Conclusion Fetal Circulation

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The increasing technical capabilities of ultrasound machines allow specific interrogation of vessels from the placental and fetal circulation. Uterine and UA Doppler are important clinical utilities to identify high-risk pregnancies. Once identified as high-risk, women can be counseled about the need for enhanced fetal surveillance using

UA Doppler. In women with pre-eclampsia, the loss or reversal of EDF in the UA signals the need for daily surveillance by experienced clinicians working in units capable of managing preterm growth-restricted neonates. As such it is a seminal finding.

Evidence from randomized trials, incorporating women with pre-eclampsia, suggest that early delivery of the very preterm fetus confers no advantage over expectant management where there is uncertainty regarding the timing of delivery. However, daily monitoring of maternal and fetal condition is vital. Doppler assessment of the fetal venous system to time delivery looks promising. However, concealing Doppler assessments from clinicians involved in the timing of delivery is increasingly difficult and the use of descriptive monitoring strategies for pregnancies with defined risk categories in the clinical trial setting is timely. Only well-designed trials of timed delivery, including long-term neurodevelopment as an outcome, will confirm the role of fetal Doppler in the management of high-risk pregnancy.


Aardema, M. W., Oosterhof, H., Timmer, A., van Rooy, I. and Aarnoudse, J. G. (2001). Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small for gestational age fetuses. Placenta, 22, 405-11.

Arduini, D. and Rizzo, G. (1990). Normal values of Pulsatility Index from fetal vessels: a cross sectional study on 1556 healthy fetuses. J. Perinatal. Med., 18, 165-72.

Arduini, D., Rizzo, G. and Romanini, C. (1992). Changes of pulsatility index from fetal vessels preceding the onset of late decelerations in growth-retarded fetuses. Obstet. Gynecol., 79, 605-10. Arduini, D., Rizzo, G. and Romanini, C. (1993). The development of abnormal heart rate patterns after absent end-diastolic velocity in umbilical artery: analysis of risk factors. Am. J. Obstet. Gynecol., 168, 43-50.

Baschat, A.A. (2004). Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet. Gynecol., 23, 111-18.

Baschat, A.A., Gembruch, U., Reiss, I., Gortner, L., Weiner, C. P. and Harman, C. R. (2000). Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet. Gynecol., 16, 407-13.

Baschat, A. A., Gembruch, U., Weiner, C. P. and Harman, C. R. (2003). Qualitative venous Doppler waveform analysis improves prediction of critical perinatal outcomes in premature growth-restricted fetuses. Ultrasound Obstet. Gynecol., 22, 240-5.

Bilardo, C. M., Wolk, H., Stigter, R. H., et al. (2004). Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet. Gynecol., 23, 119-25.

Bower, S., Vyas, S., Campbell, S. and Nicolaides, K. H. (1992). Color Doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow. Ultrasound Obstet. Gynecol., 2, 261-5.

Bower, S., Bewley, S. and Campbell, S. (1993). Improved prediction of preeclampsia by two-stage screening of uterine arteries using the early diastolic notch and color Doppler imaging. Obstet. Gynecol., 82, 78-83.

Brown, M.A., North, L. and Hargood, J. (1990). Uteropla-cental Doppler ultrasound in routine antenatal care. Aust. N.Z. J. Obstet. Gynaecol., 30, 303-7.

Chan, F. Y., Pun, T. C., Lam, P., Lam, C., Lee, C. P. and Lam, Y. H. (1996). Fetal cerebral Doppler studies as a predictor of perinatal outcome and subsequent neurologic handicap. Obstet. Gynecol., 87, 981-8.

Chappell, L.C., Seed, P.T., Briley, A.L., etal. (1999). Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Lancet, 354, 810-16.

Chari, R.S., Friedman, S.A., O'Brien, J.M. and Sibai, B. M. (1995). Daily antenatal testing in women with severe preeclampsia. Am. J. Obstet. Gynaecol., 173, 1207-10.

Chien, P. W., Arnott, N., Gordon, A., Own, P. and Khan, K. (2000). How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intra-uterine growth retardation and perinatal death? An overview. Br. J. Obstet. Gynaecol., 107, 196-208.

Coleman, M.A.G., McCowan, L.M. E. and North, R.A. (2000). Mid-trimester uterine artery screening as a predictor of adverse pregnancy outcome in high risk women. Ultrasound Obstet. Gynecol., 15, 7-12.

Edelstone, D.I. (1980). Regulation of blood flow through the ductus venosus. J. Dev. Physiol., 2, 219-38.

Eronen, M., Kari, A., Pesonen, E., Kaaja, R., Wallgren, E.I. and Hallman, M. (1993). Value of absent or retrograde end-diastolic flow in fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy-induced hypertension. Acta Paediatr., 82, 919-24.

Ferrazzi, E., Bozzo, M., Rigano, S., et al. (2002). Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound Obstet. Gynecol., 19, 140-6.

Figueras, F., Puerto, B., Martinez, J. M., Cararach, V. and Vanrell, J. A. (2003). Cardiac function monitoring of fetuses with growth restriction. Eur. J. Obstet. Gynecol. Reprod. Biol., 110, 159-63.

FitzGerald, D. E. and Drumm, J. E. (1997). Non-invasive measurement of human fetal circulation using ultrasound: a new method. Br. Med. J., ii, 1450-1.

Fong, W., Ohlsson, K., Arne, H. E., etal. (1999). Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiology, 213, 681-9.

Friedman, S. A., Schiff, E., Kao, L. and Sibai, B. M. (1995). Neonatal outcome after preterm delivery for preeclampsia. Am. J. Obstet. Gynecol., 172, 1785-8.

Frusca, T., Soregaroli, M., Zanelli, S., Danti, L., Guandalini, F. and Valcamonico, A. (1998). Role of uterine artery Doppler investigation in pregnant women with chronic hypertension. Eur. J. Obstet. Gynecol. Reprod. Biol., 79, 47-50.

Frusca, T., Soregaroli, M., Platto, C., Enterri, L., Lojacono, A. and Valcamonico, A. (2003). Uterine artery velocimetry in patients with gestational hypertension. Obstet. Gynecol., 102, 136-40.

Giles, W. B., Trudinger, B. J. and Baird, P. J. (1985). Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation. Br. J. Obstet. Gynaecol., 92, 31-8.

Harman, C. R. and Baschat, A. A. (2003). Arterial and venous Dopplers in IUGR. Clin. Obstet. Gynecol., 46, 931-46.

Harrington, K., Carpenter, R. G., Goldfrad, C. and Campbell, S. (1997). Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation. Br. J. Obstet. Gynaecol., 104, 674-81.

Harrington, K., Fayyad, A., Thakur, V. and Aquilina, J. (2004). The value of uterine artery Doppler in the prediction of uteroplacental complications in multi-parous women. Ultrasound Obstet. Gynecol., 23, 50-5.

Hecher, K., Campbell, S., Snijders, R. and Nicolaides, K. (1994). Reference ranges for fetal venous and atrioventricular blood flow parameters. Ultrasound Obstet. Gynecol., 4, 381-90.

Hecher, K., Bilardo, C.M., Stigter, R.H., et al. (2001). Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet. Gynecol., 18, 564-70.

Hofstaetter, C., Gudmundsson, S. and Hansmann, M. (2002). Venous Doppler velocimetry in the surveillance of severely compromised fetuses. Ultrasound Obstet. Gynecol., 20, 233-9.

Hornbuckle, J. and Thornton, J.G. (1998). The fetal circulatory response to chronic placental insufficiency. and relation to pregnancy outcome. Fetal. Mat. Med. Rev., 10, 137-52.

Hornbuckle, J., Sturgiss, S. N. and Robson, S. C. (2003). Mangement of fetuses with absent and reversed end-diastolic frequencies (AREDF) in the umbilical artery; outcome of a policy of daily biophysical profile (BPP). J. Obstet. Gynaecol., 23(Suppl. 1), S35.

Karsdorp, V. H. M., vanVugt, J.M.G., vanGeijn, H.P., etal. (1994). Clinical significance of absent or reversed end diastolic velocity waveforms in umbilical artery. Lancet , 344, 1664-8.

Kirsten, G. F., Van Zyl, J. I., Van Zijl, F., Maritz, J. S. and Odendaal, H. J. (2000). Infants of women with severe early pre-eclampsia: the effect of absent end-diastolic umbilical artery Doppler flow velocities on neurodevelopmental outcome. Acta Paediatr., 89, 566-70.

Konje, J.C., Bell, S.C. and Taylor, D.J. (2001). Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: is the occurrence of reversal of compensatory flow too late? Br. J. Obstet. Gynaecol., 108, 973-9.

Lees, C., Parra, M., Missfelder-Lobos, H., Morgans, A., Fletcher, O. and Nicolaides, K. H. (2001). Individualized risk assessment for adverse pregnancy outcome by uterine artery Doppler at 23 weeks. Obstet. Gynecol., 98, 369-73.

Ley, D., Tideman, E., Laurin, J., Bjerre, I. and Marsal, K. (1996). Abnormal fetal aortic velocity waveform and intellectual function at 7 years of age. Ultrasound Obstet. Gynecol., 8, 160-5.

Lin, S., Shimizu, I., Suehara, N., Nakayama, M. and Aono, T. (1995). Uterine artery Doppler velo-cimetry in relation to trophoblast invasion into the myometrium of the placental bed. Obstet. Gynecol., 85, 760-5.

Lyall, F, and Robson, S. C. (2000). Defective extravillous trophoblast function and pre-eclampsia. In The Placenta: Basic Science and Clinical Practice, ed. J. Kingdom, E. Jauniaux and S. O'Brien. London: RCOG Press, pp. 79-96.

Martin, A. M., Bindra, R., Curcio, P., Cicero, S. and Nicolaides, K. H. (2001). Screening for pre-eclampsia and fetal growth retardation by uterine artery Doppler at 11-14weeks of gestation. Ultrasound Obstet. Gynecol., 18, 583-6.

Matijevic, R. and Johnston, T. (1999). In vivo assessment of failed trophoblastic invasion of the spiral arteries in pre-eclampsia. Br. J. Obstet. Gynaecol., 106, 78-92.

McCowan, L. M. E., Harding, J. E., Roberts, A. B., Barker, S. E., Ford, C. and Stewart, A. W. (2000). A pilot randomized controlled trial of two regimes of fetal surveillance for small-for-gestational age fetuses with normal results of umbilical artery Doppler velocimetry. Am. J. Obstet. Gynecol., 182, 81-6.

Montenegro, N., Santos, F., Tavares, E., Matias, A., Barros, H. and Leite, L. P. (1998). Outcome of 88 pregnancies with absent or reversed end-diastolic blood flow (ARED flow) in the umbilical arteries. Eur. J. Obstet. Gynecol. Reprod. Biol., 79, 43-6.

Muller, T., Nanan, R., Rehn, M., Kristen, P. and Dietl, J. (2002). Arterial and ductus venosus Doppler in fetuses with absent or reverse end-diastolic flow in the umbilical artery: correlation with short-term perinatal outcome. Acta Obstet. Gynecol. Scand., 81, 860-6.

National Collaborating Centre for Women's and Children's Health. (2003). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press, pp. 105-8.

Neilson, J. P. and Alfirevic, Z. (2000). Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst. Rev., (2): p. CD000073.

Nicolaides, K.H., Bilardo, C.M., Soothill, P.W. and Campbell, A. (1988). Absence of end-diastolic frequencies in umbilical artery: a sign of fetal hypoxia and acidosis. Br. Med. J., 297, 1026-7.

Nicolini, U., Nicolaidid, P., Fisk, N.M., et al. (1990). Limited role of fetal blood sampling in prediction of outcome in intrauterine growth retardation. Lancet, 336, 768-72.

Odendaal, H.J., Pattinson, R. C., Bam, R., Grove, D. and Kotze, T.J. (1990). Aggressive or expectant management for patients with severe preeclampsia between 28-34 weeks' gestation: a randomized controlled trial. Obstet. Gynecol., 76, 1070-5.

Odendaal, H. J., Pattinson, R.C., du Toit, R. and Grove, D. (1998). Frequent fetal heart-rate monitoring for early detection of abruptio placentae in severe proteinuric hypertension. S. Afr. Med. J., 74, 19-21.

Ozeren, M., Dinc, H., Ekmen, U., Senekayli, C. and Aydemir, V. (1999). Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur. J. Obstet. Gynecol. Reprod. Biol., 82, 11-16.

Papgeorghiou, A. T., Hu, C. K. H., Cicero, S., Bower, S. and Nicolaides, K. H. (2002). Second-trimester uterine artery Doppler screening in unselected populations: a review. J. Mat. Fet. Neonatal. Med., 12, 78-88.

Parretti, E., Mealli, F., Magrini, A., et al. (2003). Cross-sectional and longitudinal evaluation of uterine artery Doppler velocimetry for the prediction of pre-eclampsia in normotensive women with specific risk factors. Ultrasound Obstet. Gynecol., 22: 160-5.

Prefumo, F., Bhide, A., Sairam, S., Penna, L., Hollis, B. and Thilaganathan, B. (2004). Effect of parity on second-trimester uterine artery Doppler flow velocity and waveforms. Ultrasound Obstet. Gynecol., 23, 46-9.

Rizzo, G., Capponi, A., Arduini, D. and Romanini, C. (1995a). The value of fetal arterial, cardiac and venous flows in predicting pH and blood gases measured in umbilical blood at cordocentesis in growth retarded fetuses. Br. J. Obstet. Gynaecol., 102, 963-9.

Rizzo, G., Capponi, A., Soregaroli, M., Arduini, D. and Romanini, C. (1995b). Umbilical vein pulsations and acid-base status at cordocentesis in growth-retarded fetuses with absent end-diastolic velocity in umbilical artery. Biol. Neonate, 68, 163-8.

Rowlands, D.J. and Vyas, S.K. (1995). Longitudinal study of fetal middle cerebral artery flow velocity waveforms preceding fetal death. Br. J. Obstet. Gynaecol., 102, 888-90.

Sagol, S., Ozkinay, E., Oztekin, K. and Ă–zdemir, N. (1999). Comparison of uterine artery Doppler velocimetry with the histopathology of the placental bed. Aust. N.Z. J. Obstet. Gynaecol., 39, 324-9.

Scherjon, S.A., Oosting, H., de Visser, B.W., de Wilde, T., Zondervan, H.A. and Kok, J.H. (1996). Fetal brain sparing is associated with accelerated shortening of visual evoked potential latencies during early infancy. Am. J. Obstet. Gynecol., 175, 1569-75.

Scherjon, S.A., Oosting, H., Smolders-DeHaas, H., Zondervan, H. A. and Kok, J. H. (1998). Neurodevelopmental outcome at three years of age after fetal 'brain-sparing'. Early Hum. Dev., 52, 67-79.

Scherjon, S., Briet, J., Oosting, H. and Kok, J. (2000). The discrepancy between maturation of visual-evoked potentials and cognitive outcome at five years in very preterm infants with and without hemodynamic signs of fetal brain-sparing. Pediatrics, 105, 385-91.

Sibai, B.M., Mercer, B.M., Schiff, E. and Friedman, S.A. (1994). Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Am. J. Obstet. Gynecol., 171, 818-22.

Soothill, P.W., Ajayi, R.A., Campbell, S., et al. (1992). Relationship between fetal acidemia at cordocentesis and subsequent neurodevelopment. Ultrasound Obstet. Gynaecol., 2, 80-3.

The GRIT Study Group (2003). A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. Br. J. Obstet. Gynaecol., 110, 27-32.

Vergani, P., Roncaglia, N., Andreotti, C., et al. (2002). Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am. J. Obstet. Gynecol., 187, 932-6.

Vyas, S., Nicolaides, K. H., Bower, S. and Campbell, S. (1990). Middle cerebral artery flow velocity waveforms in fetal hypoxaemia. Br. J. Obstet. Gynaecol., 97, 797-803.

Wilson, D.C., Harper, A., McClure, G., Halliday, H.L. and Reid, M. (1992). Long term predictive value of Doppler studies in high risk fetuses. Br. J. Obstet. Gynaecol., 99, 575-8.

Yoon, B. H., Lee, C. M. and Kim, S. W. (1994). An abnormal umbilical artery waveform: a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am. J. Obstet. Gynecol., 171, 713-21.

Zelop, C.M., Richardson, D.K. and Heffner, L.J. (1996). Outcomes of severely abnormal umbilical artery Doppler velocimetry in structurally normal singleton fetuses. Obstet. Gynecol, 87, 434-8.

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