Doppler ultrasound in pregnancy – quality requirements of DEGUM and clinical application (part 2)

Abstract

This second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

“…Setting up outpatient infection clinics in doctorʼs offices may make it easier to implement guideline recommendations 49 . Currently valid prenatal diagnostic methods which comply with these standards should additionally be available 43 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 . When planning elective examinations, postponing these examinations until the pregnant woman no longer needs to isolate/is no longer contagious should be considered.…”

“…Die Einrichtung von Infektsprechstunden kann hierbei die Umsetzung in der Arztpraxis erleichtern 49 . Es sollten zudem die jeweils gültigen und dem Standard entsprechenden pränataldiagnostischen Methoden angeboten werden 43 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 . Bei der Planung von elektiven Untersuchungen ist zu erwägen, diese bis zur Aufhebung der Isolation/Ende der Kontagiosität der Schwangeren zu verschieben.…”

Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023)

“…An increase in pulsatility above the 95th percentile for the ductus venosus with zero flow pressure and reverse flow of the A-wave is pathological. Faber et al, 2019/ 2021[9,10] Level of consensus: 100 % (strong consensus)…”

“…Pulsatility indices > 95th percentile for the uterine artery and uterine artery notching after week 24 + 0 of gestation are pathological. Faber et al, 2019/ 2021[9,10] Level of consensus: 100 % (strong consensus)…”

Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023)

“…ECAn increase in pulsatility above the 95th percentile for the ductus venosus with zero flow pressure and reverse flow of the A-wave is pathological.Faber et al, 2019/ 2021[9,10] Level of consensus: 100 % (strong consensus)…”