Ultrasound of the Placenta: A Systematic Approach. Part II: Functional Assessment (Doppler)

J. S. Abramowicz, E. Sheiner

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Doppler velocimetry is the ideal clinical tool to assess placental performance in high-risk pregnancies. It also has value in predicting later complications and outcome in pregnancies which appear uncomplicated. All three circulations (fetal, placental and maternal) may be interrogated by Doppler technology. In the following review, we present basic physics aspects of Doppler and discuss mainly Doppler investigation of the fetal-placental circulation (umbilical artery, intraplacental circulation) as well as the uterine arteries. The assessment of umbilical blood flow provides information on blood perfusion of the fetal-placental unit. The diastolic blood flow velocity component in umbilical artery increases with advancing gestation. In pregnancies complicated by placental dysfunction, there may be a reduction in the number of functional villi and/or small blood vessels with, as a result, increased impedance, reflected, mainly, by a decrease in end-diastolic velocity. When the resistance increases even more, there is no diastolic forward velocity (absent end-diastolic velocity). Further increase in the resistance causes reversed end-diastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. Doppler assessment of the umbilical arteries was found to improve outcome of high-risk pregnancies, and reduce hospital admissions. On the contrary, routine Doppler ultrasound in low risk or unselected populations does not seem to confer benefit on mother or newborn. Uterine artery Doppler is a useful test in predicting pregnancies at high risk of developing complications related to uteroplacental insufficiency. It identifies women who may benefit from increased antenatal surveillance or prophylactic therapy. Three-dimensional power Doppler sonography can provide new insights into placental pathophysiology.

Original languageEnglish
Pages (from-to)921-929
Number of pages9
JournalPlacenta
Volume29
Issue number11
DOIs
StatePublished - 1 Nov 2008
Externally publishedYes

Keywords

  • 3D ultrasound
  • Complications
  • Doppler
  • Fetus
  • Placenta
  • Pregnancy
  • Ultrasound

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Developmental Biology

Fingerprint

Dive into the research topics of 'Ultrasound of the Placenta: A Systematic Approach. Part II: Functional Assessment (Doppler)'. Together they form a unique fingerprint.

Cite this