Colour Doppler in IUGR- Where are we and where do we go?

Abstract

Intra-uterine growth restriction (IUGR) is an important perinatal problem giving rise to increased morbidity and mortality in the growth restricted fetus. The aim of fetal medicine today, is to prevent the mere occurrence of IUGR in high risk pregnancies and to deliver the fetuses already afflicted with growth restriction, before they have suffered from the effects of hypoxia. The use of Doppler provides this information, which is not readily obtained from the other conventional tests of fetal well being. The Doppler patterns follow a longitudinal trend in the arterial and venous circulation of the fetus as well as the placental vasculature guiding management decisions regarding the appropriate time of delivery. Progressive knowledge of the fetal circulation and its adaptation when the fetus is subjected to hypoxia, has helped us recognize the early signs of IUGR thereby improving the prognosis of these complicated pregnancies. It has therefore become the gold standard in the management of the growth-restricted fetus.

Doppler Assessment of Aortic Ishtmus in Fetuses with Intrauterine Growth Restriction

“…Various studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][20][21][22] have described a strong association of retrograde flow through aortic isthmus with the IUGR, our study too confirms this observation. There were some cases who had reverse isthmic diastolic blood flow although the umbilical artery diastolic flow was forward, implying that Doppler study of flow velocity patterns of aortic isthmus can detect changes prior to those occurring in UA in IUGR.…”

“…Doppler ultrasound provides this information effectively, which is not readily obtained from the other conventional tests of fetal wellbeing and can guide management decisions regarding the appropriate timing of delivery. Knowledge of the fetal circulation and the compensatory changes during fetal hypoxia has helped us recognize the early signs of IUGR thus improving the prognosis of these high risk pregnancies [1].…”

“…Ultrasound has therefore become the gold standard [1] in the management of the growth-restricted fetus. Ultrasound utilizes the reflection of sound waves to evaluate soft tissue structure.…”

The cerebroplacental ratio: association with maternal hypertension and proteinuria

“…The disease is caused by abnormal placentation leading to inadequate trophoblastic invasion of the maternal spiral arterioles, resulting in increased vascular resistance and reduced uteroplacental perfusion. Doppler ultrasound provides information on uteroplacental vascular resistance and, indirectly, on the fetal blood circulation ( 12 ) .…”

Identificación de restricción del crecimiento intrauterino tardío con doppler umbilical normal mediante algoritmo diagnóstico multiparámetro en el Instituto Nacional Materno Perinatal

“…Está descrito que los RCIU de presentación tardía (> 34 semanas ) que son más frecuentes, generalmente no presentan compromiso hemodinámico ni asociación a pre eclampsia y por tanto son subdiagnosticados. La evaluación doppler de la arteria cerebral media, el Índice Cerebro Placentario y de la arterias uterinas, la existencia de un factor materno o indicador de afección de la transferencia de nutrientes mediados por la placenta o un déficit severo del crecimiento (menor del percentil 2,5-3) mejoran su identificación y por tanto, la normalidad del doppler umbilical no debe incitar a definirlos como simples variantes extremos de lo normal ya que estos también tienen peores pronósticos perinatales y neuroconductuales [18][19][20][28][29][30][31][32] .…”