Cited by 354Pregnancy and preeclampsia studiesBirth, Development, and HealthCardiovascular Conditions and Treatments

Progression of Doppler abnormalities in intrauterine growth restriction

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Turan, O. M., Turan, S., Gungor, S., Berg, C., Moyano, D., Gembruch, U., Nicolaides, K. H., Harman, C. R. +1 more·2008·Ultrasound in Obstetrics & Gynecology

Abstract

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 < 5th 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. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

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  • Protocols for umbilical artery Doppler in FGR surveillance vary from weekly to a 2-to 4-week interval.

    “Protocols vary from weekly umbilical artery Doppler to a 2-to 4-week interval.24,108”

    From Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction (2020) · cites this paper as [108]

    The Discussion recommends weekly umbilical artery Doppler examinations after IUGR is diagnosed. It does not recommend a 2-to-4-week Doppler interval; its reference to the next two weeks concerns whether abnormalities develop, not how often to test. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • A prospective observational study suggests that rapid progression of Doppler abnormalities in FGR, if it occurs, is typically noted within the first 2 weeks after diagnosis.

    “A prospective observational study of the progression of Doppler abnormalities in FGR suggests that rapid progression, if it is going to occur, is typically noted within the first 2 weeks after diagnosis.24,108”

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  1. [20]20. Copyright  2008 ISUOG. Published by John Wiley & Sons, Ltd. Ultrasound Obstet Gynecol 2008; 32: 160-167. 14690705, 2008, 2,

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Authors
Turan, O. M., Turan, S., Gungor, S., Berg, C., Moyano, D., Gembruch, U., Nicolaides, K. H., Harman, C. R., & Baschat, A. A.
Affiliations
  • University of Maryland, Baltimore (US)
  • University of Bonn (DE)
  • Harris Birthright Research Centre for Fetal Medicine (GB)
Corresponding author
Baschat, A. A.
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2008-07-15
Volume
32
Issue
2
Pages
160-167
ISSN
  • 0960-7692 (ISSN-L)
  • 1469-0705
OpenAlex
W2136237774
Cited by
353
References
20
Citations by year
2026: 16 · 2025: 9 · 2024: 16 · 2023: 20 · 2022: 17 · 2021: 30 · 2020: 27 · 2019: 18 · 2018: 22 · 2017: 23 · 2016: 18 · 2015: 18 · 2014: 27 · 2013: 20 · 2012: 19
FWCI
19.88
Type
journal article
Language
en
Open access
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
Keywords
fetal growth restriction, placental insufficiency, umbilical artery Doppler, middle cerebral artery Doppler, ductus venosus Doppler, pulsatility index, fetal monitoring, gestational age at onset
MeSH terms
Adolescent, Adult, Female, Fetal Growth Retardation, Gestational Age, Humans, Infant, Newborn, Middle Aged, Placental Insufficiency, Pregnancy, Prospective Studies, Pulsatile Flow, Umbilical Arteries, Ultrasonography, Prenatal, Disease Progression, Ultrasonography, Doppler, Pulsed, Young Adult

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