Use of Doppler velocimetry in diagnosis and prognosis of intrauterine growth restriction (IUGR): A Review

Abstract

Intrauterine growth restriction (IUGR) is a condition which has been difficult to assess at an early stage, resulting in the delivery of children who have poor genetic growth potential. Currently, IUGR classification is based upon the system of ultrasound biometry. Doppler velocimetry allows the measurement of hemodynamic flow of major fetal vessels, comparing the flow indices and patterns of normal and IUGR cases. In this review, the effectiveness of Doppler velocimetry in assessing blood flow in major vessels including the umbilical artery, ductus venosus, and middle cerebral artery was studied for both diagnostic and prognostic screening of IUGR. The umbilical artery is the most frequently studied vessel in Doppler velocimetry due to its accessibility and the strength of its associations with fetal outcomes. Abnormalities in the ductus venosus waveform can be indicative of increased resistance in the right atrium due to placental abnormalities. The middle cerebral artery is the most studied fetal cerebral artery and can detect cerebral blood flow and direction, which is why these three vessels were selected to be examined in this context. A potential mathematical model could be developed to incorporate these Doppler measurements which are indicative of IUGR, in order to reduce perinatal mortality. The purpose of the proposed algorithm is to integrate Doppler velocimetry with biophysical profiling in order to determine the optimal timing of delivery, thus reducing the risks of adverse perinatal outcomes.

Fetal Hemodynamic Response to Maternal Oxygenation in Normal and Complicated Pregnancies

“…The most common progression of growth restriction is as follows [40]. First, oxygen and nutrient supply gradually decrease with increasing resistance in the placenta.…”

The Prediction of Adverse Perinatal Outcomes in Intrauterine Growth Restriction using the Doppler Indices of Myocardial Performance and Aortic Isthmus

“…However, the role of the DV is still limited by a relatively high false-positive rates and sensitivities for prediction of perinatal mortality [sensitivity from 40% to 70%]. This stimulated research about other Doppler indices that might be more sensitive, such as the aortic isthmus [AoI] isthmic flow index [IFI] and the myocardial performance index [MPI] [7][8] .…”

Clinical Correlation of Doppler Velocimetry and Intrauterine Growth Restriction (Iugr)

“…We selected the umbilical artery, because it represents the resistance of the placenta; nevertheless the umbilical artery is the most frequently studied vessel in Doppler velocimetry due to its accessibility and the strength of its associations with foetal outcomes. [4] Hypoxia resulting from foetoplacental insufficiency leads to IUGR. Whenever there is hypoxia, the foetal cerebral circulation undergoes autoregulatory changes in the form of cerebral vasodilatation, whereas the foetal peripheral circulation undergoes vasoconstriction.…”