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.

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