Doppler ultrasonography assessment in maternal-foetal medicine
DOI:
https://doi.org/10.18597/rcog.490Keywords:
Doppler ultrasonography, fetal growth restriction, foetal anaemia, aneuploidy, uterine arteryAbstract
Introduction: Doppler ultrasound techniques (available since the 1980s) have allowed a more precise understanding of foetal-placental haemodynamics and their physiological variants. They have also helped in recognising pathological changes produced in the foetus by different types of injury, allowing more precise action to be taken and decreasing neonatal morbidity and mortality. This article is aimed at offering a comprehensive review of Doppler technology in perinatal medicine and pointing out its practical usefulness in current obstetric practice.
Methods: electronic databases (PubMed, Ovid, Elsevier, InterScience, Cochrane) and text books were reviewed to obtain the best evidence regarding using Doppler technology in perinatal medicine. Results: Doppler ultrasonography has become a diagnostic tool having wide application in the field of maternal-foetal medicine. It is currently the key for diagnosing and managing foetuses affected by anaemia or foetal growth restriction (FGR), chromosomal abnormality screening during the first three months of pregnancy, studying foetal morphology, diagnosing placenta accreta, the early detection of foetal infection and screening for utero-placental insufficiency-derived pathologies (FGR and preeclampsia) and adverse perinatal outcomes.
Conclusion: Doppler ultrasonography used as a diagnostic tool has changed perinatal practice, allowing more precise handling of invasive foetal procedures (as well as reducing them) and giving us a better understanding of the physiological changes occurring at foetal-placental level.
Author Biography
Pablo Andrés Victoria-Gómez
References
Nicolaides K, Rizzo G, Hecher K, Ximenes R. Methodology of Doppler assessment of the placental & fetal circulationst. Tomado de Diploma in fetal medicine: Doppler in Obstetrics, Centrus 2004. Disponible en: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/index-11.htm
Baschat AA. The fetal circulation and essential organs – a new twist to an old tale. Ultrasound Obstet Gynecol 2006;27:349-54.
Kiserud T. Physiology of the fetal circulation. Semin Fetal Neonatal Med 2005;10:493-503.
Nicolaides K. Chapter 4. Diagnosis of fetal abnormalities, the 18-23 week scan. Small for gestational age. Tomado de Fetal foundation 2004. Disponible en: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/chapter-04/chapter-04-final.htm
Divon M, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002;45:1015-25.
Harman CR, Baschat AA. Arterial and venous Doppler in IUGR. Clin Obstet Gynecol 2003;46:931-46.
Herrera M. Doppler arterial y venoso fetal. Curso de nivelación ultrasonido en Obstetricia y Ginecología. Fecopen; 2005.
Park YW, Cho JS, Choi HM, Kim TY, Lee SH, Yu J. Clinical significance of early diastolic notch depth: uterine artery Doppler velocimetry in the third trimester. Am J Obstet Gynecol 2000;182:1204-9.
Nicolaides KH. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004;191:45-67.
Malone FD, D`Alton M. First-trimester sonographic screening for Down syndrome. Obstet Gynecol 2003;102:1066-79.
Huggon I, DeFigueiredo D, Allan D. Tricuspid regurgitation in the diagnosis of chromosomal anomalies in the fetus at 11–14 weeks gestation. Heart 2003;89:1071-3.
Nicolaides K, Spencer K, Avgidou K, Faiola S, Falcon O. Multicenter study of first-trimester screening for trisomy 21 in 75821 pregnancies: results and estimation of the potential impact of individual risk-orientated two-stage first-trimester screening. Ultrasound Obstet Gynecol 2005;25:221-6.
Divon M, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002;45:1015-25.
Konje J, Taylor D, Abrams K. Normative values of Doppler velocimetry of five major fetal arteries as determined by color power angiography. Acta Obstet Gynecol Scand 2005;84:230-7.
Nicolaides K, Rizzo G, Hecher K, Ximenes R. Chap 4: Doppler studies in fetal hypoxemic hypoxia. Tomado de Diploma in fetal medicine: Doppler in Obstetrics. Centrus 2004. Disponible en: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/Doppler/capitulos-html/chapter_04.htm
Avgidou K, Papageorghiou A, Bindra R, Spencer K, Nicolaides K. Prospective first-trimester screening for trisomy 21 in 30564 pregnancies. Am J Obstet Gynecol 2005;192:1761-7.
Nicolaides K. Diagnosis of fetal abnormalities, the 18-23 week scan. Risk appendix. Tomado de Fetal Foundation 2004. Disponible en: http://www.centrus.com.br/diplomaFMF/18-23-weeks/appendix-01/appendix01-html.
Fortuny A, Borrell A, Casals E, Seres A, Sanchez A, Soler A. First trimester aneuploidy screening combining biochemical and ultrasound markers. The Ultrasound Review of Obstetrics and Gynecology 2005;5:9-17.
Malone F, Canick JA, Ball RH, Nyberg DA, Comstock CH, Bukowski R, et al. First-trimester or second-trimester screening, or both, for Down’s syndrome. N Engl J Med 2005;353:2001-11.
Souka AP, Kaisenberg CS, Hyett JA, Nicolaides KH. Increased nuchal translucency with normal karyotype. Am J Obstet Gynecol 2005;192:1005-21.
Nicolaides K, Rizzo G, Hecher K, Ximenes R. Chap 5: Screening for placental insufficiency by uterine artery Doppler. Tomado de Diploma in fetal medicine: Doppler in obstetrics. Centrus 2004. Disponible en: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/Doppler/capitulos-html/chapter_05.htm
Spencer K, Yu CK, Cowans N, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free beta-hCG with second-trimester uterine artery Doppler. Prenat Diagn 2005;25:949-53.
Gomez O, Martinez JM, Figueras F, Del Rio M, Borobio V, Puerto B, et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol 2005;26:490-4.
Papageorghiou AT, Roberts N. Uterine artery Doppler screening for adverse pregnancy outcome. Curr Opin Obstet Gynecol 2005;17:584-90.
Carbillon L, Uzan M, Largilliere C, Perrot N, Tigaizin A, Paries J, et al. Prospective evaluation of uterine artery fl ow velocity waveforms at 12-14 and 22-24 weeks of gestation in relation to pregnancy outcome and birth weight. Fetal Diagn Ther 2004;19:381-4.
Campbell S, Doppler Ultrasound of the Maternal Uterine Arteries: Disappearance of Abnormal notching, Low Birthweight and Pregnancy Outcome. Acta Obstet Gynecol Scand 2000;16:171-8.
Resnik R. Intrauterine growth restriction. Obstet Gynecol 2002;99:490-6.
Loughna P. Intra-uterine growth restriction: investigation and management. Curr Obstet Gynaecol 2003;13:205-11.
Ferrazi E, Bozzo M, Rigano S, Bellotti M, Morabito A, Pardi G, et al. Temporal sequence of abnormal Doppler changes in the peripheral and central circulator y systems of the severely growth-restricted fetus. Ultrasound Obstet Gynecol 2002;19:140-6.
Bamberg C, Kalache KD. Prenatal diagnosis of fetal growth restriction. Semin Fetal Neonatal Med 2004:387-94.
Huhta JC. Fetal congestive heart failure. Semin Fetal Neonatal Med 2005;10:542-52.
Creasy R, Robert R. Fetal growth restriction. En: Creasy R, Resnik R. Maternal-fetal medicine principles and practice. 5th ed. Philadelphia: Saunders-Elsevier; 2004. p. 495-513.
GRIT Study Group. A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. BJOG 2003;110:27-32.
Illanes S, Soothill P.Management of fetal growth restriction. Semin Fetal Neonatol Med 2004;9:395-401.
Harkness U, Mari G. Diagnosis and management of intrauterine growth restriction. Clin Perinatol 2004;31:743-64.
Green P, Alfirevic Z. The evidence base for fetal medicine. Best Pract Res Clin Obstet Gynaecol 2005;19:75-83.
Segata M, Mari G. Fetal anemia: new technologies. Curr Opin Obstet Gynecol 2004;16:153-8.
Lopez J, Briceño F. Velocimetria Doppler. En: Cifuentes R. Ginecología y Obstetricia basados en la evidencia. Bogotá: Distribuna; 2002. p. 123.
Detti L, Mari G. Noninvasive diagnosis of fetal anemia. Clin Obstet Gynecol 2003;46:923-30.
Detti L, Mari G, Akiyama M, Cosmi E, Moise KJ Jr, Stefor T, et al. Longitudinal assessment of the middle cerebral artery peak systolic velocity in healthy fetuses and in fetuses at risk for anemia. Am J Obstet Gynecol 2002;187:937-9.
Mari G, Zimmermann R, Moise K, Deter R. Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions. Am J Obstet Gynecol 2005;193:1117-20.
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