Assessing the 'at-risk' fetus: Doppler ultrasound

Doppler ultrasound has become an indispensable tool in evaluating pregnancies at risk for conditions such as preeclampsia, intrauterine growth restriction, fetal anemia, and umbilical cord abnormalities. Use of umbilical artery, middle cerebral artery, and uterine artery Doppler has been the mainstay of assessment.

Recent findings promote the use of ductus venosus Doppler to aid in timing delivery of severely growth-restricted fetuses. Whereas initially it appeared that abnormalities in ductus venosus waveform were the endpoint for pregnancies afflicted with intrauterine growth restriction, newer data suggest that these abnormalities may plateau prior to further fetal deterioration as witnessed by changes in the biophysical profile.

In this review, we will discuss current ultrasound Doppler literature and the recommendations of the experts. We observe that the best algorithm for incorporation of the ductus venosus into intrauterine growth restriction management is yet to be determined. This remains a subject of intense research aimed at optimizing pregnancy outcomes and will be important to follow to provide up-to-date care of our patients.