 Dr. Laxman Chavadia, second year PG resident from Department of Radio Diagnosis, SBKS Medical College and Result Institute from Vadodara. My paper title is the role and evolution of Pulsital Index of MCA and umbilical artery in second and third trimester pregnancy, in determining the fatal well-being. Pleasantal insufficiency, the primary or secondary to the maternal factor such as hypertension or nutrition is the most important factor accounting for parental mobility or mortality. So currently, Doppler ultrasound of the utroplacental umbilical and fetal vessels have been established a method for the anterior monitoring. Out of the umbilical vessels and the middle cerebral artery are the common vessels assessed by the Doppler ultrasound and these vessels have emerged as a vessel of choice in Doppler assessment of fetal intracranial as well as other organ per fusion. Ems and objective of the study, study normal reference range of Pulsital Index in the MCA and the umbilical artery and to determine the role of VA in predicting the outcome of the pregnancy. Material and methods, inclusion criteria include the 19th to 36th week of gestation, singleton pregnancy, absence of the severe maternal complications and there is no evidence of fetal anomalies on sonogram. The exclusion criteria was any pregnancy with the documented major concentrated anomalies or multiple pregnancy. This study was conducted between the April 2023 to October. We have recruited 150 women with pregnancy that made our qualification criteria. Prior to Doppler assessment, all women underwent a grayscale ultrasonography to evaluate the multiple pregnancy fetal anomalies and for biophysical profile to include the AC, AC, FL, and BPD as per headlock formula. After a satisfactory Doppler waveform were reported, PIO of umbilical artery and MCA were noted over the three consecutive scarlet cycles and the SCO of MCA and umbilical PA was calculated. Follow-up scan for each patient was performed if needed. The outcome of each pregnancy was determined in term of C-section normal delivery, fetal live or death, upgar score, fetal weight, and NICU admission for less than or more than 7 days. The NC scan was performed there at the hospital. The observation and analysis of this study showing PI value of MCA in this study group which are plotted here, PI value of umbilical artery in this study group which are plotted here. This graph and table shows the adverse outcome of this study group. Out of 150 patients, 78 patients had a C-section and 103 patients had the small for gestation edge. 56 patients had the upgar score less than 7 and 54 patients had the NIC admission for more than 7 days. This table showing perinatal outcome in the study group according to the value of individual umbilical artery PA. So out of abnormal PA, the 93 percent source adverse prenatal outcome and 92 percent source the C-section for fetal distress. This table showing the perinatal outcome in the study group according to the value of using MCA PA. The out of abnormal MCA PA, the 72 percent had source adverse prenatal outcomes and 70 percent source C-section for fetal distress. So as compared to previous two tables, this table shows the ratio of MCA and PA effect on the adverse outcome. The out of abnormal ratio, the 96 percent has sold the adverse prenatal outcome and 88 percent had source the C-section for fetal distress as compared to the previous individual ratio. This is the graphical forms of the ratio effect on the outcome. The diagnostic performance of PA, individual PA in the ratio for adverse prenatal outcome, as compared to the individual, the cerebral umbilical ratio has a higher sensitivity, specificity, positive predictive value and negative predictive value. The result of this study, in this study 76 patients saw the abnormal cerebral umbilical ratio. Among these 96 percent had adverse outcome as compared to the individual umbilical artery and MCA PA. The diagnostic performance of various Doppler flow indices determining the adverse outcome was assessed. The result is the sensitivity, specificity and positive predictive value and the negative predictive value of the cerebral umbilical ratio was the highest as compared to the other indices. So I will give you the pathological condition strongly related to the development and function of the ultraloplasm, the ultraloplasm of circulation. An adequate fetal circulation is necessary for normal fetal growth. So the normal umbilical artery waveform shows the low impedance and high diastolic flow with the low PA. And MCA shows the high resistance and low diastolic flow with the high PA. So in IUGR, umbilical flow is significantly reduced mainly due to the changes in the plesantal vascular resistance and this is the described umbilical plesantal insufficiency. With absent diastolic volume, the reverse end diastolic volume have a gravest outcome. Fetal with the absence end diastolic volume requires the intensive surveillance as fetal well-being may be deteriorated within the days. So that's the asymmetric growth retardation. There is a high umbilical artery PA and low MCA PA. So as a result, the ratio is altered so less than one and the growth retardate of fetus. As a significant association between the cerebral umbilical ratio and the head circumference and abdominal circumference ratio can be assessed. This is the waveform of umbilical artery Doppler. So the first picture shows the low impedance and the high diastolic flow with low PA. It's normal for umbilical artery. Second is a decrease in diastolic flow. So there is an increase in PA. So this is abnormal. Third one is absence of diastolic flow. The fourth one is reversal of diastolic flow in umbilical artery. So this picture shows MCA Doppler. First shows high resistance and low diastolic flow with increased PA which is a normal. Second one is a high diastolic and which is a low MCA PA which is abnormal. Concluding the V for the diagnosis of IUCR alone Doppler velocity velocity is not sensitive enough and the normal study does not also rule out the IUCR which would be then be diagnosed using other means. Among the Doppler indices the cerebral umbilical ratio is a better reducer for small for gestation edge fetus and adverse parenter outcome than either individual umbilical artery PA or MCPA alone. However measurement of umbilical artery PA is enough to detect IUCR per se probably because umbilical artery PA is a direct reflection of the resistance of pressure to vascular dead. Thank you.