Related Experiment Video
Updated: Sep 3, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction
A A Baschat1, U Gembruch, I Reiss
1Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD 21201-1703, USA.
Insights
Abnormal venous Doppler findings in intrauterine growth restriction (IUGR) fetuses indicate a worse perinatal outcome. Gestational age at delivery significantly impacts short-term outcomes, but abnormal venous flows strongly correlate with fetal demise.
Area of Science:
- Perinatology
- Fetal Medicine
- Diagnostic Ultrasound
Background:
- Intrauterine growth restriction (IUGR) affects fetal development and can lead to adverse perinatal outcomes.
- Doppler velocimetry is a key tool for assessing fetal well-being in IUGR.
- Abnormalities in arterial and venous Doppler patterns may predict poor perinatal outcomes.
Purpose of the Study:
- To evaluate the association between abnormal arterial and venous Doppler findings and perinatal outcomes in fetuses with IUGR.
- To determine if specific Doppler patterns predict adverse outcomes such as mortality, respiratory distress, or neurological complications.
Main Methods:
- 121 fetuses with IUGR (UA PI > 2 SD and birth weight < 10th centile) underwent Doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), inferior vena cava (IVC), ductus venosus (DV), and umbilical vein (UV).
- Fetuses were grouped based on Doppler findings: UA-PI abnormal only, abnormal UA-PI with MCA-PI reduction ('brain sparing'), or abnormal venous flow (DV/IVC PVIV or pulsatile UV flow).
- Perinatal outcomes including mortality, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), circulatory failure, and umbilical artery blood gases were recorded.
Main Results:
- Fetuses with abnormal venous flow (group 3) showed the highest perinatal mortality and stillbirth rates.
- Abnormal venous flows were associated with acidemia, while 'brain sparing' (MCA-PI reduction) correlated with hypoxemia.
- The strongest predictor for complications was gestational age at delivery; however, abnormal ductus venosus flow was significantly associated with fetal death (r2 = 0.24, P < 0.05).
Conclusions:
- IUGR fetuses with abnormal venous Doppler findings experience significantly worse perinatal outcomes compared to those with isolated arterial abnormalities.
- Venous Doppler assessment is crucial for detecting deterioration in fetuses with 'brain sparing' and predicting fetal demise.
- While gestational age is a major determinant of short-term outcomes, abnormal venous flows are a critical indicator of severe fetal compromise and mortality risk.
Objective:
The aim of this investigation was to assess the relationship between abnormal arterial and venous Doppler findings and perinatal outcome in fetuses with intrauterine growth restriction (IUGR).
Methods:
Doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), inferior vena cava (IVC), ductus venosus (DV) and free umbilical vein was performed in 121 IUGR fetuses with a UA pulsatility index (PI) > 2 SD above the gestational age mean and subsequent birth weight < 10th centile for gestational age. Groups based on the last Doppler exam were: 1 = abnormal UA-PI only (n = 42, 34.7%), 2 = MCA-PI > 2 SD below the gestational age mean (= 'brain sparing') in addition to abnormal UA-PI (n = 29, 24.0%), 3 = DV or IVC peak velocity index (PVIV) > 2 SD above the gestational age mean and/or pulsatile UV flow (n = 50, 41.3%). Z-scores (delta indices) were calculated for Doppler indices. Perinatal mortality, respiratory distress (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), circulatory failure and umbilical artery blood gases were recorded.
Results:
Absence or reversal of umbilical artery end-diastolic flow was observed in 4 (9.5%) of fetuses in group 1, 10 (34.5%) fetuses in group 2 and 41 (82%) fetuses in group 3. A low middle cerebral artery pulsatility index was found in 39 (78%) fetuses in group 3. Multiple regression analysis with gestational age at delivery, delta indices and cord artery blood gas as independent parameters and individual perinatal outcomes as dependent variables was performed. In this analysis the association was strongest with gestational age for each complication. There were no significant differences in Apgar scores between groups. At delivery, 'brain sparing' was associated with hypoxemia and abnormal venous flows with acidemia. Perinatal mortality was highest in group 3 and stillbirth was only observed when venous flow was abnormal. All postpartum complications were more frequent in fetuses with abnormal venous flows. The only statistically significant relation between Doppler indices and outcome was the association between abnormal ductus venosus flow and fetal death (r2 = 0.24, P < 0.05).
Conclusion:
Growth restricted fetuses with abnormal venous flow have worse perinatal outcome compared to those where flow abnormality is confined to the umbilical or middle cerebral artery. In fetuses with low middle cerebral artery pulsatility, venous Doppler allows detection of further deterioration. While abnormal venous flows can be significantly associated with fetal demise, gestational age at delivery significantly impacts on all short-term outcomes.
Related Concept Videos
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...