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Doppler ultrasound is routinely used in the clinical setting to evaluate blood flow in many major vessels of the body. Spectral Doppler is used to display the normal and abnormal signature waveforms that are unique to each vessel. It is important for the sonographer and the radiologist to recognize both what is normal and what is abnormal in a spectral Doppler display. In this review, we briefly explain the physics behind Doppler ultrasound and some of the most common mathematical equations applied in a routine clinical examination. We also describe and demonstrate normal versus abnormal spectral Doppler signature waveforms of vessels in the neck, abdomen, pelvis, and fetus.

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plit-hand/foot malformations (SHFMs) span a wide spectrum of limb defects ranging from minor anomalies of the fingers to a lobster claw deformity. As a result, authors in the genetics and surgical literature use the term SHFM interchangeably with ectrodactyly, cleft hand, partial terminal aphalangia, oligodactyly, crab claw malformation, and lobster claw anomaly/ malformation. In this article, we use SHFM to describe the full spectrum of split-hand/foot anomalies as described by the Human Genome nomenclature in 1994, 1 including ectrodactyly and syndactyly with obvious median clefts of the hands and feet, due to aplasia or hypoplasia, or both, of the phalanges, metacarpals, and metatarsals. The purpose of this series was to identify cases that appeared on sonography to be splithand/foot malformations (SHFMs) in fetuses and correlate the sonographic findings, including 2-dimensional (2D) and 3-dimensional (3D) sonography, to outcomes. A retrospective review was conducted of sonographic studies from 2002 to 2012 at 2 fetal care centers. Data were collected with respect to the morphologic characteristics of splithand/foot abnormalities, the utility of 3D sonography, associated anatomic abnormalities, family histories, gestational ages at diagnosis, fetal outcomes, karyotype, and autopsy results. Ten cases were identified with gestational ages ranging from 15 to 29 weeks. Three-dimensional sonography was helpful in defining anatomy in 7 of 9 cases in which it was performed. Bilateral SHFMs were found in 7 cases (3 cases involving both hands and feet, 2 cases isolated to hands, and 2 cases isolated to feet), whereas 3 cases showed unilateral split-hand malformations. Associated anatomic anomalies were present in 6 cases, and 4 of these had recognized syndromes, including 2 with abnormal karyotypes, specifically, del(22q11) and del(7q31). Two cases occurred in the context of a positive family history of SHFM. Three cases were delivered at term, and 7 cases were electively terminated. In conclusion, SHFMs often occur with a broad range of chromosomal abnormalities, single-gene disorders, and other congenital anomalies. Some apparent SHFMs turn out to be other limb anomalies, such as complex syndactyly. Prenatal screening using 2D sonography can identify SHFMs, and 3D sonography often further clarifies them.

Evaluation of the fetal face with 3-dimensional ultrasound allows for evaluation of the fetal face using surface rendering, multiplanar and multislice displays. Three-dimensional ultrasound offers many benefits in evaluating the fetal face because it can be rotated into a standard symmetrical orientation and reviewed millimeters by millimeters by scrolling through the volumes. New rendering tools now allow imaging of the hard palate. Clinical applications where 3-dimensional ultrasound adds value as an adjunct to 2-dimensional ultrasound imaging that are reviewed in this paper include cleft lip and palate, micrognathia and other profile abnormalities, metopic suture abnormalities, presence and absence of the nasal bones, orbit abnormalities, and ear abnormalities. In addition, the literature regarding parental bonding to the fetus after viewing 3-dimensional images of their fetuses is reviewed.