Umblical & uterine artery Doppler

Umblical & uterine artery Doppler

1. Umblical & uterine
artery Doppler
Aboubakr Elnashar

2. I. Umbilical artery Doppler
Idea:
Umbilical Arterial Flow is normally of low
resistance.
In hypoxic states:
relative placental hypoxia:
reactive VC of umbilical artery:
higher resistance:
decrease in diastolic flow
Aboubakr Elnashar

3. Interpretation:
•Resistance index: best ability to
predict abnormal outcomes (RCOG,2002
Evidence level II)
•Enddiastolic flow
•Systolic/diastolic ratio
•Pulsatility index
•Diastolic average ratio
Aboubakr Elnashar

4. Doppler indices
Aboubakr Elnashar

5. •Resistance Index:
In normal pregnancy:
{progressive increase in end-diastolic velocity
{growth& dilatation of the umbilical circulation}:
Resistance index falls.
In fetal growth restriction and/or
preeclampsia:
> 0.72 is outside the normal limits from 26 w.

Aboubakr Elnashar

6. •End Diastolic flow
In fetal growth restriction and/or preeclampsia:
is reduced, then
absent (AED) or
reversed (RED) in severe cases
Absent or reversed:
Fetal distress is almost certain:
Immediate BPP or NST or
Delivery may be indicated.
Aboubakr Elnashar

7. •S/D
Should be <3.
Small increases in S/D= 3-5:
chronic intrauterine disease manifest by IUGR.
Not strictly useful:
{1. low sensitivity.
2. Gestation age dependent}.
Aboubakr Elnashar

8. Normal
Absent
Reversed
Aboubakr Elnashar

9. RED
Aboubakr Elnashar

10. RED
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11. Absent
Reversed
Aboubakr Elnashar

12. Advantages:Advantages:
1.In low risk
No benefit on mother or baby
(The Cochrane Library, 2003)
Aboubakr Elnashar

13. 2. In high risk:
Reduction of
perinatal morbidity and mortality
number of antenatal admissions
inductions of labor
resources compared with CTG
(Grade A RCOG, 2002; The Cochrane Library, 2003)
Comparing FHR monitoring, FBP and umbilical artery Doppler:
only umbilical artery Doppler had value in predicting poor perinatal
outcomes in SGA

Aboubakr Elnashar

14. •Frequency of monitoring in SGA
fetuses with normal Doppler:
Once/2w (RCOG, 2002 Evidence level II)
•A 4-week U/S measurement interval was shown to be superior to a 2-
week interval, in terms of reducing the false –positive rate (Owen et al,
2001).
•Once/2w (Fortnightly) scans should be undertaken where
1.linear growth velocity is not maintained or
2.AC is below the third centile (IV)

Aboubakr Elnashar

15. II.Uterine artery Doppler
•limited use in predicting FGR and
perinatal death (Grade A, RCOG,2002).
•Abnormal uterine artery suggest:
maternal cause for the growth
restriction
•Normal uterine artery Doppler
suggest:
fetal cause
Aboubakr Elnashar

16. UAD: Normal
UAD: notch,
decreased diastolic
flow
Aboubakr Elnashar

17. Prediction of preeclampsia
(Uterine Doppler velocimetry)
•Persistence of a Diastolic
Notch in uterine artery
waveform after 24 w




•Systolic/diastolic ratio >2.6
•RI > 0.58 after 24 weeks.

Systole
Diastole
Aboubakr Elnashar

18. Aboubakr Elnashar