Umbilical artery doppler sonography for fetal surveillance: Principles and practice

Objective: To examine the diagnostic value of umbilical artery velocity waveforms for the early detection of pregnancy induced hypertension and fetal growth restriction. To determine the utility of color Doppler Sonography of the fetoplacetal circulation for early detection of high risk pregnancies. Methods: This prospective study was conducted in the Department of Obstetrics & Gynecology, Sir Sallimullah Medical Collage & Mitford Hospital Dhaka in collaboration with radiology and imaging department of Dhaka hospital in 1st July, 2006 to 30 June, 2008. 126 randomly selected patients from 17-35 years of ages whose umbilical artery Doppler sonography was done between 16-22 weeks of gestation. All the patient were taken umbilical artery Doppler ultrasonography. Informed consent was taken from all patients. Results: A total 126 subjects of 16 to 22 weeks of gestation were included in this series. On application of the student‘t’ test for S/D ratio between normal and abnormal waveforms of the umbilical artery was found significant difference (P<.0001). Distribution of patient according to umbilical artery systolic / diastolic ratio (n=126). Normal UA waveform 76 (60%), abnormal UA waveform 50(40%), Age (Mean ±SD) in year, normal UA waveform 25.63 ± 4.47 and abnormal UA waveform 25.86±3.75. Para: Primiparous normal UA waveform 36 (60%) & abnormal UA waveform 24 (40%), multiparous normal UA waveform 40 (60.6%) & abnormal UA waveform 26 (39.4%). Gestation age at scan in weeks (Mean± SD), normal UA waveform 19.5 ±2.5, abnormal UA waveform 19±2.0. Gestation age at delivery in weeks (Mean± SD), normal UA waveform 39.03±1.61, abnormal UA waveform 35.78 ±1.53, P value 0.0001. Birth wt. in Kg. (Mean ±SD), normal UA waveform 3.10 ±0.38, abnormal UA waveform 2.42 ±0.53, P value 0.0001. S/D ratio (Mean ±SD), normal UA waveform 2.40 ±0.31, abnormal UA waveform 5.46±1.62, P value 0.0001. Cases with an abnormal outcome in relation to whether the umbilical artery waveform was classified as normal or abnormal (n=126). Abnormal outcome in PIH normal UA waveform (n=76) 4%, PIH abnormal UA waveform (n=50) 14%, P value 0.001. In PIH/FGR, normal UA waveform (n=76) 1% & abnormal UA waveform (n=50) 5%, P value 0.024. FGR normal UA waveform (n=76) 5% & abnormal UA waveform (n=50) 13%, P value 0.002. Asphyxia normal UA waveform (n=76) 0% & abnormal UA waveform (n=50) 3%, P value 0.017. PIH /IUD normal UA waveform (n=76) 0% & abnormal UA waveform (n=50) 1%. A significant association was found when the Chi Square (X 2) test was used to examine the relationship between umbilical artery blood flow and the outcome of patient (i.e FGR, PIH, fetal asphyxia). The screening test had a sensitivity of 78.26% & specificity of 82.5% and accuracy 80.95%. The predictive value of a positive test was 72% and of a negative test 86.84%. Conclusion : A close linear relationship between diagnosis of high risk pregnancy & umbilical artery Doppler velocity waveforms was observed .As umbilical artery Doppler is easy to perform and it is done in between 16 to 22 weeks of gestation can be done along with anomaly scan which is also done at 20-22 week of gestation. So, UA Doppler does not cause additional USG scan. Along with anomaly scan UA Doppler will help to screen out high risk pregnancy.

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Response-questions raised against our manuscript: Vascular endothelial growth factor C/A 2578 gene polymorphism and umbilical artery Doppler in preeclamptic women

Pregnancy Hypertension ◽

10.1016/j.preghy.2021.05.001 ◽

2021 ◽

Author(s):

Nesreen Shehata

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Gene Polymorphism ◽

Umbilical Artery ◽

Vascular Endothelial ◽

Umbilical Artery Doppler ◽

Factor C ◽

Endothelial Growth Factor

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Doppler ultrasound in pregnancy – quality requirements of DEGUM and clinical application (part 2)

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1452-9898 ◽

2021 ◽

Author(s):

Renaldo Faber ◽

Kai-Sven Heling ◽

Horst Steiner ◽

Ulrich Gembruch

Keyword(s):

Blood Flow ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Umbilical Artery ◽

Prophylactic Treatment ◽

Doppler Sonography ◽

First Trimester ◽

Ductus Venosus ◽

Fetal Diagnosis

AbstractThis second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.

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