Intrauterine growth restriction (IUGR) is a condition which has been difficult to assess at an early stage, resulting in the delivery of children who have poor genetic growth potential. Currently, IUGR classification is based upon the system of ultrasound biometry. Doppler velocimetry allows the measurement of hemodynamic flow of major fetal vessels, comparing the flow indices and patterns of normal and IUGR cases. In this review, the effectiveness of Doppler velocimetry in assessing blood flow in major vessels including the umbilical artery, ductus venosus, and middle cerebral artery was studied for both diagnostic and prognostic screening of IUGR. The umbilical artery is the most frequently studied vessel in Doppler velocimetry due to its accessibility and the strength of its associations with fetal outcomes. Abnormalities in the ductus venosus waveform can be indicative of increased resistance in the right atrium due to placental abnormalities. The middle cerebral artery is the most studied fetal cerebral artery and can detect cerebral blood flow and direction, which is why these three vessels were selected to be examined in this context. A potential mathematical model could be developed to incorporate these Doppler measurements which are indicative of IUGR, in order to reduce perinatal mortality. The purpose of the proposed algorithm is to integrate Doppler velocimetry with biophysical profiling in order to determine the optimal timing of delivery, thus reducing the risks of adverse perinatal outcomes.
DasheJS, McIntireDD, LucasMJ, LevenoKJ
. Effects of symmetric and asymmetric fetal growth on pregnancy outcomes. Obstet Gynecol2000;96:321–7.
4.
FiguerasF, GardosiJ
. Intrauterine growth restriction: New concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol2011;4:288–300.
5.
BernsteinIM, HorbarJD, BadgerGJ, OhlssonA, GolanA
. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The vermont oxford network. Am J Obstet Gynecol2000;182:198–206.
BaschatAA
. Doppler application in the delivery timing of the preterm growth-restricted fetus: Another step in the right direction. Ultrasound in Obstetrics & Gynecology Ultrasound Obstet Gynecol2004;23:111–8.
HoffmanC, GalanHL
. Assessing the ‘at-risk’ fetus: Doppler ultrasound. Med Sci Res2009;21:161–6.
18.
BerkleyE, ChauhanSP, AbuhamadA
. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol2012;206:300–8.
19.
SeyamYS, Al-MahmeidMS, Al-TamimiHK
. Umbilical artery doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Gynaecol Obstet2002;77:131–7.
20.
GhoshGS, GudmundssonS
. Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses. BJOG2009;116:424–30.
21.
NanthakomonT, UerpairojkitB
. Outcome of small-for-gestational-age fetuses according to umbilical artery doppler: Is there any yield from additional middle cerebral artery Doppler?J Matern Fetal Neonatal Med2010;23:900–5.
22.
JangDG, JoYS, LeeSJ, KimN, LeeGS
. Perinatal outcomes and maternal clinical characteristics in IUGR with absent or reversed end-diastolic flow velocity in the umbilical artery. Archives of Gynecology and Obstetrics2011;284:73–8.
23.
MarsoosiV, BahadoriF, EsfahaniF, Ghasemi-RadM
. The role of doppler indices in predicting intra ventricular hemorrhage and perinatal mortality in fetal growth restriction. Med Ultrason2012;14:125–32.
24.
BahlmannF, KrummenauerF, SpahnS, GallinatR, KampmannC
. Natriuretic peptide levels in intrauterine growth-restricted fetuses with absent and reversed end-diastolic flow of the umbilical artery in relation to ductus venosus flow velocities. J Perinat Med2011;39:529–37.
25.
WilliamsKP, FarquharsonDF, BebbingtonM, DansereauJ, GalerneauF, WilsonRD, KentN
. Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery doppler velocimetry: A randomized controlled clinical trial. Am J Obstet Gynecol2003;188:1366–71.
26.
SimonazziG, CurtiA, CattaniL, RizzoN, PiluG. Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability. BJOG2013.
27.
MaulikD, MundyD, HeitmannE. Umbilical artery Doppler in the assessment of fetal growth restriction. Clin Perinatol2011;38:65.
28.
ImdadA, YakoobMY, SiddiquiS, BhuttaZA
. Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: A systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health2011;11:S1.
29.
MorrisRK, MalinG, RobsonSC, KleijnenJ, ZamoraJ, KhanKS
. Fetal umbilical artery doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: Systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol2011;37:135–42.
30.
HarmanCR, BaschatAA
. Arterial and venous dopplers in IUGR. Clin Obstet Gynecol2003;46:931–46.
31.
TuranOM, TuranS, BergC, GembruchU, NicolaidesKH, HarmanCR, BaschatAA
. Duration of persistent abnormal ductus venosus flow and its impact on perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol2011;38:295–302.
32.
PicconiJL, KrugerM, MariG
. Ductus venosus S-wave/isovolumetric A-wave (SIA) index and A-wave reversed flow in severely premature growth-restricted fetuses. J Ultrasound Med2008;27:1283–9.
33.
KaponisA, HaradaT, MakrydimasG, KiyamaT, ArataK, AdonakisG, HaradaT
. The importance of venous doppler velocimetry for evaluation of intrauterine growth restriction. J Ultrasound Med2011;30:529–45.
34.
BanoS, ChaudharyV, PandeS, MehtaVL, SharmaAK
. Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome. Indian J Radiol Imaging2010;20:20.
35.
VerburgBO, JaddoeVW, WladimiroffJW, HofmanA, WittemanJC, SteegersEA
. Fetal hemodynamic adaptive changes related to intrauterine growth. Circulation2008;117:649–59.
36.
TarzamniMK, NezamiN, Gatreh-SamaniF, VahediniaS, TarzamniM
. Doppler waveform indices of fetal middle cerebral artery in normal 20 to 40 weeks pregnancies. Arch Iran Med2009;12:29–34.
37.
MariG, HanifF, KrugerM, CosmiE, Santolaya-ForgasJ, TreadwellMC
. Middle cerebral artery peak systolic velocity: A new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet & Gynecol2007;29:310–6.
38.
CosmiE, AmbrosiniG, D’AntonaD, SaccardiC, MariG
. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol2005;106:1240–5.
39.
ArduiniD, RizzoG, RomaniniC
. Changes of pulsatility index from fetal vessels preceding the onset of late decelerations in growth-retarded fetuses. Obstet Gynecol1992;79:605–10.
40.
Van den WijngaardJA, GroenenbergIA, WladimiroffJW, HopWC
. Cerebral doppler ultrasound of the human fetus. Int J Gynaecol Obstet1989;96:845–9.
41.
MoiseKJJr
. The usefulness of middle cerebral artery Doppler assessment in the treatment of the fetus at risk for anemia. Am J Obstet Gynecol2008;198:e1–161.e4.
42.
YoonBH, RomeroR, RohCR, KimSH, AgerJW, SynHC, KimSW
. Relationship between the fetal biophysical profile score, umbilical artery Doppler velocimetry, and fetal blood acid-base status determined by cordocentesis. Am J Obstet Gynecol1993;169:1586–94.
43.
BaschatAA, GembruchU, HarmanCR
. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol2001;18:571–7.
44.
BaschatAA, GalanHL, BhideA, BergC, KushML, OepkesD, HarmanCR
. Doppler and biophysical assessment in growth restricted fetuses: Distribution of test results. Ultrasound Obstet Gynecol2006;27:41–7.
45.
OttWJ
. Development of a fetal risk assessment score for the prediction of neonatal outcome in the growth-restricted fetus. J Matern Fetal Neonatal Med2012;25:1941–4.
46.
FerrazziE, BozzoM, RiganoS, BellottiM, MorabitoA, PardiG, … GalanHL
. Temporal sequence of abnormal doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound Obstet Gynecol2002;19:140–6.
47.
OdiboAO, RiddickC, PareE, StamilioDM, MaconesGA
. Cerebroplacental doppler ratio and adverse perinatal outcomes in intrauterine growth restriction: Evaluating the impact of using gestational age-specific reference values. J Ultrasound Med2005;24:1223–8.
48.
MariG, HanifF, TreadwellMC, KrugerM
. Gestational age at delivery and doppler waveforms in very preterm intrauterine growth-restricted fetuses as predictors of perinatal mortality. J Ultrasound Med2007;26:555–9.
49.
SchwarzeA, GembruchU, KrappM, KatalinicA, GermerU, Axt-FliednerR
. Qualitative venous doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery–correlation with short-term outcome. Ultrasound Obstet Gynecol2005;25:573–9.
50.
Cruz-MartinezR, FiguerasF, Benavides-SerraldeA, CrispiF, Hernandez-AndradeE, GratacosE
. Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early-onset intrauterine growth restriction. Ultrasound Obstet Gynecol2011;38:179–84.
51.
Cruz-MartinezR, FiguerasF, Hernandez-AndradeE, OrosD, GratacosE. Fetal brain doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol2011;117:618–26.
52.
StollBJ, HansenNI, BellEF, ShankaranS, LaptookAR, WalshMC
. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics2010;126:443–56.
53.
McGowanJ, AlderdiceF, HolmesV, JohnstonL
. Early childhood development of late-preterm infants: A systematic review. Pediatrics2011;127:1111–24.
54.
OrosD, FiguerasF, Cruz-MartinezR, MelerE, MunmanyM, GratacosE
. Longitudinal changes in uterine, umbilical and fetal cerebral doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol2011;37:191–5.
55.
VerganiP, RoncagliaN, GhidiniA, CrippaI, CameroniI, OrsenigoF, PezzulloJ
. Can adverse neonatal outcome be predicted in late preterm or term fetal growth restriction?Ultrasound Obstet Gynecol2010;36:166–70.
