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Updated: Jul 3, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Progression of Doppler abnormalities in intrauterine growth restriction
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201, USA.
Insights
The progression of placental insufficiency in intrauterine growth restriction (IUGR) varies based on severity and onset gestational age. Understanding these patterns of arterial and venous Doppler abnormalities is key for fetal surveillance.
Area of Science:
- Fetal Medicine
- Cardiovascular Physiology
- Perinatology
Background:
- Intrauterine growth restriction (IUGR) is associated with placental insufficiency.
- Doppler ultrasound is crucial for assessing fetal well-being in IUGR.
- The sequence of Doppler abnormalities reflects the severity and progression of placental dysfunction.
Purpose of the Study:
- To delineate the sequential progression of arterial and venous Doppler abnormalities in fetuses with IUGR.
- To correlate Doppler changes with gestational age at onset and severity of placental disease.
- To inform optimal fetal surveillance strategies for IUGR.
Main Methods:
- Prospective observational study of singleton pregnancies with IUGR.
- Serial Doppler ultrasound of umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and umbilical vein (UV).
- Analysis of time intervals and patterns of progressive Doppler abnormalities.
Main Results:
- Three distinct patterns of Doppler progression were identified based on placental dysfunction severity.
- Mild dysfunction affected UA/MCA, with later delivery (median 35 weeks).
- Progressive and severe early-onset dysfunction showed rapid deterioration of UA, MCA, DV, and UV flow, requiring earlier delivery (median 33 and 30.6 weeks, respectively).
Conclusions:
- Cardiovascular manifestations in IUGR are dictated by the gestational age at onset and placental disease severity.
- Recognizing these Doppler progression patterns is critical for tailoring fetal surveillance in IUGR.
- This study provides a framework for understanding the natural history of Doppler changes in IUGR.
Objective:
To identify the sequence of progression of arterial and venous Doppler abnormalities from the onset of placental insufficiency in intrauterine growth restriction (IUGR).
Methods:
Prospective observational study of singletons with IUGR (abdominal circumference < 5(th) percentile) who underwent serial standardized umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) Doppler surveillance. Time intervals between progressive Doppler abnormalities and patterns of deterioration were related to UA Doppler status and gestational age.
Results:
Six hundred and sixty-eight longitudinal examinations were performed in 104 fetuses, identifying three patterns of progression: (1) Mild placental dysfunction (n = 34) that remained confined to the UA/MCA. The UA became abnormal at a median of 32 weeks' gestation but the pulsatility index never exceeded 3 SD above normal. Progression took a median of 33 days, requiring delivery at a median of 35 weeks. (2) Progressive placental dysfunction (n = 49). Initially normal UA Doppler PI at 29 weeks' gestation increased beyond 3 SD, progressing to abnormal MCA, absent/reversed UA diastolic flow, abnormal DV, UV pulsations in 9-day intervals requiring delivery by 33 weeks. (3) Severe early-onset placental dysfunction (n = 21). Markedly elevated UA PI established by 27 weeks' gestation was associated with rapid (7-day intervals) progression to abnormal venous Doppler with median delivery at 30.6 weeks. Gestational age at onset, time to delivery and progression intervals were different between patterns (all P < 0.05).
Conclusion:
The characteristics of cardiovascular manifestations in IUGR are determined by the gestational age at onset and the severity of placental disease. Recognition of these factors is critical for planning fetal surveillance in IUGR.
