 A.M.O.F.M.A study was to assess the role of modified bi-physical profile and cerebral-placental ratio for prediction of perinatal outcome in pregnancy beyond 40 weeks. Now, coming to introduction, pregnancy beyond 40 weeks is associated with the induced chances of fetal as well as maternal complications. Fetal complications included hypoxia, intercainal damage, meconium aspiration syndrome, mekrosomia at electricity, cyclismia, etc. Maternal complications includes higher chances of caesarean deliveries, instrumental deliveries, pph and perinatal damage from a mekrosomic fetus. Elective induction of labour and expected management with intermittent fetal monitoring are two choices for management. Antinatal fetal monitoring can be done by non-stress test, bi-physical profile, amniotic fluid index, ultrasonography and Doppler value symmetry and their combinations. However, till today no single test has demonstrated that it is superior to others and there is also little information regarding the ideal type. Now, coming to method, study type is a prospective observational study, Vhenu. Vhenu is department of radio diagnosis in collaboration with department of obstetrics and gynaecology. Bharatman may have been medical college and Saptasim Hospital, New Delhi. The study was conducted over a period of 18 months, sample size was 80, now coming to inclusion criteria. Pregnant women with single root pregnancy and cephalic presentation with gestational age beyond 40 weeks and included in my study, exclusion criteria were presence of pre-existing medical conditions like chronic hypertension, chronic renal failure and diabetes moleters, presence of fetal anomaly, previous LCS and present onset of labour. An informed detailed concern along with the detailed clinical history was taken, gestational age was confirmed by CO data of LMP and early pregnancy ultrasound that is before 22 weeks. Then the women underwent glacial ultrasound for fetal biometric and quantified by physical profile and fetal Doppler using Philips machine 2 to 5 megabit curvilinear transducer with color Doppler, the compliance of PC PNDT actors ensured. Continuing the method, modified biophysical profile, it was done by assessment of amniotic fluid volume and non-stress test. Amniotic fluid volume was assessed by obtaining amniotic fluid index using four-quarton technique. For non-stress test, a real-time ultrasound was performed to look for a fetal heart rate reactivity with the fetal movement. During initiation of test, this baseline fetal heart rate was taken, fetal heart rate rate was recorded again after its fetal movement activity. Presence of at least two accelerations of fetal heart rate of more than 15 bits per minute above the baseline lasting for at least 15 seconds during 20 minutes of observation was considered as reactive. Industry was considered as non-reactive if the criteria for acceleration were not fulfilled. And modified biophysical profile was considered abnormal if either NST was non-reactive or the amniotic fluid index was 5 centimeter or less. Now, technique of middle cerebral artery and umbilical artery Doppler. Middle cerebral artery was assessed at the standard transthalamic plane which contained thalamine and gave symptom pellucidum. The MCA was seen at the level of origin of the circular pulleys. Care was taken up to exert pressure on the fetal head because this may alter flow pellucity web forms of MCA. There is the first image where you can see the MCA was Doppler was done in the standard transthalamic plane and the MCA Doppler parameter was taken near the origin of circular pulleys. Then umbilical artery Doppler was done from the free loops of the cord here in the second image. You can see Doppler values were taken from the free loop. Then Doppler blood to parameters like PSB, EDB, PI and RI of umbilical artery and medicelebral artery were calculated. After the cerebroplacental lesions calculated using MCA PI and umbilical artery PI. Then outcome measures. Outcome measures were mode of delivery, vaginal or caesarean section. Then indication of caesarean section, birth to weight, strain leaker, 5 minute abgas core, admission in NICU and indication for the same neonatal and perinatal birth, death. Adverse outcome. Adverse outcome was defined as either of the following. Number one is emergency LHS for fetal distress. Then 5 minute abgas core of less than 7 admission to NICU, meconium aspiration syndrome, intravenous fetal death or neonatal death. Coming to result. Total number of participants in my study was 80 and overall adverse perinatal outcome was seen in 12.5 percent of the participants and most of the participants were between the 40 to 40 weeks stage of gestation and majority of the participants were primary clavidus. Here is the first table showing the distribution of outcome. Here you can see that out of 80 70 participants had normal vaginal delivery and 10 of the participants had LHS. And the indication for LHS was fetal distress in 90 percent of the patient and fell induction in on the one patient. Low abgas core NICU admission and meconium strain leaker were seen in its 2.5 percent of the participant. Then this is the table showing the distribution of modified biophysical profile. Where you can see 80 percent of the participants had normal modified biophysical profile and 20 percent had abnormal modified biophysical profile. And second table showing association between modified biophysical profile and adverse perinatal outcome. Here you can see that 37.5 percent of the participants with abnormal modified biophysical profile had adverse perinatal outcome and 6.2 percent of the participants with normal modified biophysical profile had adverse perinatal outcome. And this is the ROC curve showing diagnostic performance of cerebral placental ratio. At a cut-off of cerebral placental ratio less than equal to 1, it predict adverse perinatal outcome with a sensitivity of 70 percent, a specificity of 89 percent and negative predictive value of 95 percent. The mean CPR in the group with adverse perinatal outcome was higher that is 1.4 as compared to those with adverse perinatal outcome in which CPR value was 1.0 mean CPR was 1.0. These are the representative cases. First case is 24 years old primary diabetes at 43 days of gestation with reactive NST, normal AFI and CPR of more than 1 and one polar perinatal outcome was normal vision delivery with a healthy baby. These are the M-mode ultrasound where the images showing the baseline fetal artery and BNC showing BNC showing on the significant acceleration with fetal movement suggestive of reactive panonstase test and this image showing calculation of pneumatic fluid index is showing full pattern technique where AFI was 8 and this image showing the Doppler of middle cerebral artery where you can see the PI was 1.1 and second image showing umbilical artery Doppler where PI was 0.9 and so CPR was more than 1. Second case was 26-year old primary diabetes at 41 weeks on day of gestation with AFI of 1.7 non-deactive NST and CPR of less than 1 and one polar perinatal outcome was LCS due to fetal distress and AFGAS score of baby also of 5. So in this case is these are the M-mode ultrasound images showing baseline fetal heart rate and BNC shows absent acceleration with the fetal movement suggestive of non-deactive NST and these are the images showing AFI where only one you can see only one content content and mutate fluid so total AFI was 1.7 suggestive of polygohydrinase and this is the middle cerebral artery Doppler where you can see in the response there is a low resistance flow and PI of MCA was 0.7 and in the second image this is the umbilical artery Doppler where PI was 0.8 so CPR was less than 1. Now coming to discussion part so a total 80-perinatal movement with gestational age of more than 40 weeks were included in my study. Modified biophysical profile was statistically significant and it predicts adverse perinatal outcome with the sensitivity of 60% specificity of 85.7% and negative predictive value of 94% and positive predictive value of 38%. The participant with abnormal MVP and had high incidence of adverse perinatal outcome so our result was very similar to study by porate etual and negative etual and found that MVP is an MVP or Modified Biophysical Compile is an excellent means of vital surveillance test to predict adverse perinatal outcome. Now next is the area under the area under the ROC curve for CPR predictive adverse perinatal outcome is 0.8 thus demonstrating the good diagnostic performance at a cutoff of CPR of less than equal to 1. It predicts adverse perinatal outcome with the sensitivity of 70% specificity of 89 and negative predictive value of 95%. So our observations were very similar to the study done by up to above etual which showed that CPR had high predictive value in post-dated pregnancy with a cutoff of 0.94. Our cutoff was also near similar to the study by divine etual in which the CPR of less than 1.05 was found to be an accurate parameter to predict a post-dated related adverse outcome. But our findings were contrary to the results of de-anteneal etual who inferred that CPR is not predictive of unfavorable outcome in women with pregnancy lasting more than 41 weeks. And to conclude in our study a modified biophysical profile and cerebral placental ratio have shown statistically significant results in prediction of adverse perinatal outcome and overall diagnostic performance of cerebral placental ratio is better than modified biophysical profile. So these are the references which I have used in my study. Thank you.