Published: 2019-04-29

Efficacy of doppler velocimetry of the umbilical artery in the defined high-risk groups to determine the fetal outcome

Maneesha R. Suryavanshi, Shriraj S. Katakdhond


Background: Doppler ultrasound provides a non-invasive method of studying the status of various blood vessels. It provides a spectrum analysis of the velocities of moving red blood cells. Doppler sonography can provide useful information in a variety of gynecological and obstetric conditions. In obstetrics, Doppler velocimetry of the uteroplacental and fetoplacental circulation can be used to further investigate complications of pregnancy such as fetal growth restriction, other forms of fetal distress that result from fetal hypoxemia or asphyxia.

Methods: In a prospective observational study, 93 pregnancies fitting in the criteria for high risk were evaluated by doppler velocimetry between 28-40 weeks of gestation. The flow velocity time wave forms were examined and quantitated by use of systolic/diastolic (S/D) ratio, resistance index (RI), pulsatility index (PI) values. The outcome of pregnancy was noted.

Results: Fetuses with abnormal velocimetry are at higher risk with regard to birth weight, Apgar score, fetal distress, need of cesarean section, need of NICU admission. The patients with absent end-diastolic flow (AEDF)/reversal of end-diastolic flow (REDF) had poor perinatal outcome. Positive predictive value for small for gestational age (SGA) and fetal distress was 75% and 60% respectively. 23.8% babies needed to be kept in neonatal intensive care unit (NICU).

Conclusions: Doppler velocimetry can be useful prenatal test for the patients of hypertensive disorder of pregnancy and IUGR. Abnormal doppler waveform changes indicate adverse perinatal outcome. Appropriate and timely interventions guided by doppler study help to reduce perinatal morbidity and mortality.


Doppler velocimetry, Perinatal outcome, Umbilical artery

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Rochelson BL, Schulman H, Fleischer A, Farmakides G, Bracero L, Ducey J, et al. The clinical significance of doppler umbilical artery velocimetry in the small for gestational age fetus. Am J Obs Gynecol. 1987;156(5):1223-6.

Trudinger BJ, Giles WB, Cook CM. Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations. Am J Obs Gynecol. 1985;152(2):155-63.

O’Neill AM, Burd ID, Sabogal JC, Seamon JS, Weiner S. Doppler Ultrasound in obstetrics and Gynecology. 17th ed. 2005;98-112.

Schulman H, Fleischer A. Umbilical velocity wave ratio in human pregnancy. Am J Obstet Gynecol. 1984;148:985-9.

Divon MY, Ferber A. Doppler evaluation of fetus. Cinlical Obstet Gynecol. 2002;45:1015-25.

Arora D, Desai SK, Sheth PN, Kania P. Significance of umbilical artery velocimetry in perinatal outcome of growth restricted fetuses. J Obstet Gynecol. 2005;55(2):138-143.

Agrawal S, Das V, Agarwal A,

Pandey A. Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting. Int J Reprod Contracept Obstet Gynecol. 2016;5:3439-43.

Haley J, Tuffnell DJ, Johnson N. Randomised controlled trial of cardiotocography versus umbilical artery doppler in the management of small for gestational age fetuses. Brit J Obstet Gynaecol. 1997;104:431-5.

Pattinson RC, Norman K, Odendaal HJ. The role of doppler velocimetry in the management of high-risk pregnancies. Brit J Obstet Gynaecol. 1994;101:114-20.

Johnstone FD, Prescott R, Hoskins P, Greer IA, McGlew T, Compton M. The effect of introduction of umbilical Doppler recordings to obstetric practice. Br J Obstet Gynaecol. 1993;100:733-41.

Rochelson B, Schulman H, Farmakides G, Bracero L, Ducey J, Fleischer A, et al. The significance of absent end diastolic velocity in umbilical artery waveforms. Am J Obstet Gynecol. 1987;156(5):1213-8.

Brar HS, Lowrence PD. Reverse end diastolic flow velocity on umbilical artery velocimetry in high risk pregnancies: an ominous finding with adverse pregnancy outcome. Am J Obstet Gynecol. 1988;159:559-61.

Ley D, Tideman E, Laurin J, Bjerre I, Marsal K. Abnormal fetal aortic velocity waveform and intellectual function at 7 years of age. Ultrasound Obstet Gynecol. 1996;8:160-5.

Kurkinen-Raty M, Kivela A, Jouppila P. The clinical significance of an absent end-diastolic velocity in the umbilical artery detected before the 34th week of pregnancy. Acta Obstet Gynecol Scand. 1997;76:398-404.

GRIT Study group. When do obstetricians recommend delivery for a high-risk preterm growth-retarded fetus? Euro J Obstet Gynecol Reprod Biol. 1996;67:121-6.

Tyrrell SN, Lilford RJ, Macdonald HN, Nelson EJ, Porter J, Gupta JK. Randomized comparison of routine vs. highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies. Brit J Obstet Gynecol. 1990;97:909-16.

Gezginc K, Acar A, Peru H, Karatoyli R, Colic C, Capar M. How to manage intrauterine growth restriction associated with severe preeclampsia at 28-34 weeks of gestation? Eur J Gen Med. 2008;5(4):212-5.

Maulik D, Mundy D, Heitmann E, Maulik D. Umbilical artery Doppler in the assessment of fetal growth restriction. Clin Perinatol. 2011;38:65-82.

Mendez MA, Gayta MV, Flores R. Doppler ultrasound evaluation in preeclampsia. BMC Res Notes. 2013;19:477.

Tyrrell S, Obaid AH, Lilfora RJ. Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth. Obstet Gynecol. 1989;74:332-7.

Fleischer A, Schulman H, Farmakides G, Bracero L, Randolph BG. Umbilical artery velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151:502-5.

Trudinger BJ, Giles WB, Cook CM, Bombardieri J Collins LE. Fetal umbilical artery flow velocity wave forms and placental resistance clinical significance. Brit J Obstet Gynaecol. 1985;92:23-30.

Dempster J,Mires GJ, Patel N, DJ Taylor. Umbilical artery velocity waveforms: poor association with small for gestation age babies. Brit J Obs Gynecol. 1989;96(6):692-6.

Zelop CM, Richardson DK, Heffner LJ. Outcomes of severely abnormal umbilical artery Doppler velocimetry in structurally normal singleton fetuses. Obstet Gynecol. 1996;87:434-8.

Byun YJ, Kim HS, Yang JI, Kim JH, Kim HY, Chang SJ. Umbilical artery doppler study as a predictive marker of perinatal outcome in preterm small for gestational age infants. Yonsei Med J. 2009;50(1):39-44.

Trudinger BJ, Giles WB, Cook CM. Umbilical artery flow velocity in high risk pregnancy. Lancet. 1987;329:188-190.

Westergaard HB, J. Langhoff-Roos G. Lingman K. Marsal: a critical appraisal of the use of umbilical artery doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound Obstet Gynecol. 2001;17:466-76.

Michael DY, Jeffery J. Umbilical artery Doppler velocimetry. Clinical utility in high risk pregnancy. Am J Obstet Gynecol. 1996;174(4):10-4.

Chanprapaph P, Tongsong T, Siriaree S. Validity of antenatal diagnosis of intrauterine growth restriction by umbilical doppler waveform index. J Med Assoc Thailand. 2004;87(5):492-6.

Berkowitz GS, Chikara U, J Rosenberg. Sonographic estimation of fetal weight and Doppler analysis of umbilical artery velocimetry in the prediction of intrauterine growth retardation: a prospective study. Am J Obstet Gynecol. 1988;158:1149-53.

Weiner Z, Farmakides G, Schulman H, Lopresti S, Schneider E. Surveillance of growth-retarded fetuses with computerized fetal heart rate monitoring combined with doppler velocimetry of the umbilical and uterine arteries. J Repro Med. 1996;41(2):112-8.

Brar HS, Lowrence PD. Antepartum improvement of abnormal umbilical artery velocimetry: Does it occur?. Am J Obstet Gynecol. 1988;160:36-9.

Seyam YS, Al‐Mahmeid MS, Al‐Tamimi HK. Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Gynecol Obs. 2002;77(2):131-7.

James Ducey. Velocity waveform in hypertensive disease. Clin Obs Gynecol. 1989:32(4);679-86.

Rajan R, Vasantha R, Jaya S. Classification of PIH based on Doppler flow velocimetry studies. Ind J Obstet Gynecol. 1994:495-501.

Kofinas AD, Penry M, Nelson LH, Meis PJ, Swain M. Uterine and umbilical artery flow velocity waveform analysis in pregnancies complicated by chronic hypertension or preeclampsia. South Med J. 1990;83:150-5.

Maulik D. Doppler ultrasound velocimetry for fetal surveillance. Clini Obstet Gynecol. 1995;38:91-111.

Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;2:CD000073.