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Doppler examinations of the umbilical artery, both uterine arteries, and the fetal middle cerebral artery were performed in the third trimester in 18 patients with pregnancy induced hypertension, 52 patients with preeclampsia, and 32 patients with HELLP syndrome and the results were correlated with the parameters fetal outcome. For 74% of the patients this was the first pregnancy, in 93% of the cases a cesarean section was necessary; 66% of the newborn babies were dystrophic and 90% of them were born prematurely. The blood flow in one uterine artery was restricted in 95% of all 102 pregnant women, only 5% did not show any pathological findings. A pathological blood flow was observed on Doppler sonography in the umbilical artery in 70% of the group and 39% showed a pathologically increased perfusion of the fetal middle cerebral artery. The average birth weights and gestational ages in the study group were markedly reduced in comparison with healthy pregnant women (pregnancy induced hypertension: 1620 g/35 weeks; preeclampsia: 1660 g/34 weeks; HELLP syndrome: 1160 g/31 weeks, respectively). The lowest values for average birth weight and gestational age occurred when all four investigated blood vessels showed pathological Doppler findings: 1180 g/31 weeks (0 to 1 pathological vascular findings: 2780 g/38 weeks; 2 pathological vascular findings: 1845 g/34.5 weeks; 3 pathological vascular findings: 1330 g/31 weeks). This Doppler study underlines the importance of examining four blood vessels: the uterine, the umbilical, and the fetal middle cerebral arteries for a complete analysis of the fetoplacental hemodynamics. On account of the severely impaired hemodynamics observed in the placentas of our patients with hypertensive diseases in pregnancy or HELLP syndrome, we believe the early diagnosis of these disorders by Doppler sonography and an early start of therapy to be essential.

Objective: To determine the value of Doppler ultrasonographic examinations of the uterine artery in high-risk collectives and their importance as compared to examinations of the umbilical artery. Methods: In 142 patients with fetal growth retardation (birth weight <10th percentile) and/or pre-eclampsia/HELLP syndrome (as defined by ACOG criteria), the umbilical artery and the uterine arteries were examined bilaterally using a 3.5/5-MHz color Doppler system (Acuson 128). The patients were assigned to six groups according to the Doppler findings (uterine artery unilaterally/bilaterally normal/pathologic and umbilical artery normal/pathologic). For each group, the median of the birth weight and the gestational age at delivery was determined and the frequency of occurrence of complications was calculated. Results: In cases with pathologic results in all three vessels, the median gestational age at delivery and the median birth weight were significantly lower than in all other subgroups. Of the cases with pathologic findings in the umbilical artery only, 6% had pre-eclampsia/HELLP syndrome. However, this complication developed in 90% of the cases with pathologic findings in both uterine arteries. If only the umbilical artery was examined (and not the uterine arteries) the Doppler results were normal in 40 (28%) of the patients in our high-risk group, thus incorrectly simulating undisturbed placental hemodynamics. Conclusions: Examination of both uterine arteries is an indispensable element of Doppler examination to assess placental performance and risk to the fetus.

Objective: Subject of the study was the significance of umbilical artery Doppler velocimetry findings for the further course of pregnancy and fetal outcome in cases of twin pregnancies. Methods: In 206 cases of twin pregnancy, the umbilical artery was examined using Doppler velocimetry in the median 9 days prior to delivery, and the result was correlated with the further course of pregnancy and fetal outcome. 174 pregnancies showed normal Doppler findings of the umbilical artery (group A), 32 twin pregnancies showed pathological Doppler findings of at least one twin (group B). The median of the maternal age and the parity between the groups were not different. Results: In group B (pathological Doppler findings), intrauterine growth retardation and pre-eclampsia occurred 5 times more often than in group A (normal Doppler findings). The total rate of cesarean sections was not different between the study populations; the rate of deliveries by cesarean section in group B was significantly increased by a factor of 2.4 due to a pathological CTG. The median birth weight and the gestational age at birth were significantly lower in group B (1,660 g; 35 weeks) as compared to group A (2,460 g; 37 weeks; p < 0.001). In group B, the rate of premature deliveries up to reaching the 34th week of gestation was 3.4 times higher; the rate of SGA newborns was 6.3 times higher. Perinatal mortality was increased by a factor of 1.5 in group B compared to group A. Conclusion: The Doppler velocimetry findings have considerable effects on the further course of a multiple pregnancy. In case of pathological Doppler findings, early hospitalization and close monitoring of the pregnancy should be performed. In cases of additional pathological findings (maternal illness, pathological Doppler findings of fetal blood vessels), termination of the pregnancy has to be considered.

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