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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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The cerebroplacental Doppler ratio revisited
Baschat, A., & Gembruch, U. (2003) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.20 · Cited by 505
Self-citationMonitoring of fetuses with intrauterine growth restriction: a longitudinal study
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Predictors of neonatal outcome in early-onset placental dysfunction
Baschat, A. A., Cosmi, E., Bilardo, C. M., Wolf, H., Berg, C., Rigano, S., Germer, U., Moyano, D., Turan, S., Hartung, J., et al. (2007) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000253215.79121.75 · Cited by 485
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Self-citationDoppler ultrasound assessment of cerebral blood flow in the human fetus
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Self-citationFetal responses to placental insufficiency: an update
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Doppler ultrasound assessment of cerebral blood flow in the human fetus
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Doppler, Cardiotocography, and Biophysical Profile Changes in Growth-Restricted Fetuses
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Longitudinal study of fetal middle cerebral artery flow velocity waveforms preceding fetal death
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Comprehensive fetal assessment with three ultrasonographic characteristics
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Magee, L. A., Brown, M. A., Hall, D. R., Gupte, S., Hennessy, A., Karumanchi, S. A., Kenny, L. C., McCarthy, F., Myers, J., Poon, L. C., et al. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2021.09.008 · Cited by 1,134
Figueras, F., & Gratacós, E. (2014) · Fetal Diagnosis and Therapy · doi:10.1159/000357592 · Cited by 799
Melamed, N., Baschat, A., Yinon, Y., Athanasiadis, A. P., Mecacci, F., Figueras, F., Berghella, V., Nazareth, A., Tahlak, M., McIntyre, D. H., et al. (2021) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13522 · Cited by 629
Self-citationMartins, J. G., Biggio, J. R., & Abuhamad, A. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.05.010 · Cited by 584
“108 With decreased end-diastolic velocity (ie, flow ratios greater than the 95th percentile) or in pregnancies with severe FGR (EFW less than the 3rd percentile), we suggest weekly umbilical artery Doppler evaluation 24,95 (GRADE 2C).”
InfluentialIntrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management
Figueras, F., & Gardosi, J. (2011) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.08.055 · Cited by 485
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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