IUGR: Maternal Doppler Uterine artery: S/D > 2.6 associated
with IUGR, IUFD Elevated resistance index and IUGR: 70.6% sensitive
33.3% PPV
Slide 5
IUGR: Fetal Dopplers Umbilical: rising S/D ratio = increasing
placental resistance associated with fewer small arteries of
tertiary placental villi Falling pulsatility index in head:
indicates increased flow to brain Venous Dopplers: Cardiovascular
performance
Slide 6
IUGR: Fetal Dopplers Study of 43 IUGR fetuses: 85% had S/D
ratios > 95th percentile decreased diastolic flow indicating
high placental flow resistance Trudinger et al., Br J Obstet
Gynaecol 92:39, 1985
Slide 7
IUGR: Dopplers and Outcome When umbilical S/D known: lower PNM
rates, fewer antenatal admissions, fewer inductions, fewer C/S no
improvement noted for low risk pregnancies Divon & Ferber,
Perinat Neonat Med 5:3, 2000
Slide 8
Absent/Reversed EDV Doppler
Slide 9
80% will have IUGR 36% PNM rate REDV: >70% placental
arteries obliterated Mean time to delivery 7 days (0-49)
Management: BMS, hospital bed rest, intensive monitoring, liberal
delivery venous Dopplers
Slide 10
Slide 11
MCA Doppler Technique Obtain axial section of the brain,
including the thalami and the CSP. Sweep lower. The circle of
Willis is visualized. MCA of one side is examined close to its
origin from the internal carotid artery. The angle of insonance is
kept as close as possible to 0 degrees.
IUGR: Middle Cerebral Doppler Normally demonstrates low
diastolic flow Increased diastolic flow: possible early indicator
of fetal hypoxemia (Gudmundsson, 1996) Sign of cerebral
redistribution with chronic hypoxemia (brain sparing effect)
(Wladimiroff, 1986; Mari, 1992; Gramellini, 1992)
Slide 14
IUGR: Middle Cerebral Doppler Normal MCAAbnormal MCA
Slide 15
IUGR: Value of Doppler SGA fetuses with: Normal AFV Normal UmA
S/D Normal MCA Dopplers >97% NPV for major negative perinatal
sequellae Fong et al., Radiology 213:681, 1999.
Slide 16
Fetal Venous Circulation
Slide 17
Central Venous Circulation Doppler flow waveforms Fetal venous
system has characteristic pulsations which reflect CVP
Slide 18
DV UV Normal Venous Dopplers
Slide 19
Abnormal Venous Dopplers DV UV
Slide 20
IUGR: Venous Dopplers AEDV + umbilical vein pulsations = 54%
mortality AEDV - umbilical vein pulsations = 10% mortality Indik,
Obstet Gynecol 77:551, 1991 Venous atrial back flow waves are
suggestive of metabolic Acidemia documented by PUBS Hecher et al.,
Am J Obstet Gynecol 173:10, 1995
Slide 21
Fetal Diagn Ther. 2012;32(1-2):116-22
Slide 22
IUGR: Fetal Response to UPI Respiratory/MetabolicHypoxia
andAcidosis DysfunctionHypercarbia Compensation Decompensation
Shunting:High right atrial pressure To: brain, heart, adrenalDV
dilatation From: lungs, bowel, kidneyMyocardial dysfunction
Ultrasound/Doppler:Doppler: Oligohydramnios venous/cardiac changes
UmA and MCA DopplersBPP abnormal
Slide 23
IUGR: Fetal Well-Being BPP use with IUGR: strong association
with cord pH cascade of decompensation: BPP: lower rates of
intervention compared to OCT/CST, with equal outcomes pHNR NST No
FBM Movement ToneDead Man Float