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Progression of Doppler abnormalities in intrauterine growth restriction
Open accessAbstract
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 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]
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“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”
From Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction (2020) · cites this paper as [108]
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BackgroundZohav, E., Zohav, E., Rabinovich, M., Shenhav, S., Ovadia, Y. S., Anteby, E. Y., & Grin, L. (2019) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2019.1685968
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Fetal Growth Disorders (Content last reviewed: 15th March 2020)
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Self-citationCurrent awareness in prenatal diagnosis
(2008) · Prenatal Diagnosis · doi:10.1002/pd.1863
Dall’Asta, A., Ghi, T., & Frusca, T. (2018) · Springer eBooks · doi:10.1007/978-3-030-00051-6_10
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(2020) · International Journal of Biology Pharmacy and Allied Sciences · doi:10.31032/ijbpas/2020/9.2.4949
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“It has been demonstrated that low CPR in fetuses was associated with increased risks of lower birth weights (16), meconium stained amniotic uid (21), NICU admission (21), low Apgar score at 5 min (25), and neonatal complications (3).”
BackgroundDisha, D., Kaur, S., & Rathore, M. (2022) · INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH · doi:10.36106/ijsr/2702557
Ramírez, M. A. M., Gamboa, V. M. V., Infante, X. C. R., Calvo, M. U., & Hernández, A. M. B. P. (2023) · Revista Brasileira de Saúde Materno Infantil · doi:10.1590/1806-9304202300000293-en
Ramírez, M. A. M., Gamboa, V. M. V., Infante, X. C. R., Calvo, M. U., & Hernández, A. M. B. P. (2023) · Revista Brasileira de Saúde Materno Infantil · doi:10.1590/1806-9304202300000293
Prävention ungünstiger metabolischer Prägung bei intrauteriner Wachstumsrestriktion
Nüsken, K., Tauscher, A., Dötsch, J., Stepan, H., & Nüsken, E. (2023) · Die Diabetologie · doi:10.1007/s11428-023-01079-4
“Eine negative oder reverse A-Welle im Ductus venosus ist ein Zeichen einer bereits bestehenden Azidose, bei der sich das Risiko eines IUFT täglich verdoppelt [13, 107].”
BackgroundDirective clinique no 441 : Surveillance prénatale du bien-être fœtal
Niles, K. M., Jain, V., Chan, C., Choo, S., Dore, S., Kiely, D., Lim, K. I., Roy‐Lacroix, M., Sharma, S., & Waterman, E. (2023) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2023.05.021
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Yoshida, T., Kurihara, Y., Yokoi, N., Kitada, K., Nakagawa, K., Tahara, M., Hamuro, A., Nakano, A., Misugi, T., & Tachibana, D. (2023) · Research Square · doi:10.21203/rs.3.rs-3361702/v1
The Reproducibility of 3D power Doppler in Intrauterine Growth Restriction
Sultan, Y. (2022) · Obstetrics Gynecology and Reproductive Sciences · doi:10.31579/2578-8965/129
Fehlbildungsdiagnostik, Echokardiographie und Doppler im 2. Trimenon
Kalache, K. D., Ostermayer, E., & Dückelmann, A. M. (2024) · Springer Reference Medizin · doi:10.1007/978-3-662-44369-9_9-2
Fehlbildungsdiagnostik, Echokardiographie und Doppler im 2. Trimenon
Kalache, K. D., Ostermayer, E., & Dückelmann, A. M. (2024) · Springer Reference Medizin · doi:10.1007/978-3-662-63506-3_9
Grah, M., Poljak, L., Starčević, M., Stanojević, M., Vukojević, K., Saraga‐Babić, M., & Salihagić, A. (2024) · Journal of Perinatal Medicine · doi:10.1515/jpm-2024-0138
Prognostic significance of cerebro-placental ratio in predicting perinatal
Negi, P., Choudhary, A., Kaushik, S., & Nimonkar, S. (2024) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20242066
Pregnancy and chronic kidney disease
Al-Sum, H., Al‐Bakri, M., & Alsurori, S. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-21473-8.00007-0
Nguyen, T. H., Tran, N. H. T., Cao, H., Truong, T. N. D., Nguyen, A. T. M., & Le, Q. T. (2024) · Y HOC TP HO CHI MINH · doi:10.32895/ump.mpr.8.4.28
“In our findings, the investigation of cerebral Doppler mea - surements was consistent with previous studies, affirming that CPR becomes abnormal earlier than the MCA-PI [31].”
ResultAggarwal, S., Khatri, N., Agarwal, K., & Puleria, R. (2025) · Indian Journal of Obstetrics and Gynecology Research · doi:10.18231/j.ijogr.2025.009
Baschat, A. (2025) · Springer eBooks · doi:10.1007/978-3-662-67373-7_22
Self-citationCardiovascular Hemodynamics and Brain Health in Congenital Heart Disease
Hogan, W. J., & Peyvandi, S. (2025) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2025.05.008
sFlt-1/PlGF Ratio Predicts Serious Outcomes in Early-Onset Fetal Growth Restriction
Shinohara, S., Sunami, R., Yasuda, G., & Kasai, M. (2025) · Fetal Diagnosis and Therapy · doi:10.1159/000547695 · Cited by 4
“Pre-dicting rapid maternal or fetal deterioration remains challenging due to the complex and heterogeneous nature of early-onset FGR [9, 10, 13], and prolonging pregnancy carries inherent clinical risks.”
Lemoine, F. V., Ranzini, A. C., Imbroane, M. R., Ghosalkar, E., Hackney, D. N., & Hamburg‐Shields, E. (2025) · Journal of Perinatal Medicine · doi:10.1515/jpm-2025-0078
“The GA at delivery reported in previous studies ranges from 27.7 to 37 weeks [19 – 22, 25, 29].”
InfluentialSilver, R. M., & Reddy, U. M. (2026) · Clinics in Perinatology · doi:10.1016/j.clp.2025.11.002
Trajchevski, M. E. (2026) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20260155
Optimal umbilical artery Doppler chart for predicting placenta‐mediated fetal growth restriction
Vayenas, A., Kingdom, J. C., Kongkham, N., Stratulat, V., Nevo, O., Rahimi, S., & Melamed, N. (2026) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.70222
“Furthermore, an elevated UA pulsatility index (PI), regardless of the reference chart used, is an early Doppler finding in the development of placenta-mediated FGR that is unlikely to directly cause or be associated with perinatal mortality or morbidity 4,27,28 .”
Aktaş, H. A., Arzik, I. G., Çakır, Z. E., Bayraktar, B., Atakul, B. K., Bayram, E., Timur, E. S., Ömeroğlu, İ., Ekin, A., & Gölbaşı, H. (2026) · Diagnostics · doi:10.3390/diagnostics16101488
Second Trimester Fetal Anomaly Scan, Echocardiography, and Doppler Sonography
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“Touran et al. 20 In contrast, after an initial normal assessment of umbilical and cerebral artery pulsatility indices, the probability of finding abnormal umbilical and cerebral artery indices on a weekly repeat is 5%–7%.”
Gupta, R. A., Anand, M. N., Senapati, J. B., & More, P. (2026) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20262788
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“…the fetal brain (Meijerink et al., 2025), or on ultrasound Doppler indices of cerebral blood vessels to measure the varying degrees of brain sparing effects (Ciobanu et al., 2019; Romero and Hernandez-Andrade, 2015; Turan et al., 2008), without characterizing the extent of damage to this mechanism.”
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Metadata
- 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
- Semantic Scholar
- a3107662a43e356994ae81184ea4120ca9962b26
- 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
- bronze
- doi.org
- 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 › Pediatrics, Perinatology and Child Health › 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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