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Doppler in Obstetrics

Farhan Hanif,MD Maternal Fetal Medicine. Doppler in Obstetrics. Doppler assessment of the placental and fetal circulation is important tool screening for adverse pregnany outcomes. Angle Dependence. Doppler in IUGR. EFW<10 th %ile EFW <2SD above the mean EFW <5 th %ile AC <5 th %ile

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Doppler in Obstetrics

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  1. Farhan Hanif,MD Maternal Fetal Medicine Doppler in Obstetrics

  2. Doppler assessment of the placental and fetal circulation is important tool screening for adverse pregnany outcomes

  3. Angle Dependence

  4. Doppler in IUGR • EFW<10th %ile • EFW <2SD above the mean • EFW <5th %ile • AC <5th %ile • ACOG defines IUGR as EFW <10thile

  5. Compensatory Mechanisms Fetal Hypoxemia- placental insufficiency UA Blood flow Redistribution Brain, heart, adrenal Gland MCA PI AF Echogenic Bowel Lung, kidney, bowel

  6. Myocardial dysfunction Pressure in Rt Atrium / Dilatation of DV Abnormal Venous Doppler Decompensation

  7. Fetal Hypoxemia / Acidosis Abnormalities in Central Control of FHR “ANS” or Direct Myocardial Depression Variability Baseline Deceleration

  8. Umbilical artery Abnormal Umbilical vein

  9. Abnormal Umbilical vein Abnormal Umbilical artery

  10. MCA waveforms A = Normal Normal Brain Sparing B = “Brain sparing effect”

  11. MCA Doppler In Anemia • In Anemic fetuses, the PSV will inrease. • Obtaining PSV at 0 degrees angle is important in anemic fetuses. • Increase False positive rate after 34 weeks

  12. AGA IUGR a IUGR D S

  13. Role of Ductus Venosus Baschat et al ultrasound obstet gynecol 2004

  14. Temporal Sequence of Cardiovascular changes in IUGR fetuses

  15. Ferrazi et al. US Obstet Gynecol 2002; 19: 140-6

  16. Doppler Indices and outcomes • In complicated pregnancies abnormal Doppler indices are powerful predictors of adverse perinatal outcome; Low Apgar score Nonreassuring fetal status Low pH Presence of thick meconium Admission to NICU

  17. Doppler Indices and outcomes • Reduce perinatal death and unnecessary induction of labor in the preterm growth restricted fetus. • A meta-analysis use of Doppler ultrasonography reduced the odds of perinatal death by 38 percent (95% CI 15-55) Alfirevic Z et al Am J Obstet Gynecol 1995

  18. Umbilical Artery • Absence or reversal of end-diastolic flow in the umbilical artery is suggestive of poor fetal condition, whereas normal or slightly decreased umbilical Doppler flow is rarely associated with significant morbidity Ott WJ J Ultrasound Med 2000

  19. IUGR Doppler UA and MCA If Normal Repeat Doppler in 1-2 weeks If normal Serial Growth Scan 4 weeks interval Doppler UA and MCA every 1-2 weeks Evaluate MCA at term ?APFS Consider Delivery at 39 weeks

  20. Abnormal Doppler UA and MCA Present DV Normal Absent/Reverse EDF Ab/Reverse Present DV EDF Growth Scan 2-4 wks Weekly UA, MCA,+/-DV Admit Steroids NST q shift and daily BPP Admit Steroids Continuous monitoring May follow as outpatient BMZ,APFS Deliver at 32-34wks Abnormal APFS ?Timing of Delivery Consider Delivery at 35-37 weeks

  21. Absent or Reversed Flow in the Ductus Venosus EGA <30weeks >30weeks Deliver Continuous Monitoring Daily BPP Daily Doppler Evaluate AoA, Valves Deliver for Abnormal BPP,FHT ?Reversed AoA,E:A Ratio

  22. Doppler in AGA Fetuses • Routine screening with dopplers in AGA fetuses is controversial • However, abnormal UA identifies the fetuses at risk in uncomplicated pregnancies as DM Ch HTN SLE Maternal autoimmune Twins Postterm

  23. Uterine Artery Doppler

  24. Uterine Artery Doppler First trimester Early 2nd Trimester Late 2nd trimester

  25. Prediction of PE

  26. Prevention

  27. Uterine Artery in 1st trimester 7797 women with singleton pregnancies at 11 to 13 weeks. In 34 women , at < 34 weeks. At a 5% FPR; The sensitivity 94.1 percent The specificity was 94.3 percent

  28. Doppler in first Trimester • Increases the sensitivity of first trimester screening and decreases the false postivie rate • DV reversed flow in DV in first trimester is a risk factor for CHD even in the presence of normal NT • Can be used as a part of risk calculation for stillbirth • CAN be used as a tool to

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