To Doppler or not to Doppler

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Abstract

This review aims to provide the reader with an update on the present and potential clinical applications in Doppler ultrasound in perinatal medicine. Umbilical artery Doppler plays an important role in the management of intrauterine growth restriction (IUGR) and preeclampsia and aids in twin-to-twin transfusion syndrome management while notching in the waveform is a predictor of umbilical cord abnormalities. Middle cerebral artery Doppler reliably detects fetal anemia and may be useful in the assessment of IUGR as well. Abnormal uterine artery Doppler may play a role in predicting growth restriction, hypertensive disorders of pregnancy and preterm delivery. Abnormal ductus venosus waveforms can also be used to predict adverse fetal outcome and may allow for better timing of delivery while umbilical venous pulsations may be a sensitive marker for fetal heart failure in hydropic pregnancies. 3D power Doppler allows better small vessel visualization that is not affected by angle of insonation and has been used to diagnose placental and cord abnormalities. Significant improvements have recently occurred, improving the visualization and evaluation of placental vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/ or amplitude-based color Doppler ultrasound. Spatial representation of vascularity can be improved by utilizing 3D processing. Greater sensitivity of 3D Doppler ultrasound to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy. The rapid development of these new ultrasound techniques will continue to enlarge the scope of clinical applications in placental studies. As clinical experience with these new technologies increase and as the technology improves further, it is reasonable to expect that 3D Doppler and 4D ultrasound will be complementary addition to well established 2D Doppler ultrasound imaging.

About the authors

William A Goh

Hawaii Permanente Medical Group

Zalud Ivica

University of Hawaii

Email: ivica@hawaii.edu
M.D., PhD, Professor and Chair, Kosasa Endowed Chair, Department of Obstetrics, Gynecology & Women’s Health

References

  1. Doppler C. Ueber das farbige. Licht der Dopplersterne und einiger anderer Gestirne des Himmels. [On the coloured light of double stars and certain other stars of the heavens]. Royal Bohemian Society 2: 465, 1842.
  2. Callen P. Ultrasonography in Obstetrics and Gynecology. 5th edition. Saunders Elsevier 2008.
  3. Hoffman S, Galan H. Assessing the ‘at-risk’ fetus: Doppler ultrasound. Curr Opin Obstet Gynecol 2009. 21: 161-6.
  4. Stuart B, Drumm J, Fitzgerald D, Duignan N. Fetal blood velocity waveforms in normal pregnancy. Br J Obstet Gynaecol. 1980 Sep;87 (9): 780-5.
  5. Trudinger B, Giles W, Cook C, Bombardieri J, Collins L. Fetal umbilical artery flow velocity waveforms and placental resistance: clinical significance. Br J Obstet Gynaecol. 1985 Jan; 92 (1): 23-30.
  6. Alfirevic Z, Neilson J. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol. 1995 May; 172 (5): 1379-87.
  7. Kontopoulous E, Quintero R, Chmait R, Bornick P, Russell Z, Allen M. Percent absent end-diastolic velocity in the umbilical artery waveform as a predictor of intrauterine fetal demise of the donor twin after selective laser photocoagulation of communicating vessels in twin-twin transfusions syndrome. Ultrasound Obstet Gynecol. 2007 Jul; 30 (1): 35-9.
  8. Mari G, Adrignolo A, Abuhamad Z, Pirhonen J, Jones D, Ludomirsky A et al. Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group isoimmunization. Ultrasound Obstet Gynecol. 1995 Jun; 5 (6): 400-5.
  9. ACOG Practice Bulletin No. 75: management of alloimmunization. Obstet Gynecol. 2006 Aug; 108 (2): 457-64.
  10. Slaghekke F, Kist W, Oepkes D, Pasman S, Middeldorp J, Klumper F et al. Twin Anemia-Polycythemia Sequence: Diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 2010 Mar; pub online.
  11. Mari G, Hanif F, Kruger M, Cosmi E, Santolaya-Forgas J, Treadwell M. Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol. 2007 Mar; 29 (3): 310-6.
  12. Ghidini A, Locatelli A. Monitoring of Fetal well-being: Role of uterine artery Doppler. Semin Perinatol. 2008; 32: 258-62.
  13. Phupong V, Dejthevaporn T. Predicting risks of preeclampsia and small for gestational age infant by uterine artery Doppler. Hypertens Pregnancy. 2008; 27: 387-95.
  14. Onwudiwe N, Yu C, Poon L, Spiliopoulos I, Nicolaides K. Prediction of preeclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure. Ultrasound Obstet Gynecol. 2008 Dec; 32 (7): 877-83.
  15. Li H, Gudnason H, Olofsson P, Dubiel M, Gudmundsson S. Increased uterine artery vascular impedance is related to adverse outcome of pregnancy but is present in only one-third of late third-trimester pre-eclamptic women. Ultrasound Obstet Gynecol. 2005 May; 25 (5): 459-63.
  16. Ferrazzi E, Bulfamante G, Mezzopane R, Barbera A, Ghidini A, Pardi G. Uterine Doppler velocimetry and placental hypoxic-ischemic lesion in pregnancies with fetal intrauterine growth restriction. Placenta. 1999 Jul-Aug; 20 (5-6): 389-94.
  17. McCowan L, North R, Harding J. Abnormal uterine artery Doppler in small-for-gestational-age pregnancies is associated with later hypertension. Aust N Z J Obstet Gynaecol. 2001 Feb;41 (1): 56-60.
  18. Gudmundsson S, Korszun P, Olofsson P, Dubiel M. New score indicating placental vascular resistance. Acta Obstet Gynecol Scand. 2003 Sep; 82 (9): 807-1
  19. Abuhamad A, Mari G, Copel J, Cantwell C, Evans A. Umbilical artery flow velocity waveforms in monoamniotic twins with cord entanglement. Obstet Gyencol. 1995 Oct;86 (4 Pt 2): 674-7.
  20. Abuhamad A, Sclater A, Carlson E, Moriarity R, Aguiar M. Umbilical artery Doppler waveform notching: is it a marker for cord and placental abnormalities. J Ultrasound Med. 2002 Aug; 21 (8): 857-60.
  21. Baschat A, Harman C. Venous Doppler in the assessment of fetal cardiovascular status. Curr Opin Obstet Gynecol. 2006; 18: 156-63.
  22. Rizzo G, Capponi A, Talone P, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth retarded fetuses. Ultrasound Obstet Gynecol. 1996 Jun;7 (6): 401-10.
  23. Baschat A, Guclu S, Kush M, Gembruch U, Weiner C, Harman C. Venous Doppler in the prediction of acid-base status of growth-restriction fetuses with elevated placental blood flow resistance. Am J Obstet Gynecol. 2004 Jul;191 (1): 277-84.
  24. Schawarze A, Gembruch U, Krapp M, Katalinic A, Germer U, Axt-Fliedner R. Qualitative venous Doppler flow waveform analysis in preterm intrauterine growth-restricted fetuses with ARED flow in the umbilical artery - correlation with short term outcome. Ultrasound Obstet Gynecol. 2005 Jun;25 (6): 573-9.
  25. Mari G, Hanif F, Treadwell M, Kruger M. Gestational age at delivery and Doppler waveforms in very preterm intrauterine growth-restricted fetuses as predicators of perinatal mortality. J Ultrasound Med. 2007 May;26 (5): 555-9.
  26. Rizzo G, Arduini D, Romanini C. Umbilical vein pulsations: a physiologic finding in early gestation. Am J Obstet Gynecol. 1992 Sep; 167 (3): 675-7.
  27. Mari G, Hanif F. Fetal Doppler: umbilical artery, middle cerebral artery and venous system. Semin Perinatol. 2008 Aug; 32 (4): 253-7.
  28. Hofstaetter C, Hansmann M, Eik-Nes S, Huhta J, Luther S. A cardiovascular profile score in the surveillance of fetal hydrops. J Matern Fetal Neonatal Med. 2006 Jul; 19 (7): 407-1330.
  29. Bellotti, Pennati G, De Gasperi C, Bozzo M, Battaglia F, Ferrazzi E. Simultaneous measurements of umbilical venous, fetal hepatic and ductus venosus blood flow in growth-restricted human fetuses. Am J Obstet Gynecol. 2004 May; 190 (5): 1347-58.
  30. McDicken W, Anderson T. The difference between colour Doppler velocity imaging and power Doppler imaging. Eur J Echocardiography. 2002; 3: 240-4.
  31. Fortunato S. The use of power Doppler and color power angiography in fetal imaging. Am J Obstet Gynecol. 1996; 174: 1828-33.
  32. Guerriero S, Ajossa S, Mais V, Risalvato A, Angiolucci M, Labate F et al. Color Doppler energy imaging in the diagnosis of fetal intracranial hemorrhage in the second trimester. Ultrasound Obstet Gynecol. 1997 Sep; 10 (3): 205-8.
  33. Pilu G, Falco P, Milani V, Perolo A, Bovicelli L. Prenatal diagnosis of micrcophaly assisted by vaginal sonography and power Doppler. Ultrasound Obstet Gynecol. 1998 May; 11 (5): 357-60.
  34. Fox D, Bruner J, Fleischer A. Amplitude-based color Doppler sonography of fetus with sacrococcygeal teratoma. J Ultrasound Med. 1996; 15: 785-7.
  35. Chua L, Twining P. A comparison of power colour flow with frequency based color flow Doppler fetal echocardiography. Clin Radiol. 1997 Sep; 52 (9): 712-4.
  36. DeVore G. The value of color Doppler sonography in the diagnosis of renal agenesis. J Ultrasound Med. 1995 Jun; 14 (6): 443-9.
  37. Chou M, Ho E, Lee Y. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol. 2000 Jan; 15 (1): 28-35.
  38. Devesa R, Munoz A, Torrents M, Carrera J. Prenatal diagnosis of vasa previa with transvaginal color Doppler ultrasound. Ultrasound Obstet Gynecol. 1996 Aug; 8 (2): 139-41.
  39. Chaoui R, Kalache K, Hartung J. Application of three-dimensional power Doppler ultrasound in prenatal diagnosis. Ultrasound Obstet Gynecol. 2001; 17: 22-9.
  40. Pairleitner H, Steiner H, Hasenoehrl G, Staudach A. Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet Gynecol. 1999; 14: 139-43.
  41. Pretorius DH, Nelson TR, Baergen RN, et al. Imaging of placental vasculature using three-dimensional ultrasound and color power Doppler: a preliminary study. J Perinat Med 2002; 30: 48-56.
  42. Chaoui R, Hoffmann J, Heling KS. Three-dimensional (3D) and 4D color Doppler fetal echocardiography using spatio-temporal image correlation (STIC). Ultrasound Obstet Gynecol 2004; 23: 535-45.
  43. Matijevic R, Kurjak A. The assessment of placental blood vessels by three-dimensional power Doppler ultrasound. J Perinat Med 2002; 30: 26-32.
  44. Shih JC, Ko TL, Lin MC, et al. Quantitative three-dimensional power Doppler ultrasound predicts the outcome of placental chorioangioma. Ultrasound Obstet Gynecol 2004; 24: 202-6.
  45. Hartung J, Kalache KD, Chaoui R. Three-dimensional power Doppler ultrasonography (3D-PDU) in fetal diagnosis. Ultraschall Med 2004; 25: 200-5.
  46. Ritchie CJ, Edwards WS, Mack LA, et al. Three-dimensional ultrasonic angiography using power-mode Doppler. Ultrasound Med Biol 1996; 22: 277-86.
  47. Chaoui R, Kalache K, Hartung J. Application of three-dimensional power Doppler ultrasound in prenatal diagnosis. Ultrasound Obstet Gynecol. 2001; 17: 22-9.
  48. Zalud I, Shaha S. Evaluation of the utero-placental circulation by three-dimensional Doppler ultrasound in the second trimester of normal pregnancy. J Matern Fetal Neonatal Med. 2007 Apr; 20 (4): 299-305.
  49. Zalud I, Shaha S. Three-dimensional sonography of the placenta and uterine spiral vasculature: influence of maternal age and parity. J Clin Ultrasound. 2008 Sep; 36 (7): 391-6.
  50. Merce L, Barco M, Bau S, Kupesic S, Kurjak A. Assessment of placental vascularization by three-dimensional power Doppler “Vascular Biospy” in normal pregnancies. Croat Med J. 2005; 465): 765-71.
  51. Bartha J, Moya E, Hervias-Vivancos B. Three-dimensional power Doppler analysis of cerebral circulation in normal and growth restricted fetuses. J Cereb Blood Flow Metab. 2009 Sep;29 (9): 1609-18.
  52. Kalache K, Romero R, Goncalves L, Chaiworapongsa T, Espinoza J, Schoen M et al. Three-dimensional color power imaging of the fetal hepatic circulation. Am J Obstet Gynecol. 2003 Nov;189 (3):1401-6.
  53. Miller D, Chollet J, Goodwin T. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997; 177: 210-4.
  54. Warhak C, Ramos G, Eskander R, Benirschke K, Saenz C, Kelly T et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 2010 Jan; 115 (1): 65-9.
  55. Shih J, Jaraquemada P, Su Y, Shyu M, Lin C, Lin S et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol. 2009; 33: 193-203.

Copyright (c) 2015 Goh W.A., Ivica Z.

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