatal Outcomes

Background & Objective: Fetal Growth Restriction (FGR) is a major cause of perinatal morbidity and mortality. Early prediction of adverse neonatal outcomes is critical for management. To compare the predictive value of Myocardial Performance Index (MPI) and umbilical artery Doppler in early-onset FGR.Materials & Methods: A prospective cohort study was conducted at Ain Shams University Maternity Hospital between April 2022 and April 2024. Thirty singleton pregnant women with antenatally diagnosed early-onset FGR were enrolled. All participants underwent serial evaluations of umbilical artery Doppler (Resistance Index [RI] and Pulsatility Index [PI]) and MPI. Outcomes assessed included Apgar scores, Neonatal Intensive Care Unit (NICU) admissions, intrauterine fetal death, neonatal death, and respiratory distress.Results: A statistically significant difference in the umbilical artery Resistance Index (RI) was observed between neonates with good outcomes (0.65±0.11) and those with poor outcomes (0.76±0.12; P=0.015). In contrast, the MPI did not show a significant association with neonatal outcome (P=0.257). The area under the ROC curve (AUC) for RI was 0.775 (P=0.0015), indicating good predictive value, while the AUC for MPI was 0.678 (P=0.1037), indicating fair but non-significant predictive ability. A cutoff RI value of >0.79 yielded a specificity of 94.44% and a positive predictive value of 85.7% for predicting adverse outcomes.Conclusion: In early-onset FGR, umbilical artery Doppler, particularly resistance index, is superior to myocardial performance index in predicting adverse neonatal outcomes. Modified myocardial performance index (Mod-MPI) does not offer reliable predictive value in this clinical setting compared to umbilical artery Doppler surveillance.