Skip to main content

Umbilical Doppler Velocimetry: Normative Data and Diagnostic Efficacy

  • Chapter
  • First Online:
Doppler Ultrasound in Obstetrics and Gynecology

Abstract

The umbilical artery is readily accessible to continuous-wave and pulsed-wave Doppler interrogation. The variance of umbilical artery Doppler indices is affected by both hemodynamic and nonhemodynamic factors. The latter represent the error component of the measurement and are attributable to observer and probably instrumental factors. Hemodynamic factors include physiologic and pathologic phenomena. Of the former, gestational age, fetal breathing, fetal heart rate, and site of measurement are the most important contributors. Recent studies have significantly advanced the normative information on gestational age-specific distribution of umbilical artery Doppler indices, contributing to a more reliable utilization of these indices for clinical use.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Maulik D, Yarlagadda P, Youngblood JP, Ciston P. Comparative efficacy of umbilical arterial Doppler indices for predicting adverse perinatal outcome. Am J Obstet Gynecol. 1991;164:1434–40.

    Article  CAS  Google Scholar 

  2. Maulik D, Yarlagadda AP, Youngblood JP, Willoughby L. Components of variability of umbilical arterial Doppler velocimetry: a prospective analysis. Am J Obstet Gynecol. 1989;160:1406–12.

    Article  CAS  Google Scholar 

  3. Schulman H, Fleischer A, Stern W, et al. Umbilical velocity wave ratios in human pregnancy. Am J Obstet Gynecol. 1984;148:985–90.

    Article  CAS  Google Scholar 

  4. Nienhuis SJ, van Vugt JM, Hoogland HJ, Ruissen CJ, de Haan J. Interexaminer variability of fetal Doppler velocity waveforms. Gynecol Obstet Investig. 1988;25:152–7.

    Article  CAS  Google Scholar 

  5. Gudmundsson S, Fairlie F, Lingman G, Marsal K. Recording of blood flow velocity waveforms in the uteroplacental and umbilical circulation: reproducibility study and comparison of pulsed and continuous wave Doppler ultrasonography. J Clin Ultrasound. 1990;18:97–101.

    Article  CAS  Google Scholar 

  6. Davies JA, Lee A, Spencer JA. Variability of continuous-wave Doppler flow velocity waveform indices from the umbilical artery. Obstet Gynecol. 1990;76:366–99.

    CAS  Google Scholar 

  7. Scherjon SA, Kok JH, Oosting H, Zondervan HA. Intra-observer and inter-observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels. Br J Obstet Gynaecol. 1993;100:134–8.

    Article  CAS  Google Scholar 

  8. Brar HS, Medearis AL, De Vore GR, Platt LD. Fetal umbilical velocimetry using continuous-wave and pulsed-wave Doppler ultrasound in high-risk pregnancies: a comparison of systolic to diastolic ratios. Obstet Gynecol. 1988;72:607–12.

    CAS  Google Scholar 

  9. Mehalek KE, Berkowitz GS, Chitkara U, Rosenberg J, Berkowitz RL. Comparison of continuous-wave and pulsed Doppler S/D ratios of umbilical and uterine arteries. Obstet Gynecol. 1988;72:603–6.

    CAS  Google Scholar 

  10. Chan FY, Pun TC, Lee CP, et al. A comparative study of continuous- and pulsed-wave Doppler velocimetry in fetal and uteroplacental circulation. J Ultrasound Med. 1991;10:277–80.

    Article  CAS  Google Scholar 

  11. Van Vugt JM, Ruissen CJ, Nienhuis SJ, Hoogland HJ, de Hann J. Comparison of blood velocity waveform indices recorded by pulsed Doppler and continuous wave Doppler in the umbilical artery. J Clin Ultrasound. 1988;16:573–6.

    Article  Google Scholar 

  12. Jorn H, Fendel H, Christ B. Ein Vergleich zwischen einfachen Dopplermethoden (kontinuierlicher oder gepulster Doppler) und dem Duplex-System (Kombination von B-Bild und gepulstem Doppler). Z Geburtshilfe Perinatol. 1991;195:107.

    CAS  Google Scholar 

  13. Gaziano EP, Knox GF, Wager GP, Bendel RP, Olson JD. Pulsed Doppler umbilical artery waveforms: significance of elevated umbilical artery systolic/diastolic ratios in the normally grown fetus. Obstet Gynecol. 1990;75:189–95.

    CAS  Google Scholar 

  14. Abramowicz JS, Warsof SL, Arrington J, Levy DL. Doppler analysis of the umbilical artery: the importance of choosing the placental end of the cord. J Ultrasound Med. 1989;8:219–21.

    Article  CAS  Google Scholar 

  15. Mehalek KE, Rosenberg J, Berkowitz GS, Chitkara U, Berkowitz RL. Umbilical and uterine artery flow velocity waveforms: effect of the sampling site on Doppler ratios. J Ultrasound Med. 1989;8:171–6.

    Article  CAS  Google Scholar 

  16. Vieyres P, Durand A, Patat F, et al. Influence of the measurement location on the resistance index in the umbilical arteries: a hemodynamic approach. J Ultrasound Med. 1991;10:671–5.

    Article  CAS  Google Scholar 

  17. Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of blood velocity and pulsatility index at the intra-abdominal portion, and fetal and placental ends of the umbilical artery. Ultrasound Obstet Gynecol. 2005;26(2):162–9.

    Article  CAS  Google Scholar 

  18. Ruissen CJ, von Drongelen MM, Hoogland HJ, Jager W, Hoeks AP. Characteristics of the umbilical artery velocity waveform as function of measurement site. Gynecol Obstet Investig. 1990;30:212–6.

    Article  CAS  Google Scholar 

  19. Bhide A, Badade A, Khatal K. The effect of sampling site on the variability of umbilical artery PI. Eur J Obstet Gynecol Reprod Biol. 2019;235:102–5.

    Article  Google Scholar 

  20. FitzGerald DE, Stuart B, Drumm JE, Duignan NM. The assessment of fetoplacental circulation with continuous wave Doppler ultrasound. Ultrasound Med Biol. 1984;10:371–6.

    Article  CAS  Google Scholar 

  21. Hastie SJ, Howie CA, Whittle MJ, Rubin PC. Daily variability of umbilical and lateral uterine wall artery blood velocity waveform measurements. Br J Obstet Gynaecol. 1988;95:571–4.

    Article  CAS  Google Scholar 

  22. Avitan T, Sanders A, Brain U, Rurak D, Oberlander TF, Lim K. Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus. J Clin Ultrasound. 2018;46:235–40.

    Article  Google Scholar 

  23. Stuart B, Drumm JE, FitzGerald DE, Duignan NM. Fetal blood flow velocity waveforms in normal pregnancy. Br J Obstet Gynaecol. 1980;87:780–6.

    Article  CAS  Google Scholar 

  24. Reuwer PJHM, Bruinse HW, Stoutenbeek P, Haspels AA. Doppler assessment of the fetoplacental circulation in normal and growth retarded fetuses. Eur J Obstet Gynecol Reprod Biol. 1984;18:199–205.

    Article  CAS  Google Scholar 

  25. Arduini D, Rizzo G. Umbilical artery velocity waveforms in early pregnancy: a transvaginal color Doppler study. J Clin Ultrasound. 1991;19:335–9.

    Article  CAS  Google Scholar 

  26. Wladimiroff JW, Huisman TW, Stewart PA. Fetal and umbilical flow velocity waveforms between 10–16 weeks’ gestation: a preliminary study. Obstet Gynecol. 1991;78:812–4.

    CAS  Google Scholar 

  27. Maulik D. Basic principles of Doppler ultrasound as applied in obstetrics. Clin Obstet Gynecol. 1989;32:628.

    Article  CAS  Google Scholar 

  28. Dawes GS. Fetal and neonatal physiology. Chicago: Year Book; 1968.

    Google Scholar 

  29. Anderson DF, Faber JJ. Regulation of the fetoplacental blood flow in the lamb. Am J Phys. 1984;247:R567–74.

    CAS  Google Scholar 

  30. Kaufmann P, Luckhardt M, Leiser R. Three dimensional representation of the fetal vessel system in the human placenta. Trophoblast Res. 1984;3:113–38.

    Google Scholar 

  31. Thompson RS, Trudinger BJ, Cook CM. Doppler ultrasound waveforms in the fetal umbilical artery: quantitative analysis technique. Ultrasound Med Biol. 1985;11:707–14.

    Article  CAS  Google Scholar 

  32. Mires G, Dempster J, Patel NB, et al. The effect of fetal heart rate on umbilical artery flow velocity waveform. Br J Obstet Gynaecol. 1987;94:665–9.

    Article  CAS  Google Scholar 

  33. Yarlagadda P, Willoughby L, Maulik D. Effect of fetal heart rate on umbilical arterial Doppler indices. J Ultrasound Med. 1989;8:215–8.

    Article  CAS  Google Scholar 

  34. Maulik D, Downing GJ, Yarlagadda P. Umbilical arterial Doppler indices in acute uteroplacental flow occlusion. Echocardiography. 1990;7:619–27.

    Article  Google Scholar 

  35. Downing GJ, Yarlagadda P, Maulik D. Effects of acute hypoxemia on umbilical arterial Doppler indices in a fetal ovine model. Early Hum Dev. 1991;25:1–10.

    Article  CAS  Google Scholar 

  36. Downing GJ, Maulik D, Phillips C, Kadado T. In vivo correlation of Doppler waveform analysis with arterial input impedance parameters. J Ultrasound Med Biol. 1993;19:549–59.

    Article  CAS  Google Scholar 

  37. Mansouri H, Gagnon R, Hunse C. Relationship between fetal heart rate and umbilical blood flow velocity in term human fetuses during labor. Am J Obstet Gynecol. 1989;160:1007–12.

    Article  CAS  Google Scholar 

  38. Ruhle W, Gnirs J, Schmidt W. Fetal heart rate and Doppler flow parameters in fetal blood vessels—evaluation of 2517 individual signals. Z Geburtshilfe Perinatol. 1993;197:90–4.

    CAS  Google Scholar 

  39. Mulders LG, Muijers GJ, Jongsma HW, Nijhuis JG, Hein PR. The umbilical artery blood flow velocity waveform in relation to fetal breathing movements, fetal heart rate and fetal behavioural states in normal pregnancy at 37 to 39 weeks. Early Hum Dev. 1986;14:283–93.

    Article  CAS  Google Scholar 

  40. Dawes GS, Fox HE, Leduc BM, Liggins GC, Richards RT. Respiratory movements and rapid eye movement sleep in the fetal lamb. J Physiol Lond. 1972;220:119–43.

    Article  CAS  Google Scholar 

  41. Chiba Y, Utsu M, Kanzaki T, Hasegawa T. Changes in venous flow and intratracheal flow in fetal breathing movements. Ultrasound Med Biol. 1985;11:43–9.

    Article  CAS  Google Scholar 

  42. Koppelaar I, Wladimiroff JW. Quantitation of breathing-related modulation of umbilical arterial and venous flow velocity waveforms in the normal term fetus. Eur J Obstet Gynecol Reprod. 1992;45:177–80.

    Article  CAS  Google Scholar 

  43. Nyberg MK, Johnsen SL, Rasmussen S, Kiserud T. Fetal breathing is associated with increased umbilical blood flow. Ultrasound Obstet Gynecol. 2010;36(6):718–23.

    Article  CAS  Google Scholar 

  44. Spencer JA, Price J, Lee A. Influence of fetal breathing and movements on variability of umbilical Doppler indices using different numbers of waveforms. J Ultrasound Med. 1991;10:37–41.

    Article  CAS  Google Scholar 

  45. Hoskins PR, McDicken WN, Johnstone FD, et al. Determination of the presence of fetal apnoea using umbilical artery and umbilical vein Doppler waveforms. Ultrasound Med Biol. 1988;14:589–92.

    Article  CAS  Google Scholar 

  46. Prechtl HFR, Beintema DJ. The neurological examination of the full term newborn infant. Clinics in developmental medicine no 12. London: Heinmann Medical Books Ltd; 1964.

    Google Scholar 

  47. Nijhuis JG, Prechtl HFR, Martin CB Jr, Bots RSGM. Are there behavioral states in the human fetus? Early Hum Dev. 1982;6:177–95.

    Article  CAS  Google Scholar 

  48. Van Eyck J, Wladimiroff JW, van der Wijngaard JA, Noordam MJ, Prechtl HFR. The blood flow velocity waveform in the fetal internal carotid and umbilical artery; its relationship to fetal behavioral states in normal pregnancy at 37–38 weeks of gestation. Br J Obstet Gynaecol. 1987;94:736–41.

    Article  Google Scholar 

  49. Buchan PC. Pre-eclampsia—a hyperviscosity syndrome. Am J Obstet Gynecol. 1982;142:111–5.

    Article  CAS  Google Scholar 

  50. Giles WB, Trudinger BJ. Umbilical cord whole blood viscosity and the umbilical artery flow velocity time waveforms: a correlation. Br J Obstet Gynaecol. 1986;93:466–70.

    Article  CAS  Google Scholar 

  51. Steel SA, Pearce JM, Nash G, et al. Correlation between Doppler flow velocity waveforms and cord blood viscosity. Br J Obstet Gynaecol. 1989;96:1168–72.

    Article  CAS  Google Scholar 

  52. Kinsella SM, Lee A, Spencer JA. Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy. Eur J Obstet Gynecol Reprod Biol. 1990;36:11–7.

    Article  CAS  Google Scholar 

  53. Sorensen TK, Hendricks S, Easterling TR, Carlson KL, Benedetti TJ. Effect of orthostatic stress on umbilical Doppler waveforms in normal and hypertensive pregnancies. Am J Obstet Gynecol. 1992;167:643–7.

    Article  CAS  Google Scholar 

  54. Drack G, Kirkinen P, Baumann H, Muller R, Huch R. Doppler ultrasound studies before and following short-term maternal stress in late pregnancy. Z Geburtshilfe Perinatol. 1988;192:173–7.

    CAS  Google Scholar 

  55. Veille JC, Bacevice AE, Wilson B, Janos J, Hellerstein HK. Umbilical artery waveform during bicycle exercise in normal pregnancy. Obstet Gynecol. 1989;73:957–60.

    CAS  Google Scholar 

  56. Erkkola RU, Pirhonen JP, Kivijarvi AK. Flow velocity waveforms in uterine and umbilical arteries during submaximal bicycle exercise in normal pregnancy. Obstet Gynecol. 1992;79:611–5.

    CAS  Google Scholar 

  57. Nabeshima Y, Sasaki J, Mesaki N, Sohda S, Kubo T. Effect of maternal exercise on fetal umbilical artery waveforms: the comparison of IUGR and AFD fetuses. J Obstet Gynaecol Res. 1997;23(3):255–9.

    Article  CAS  Google Scholar 

  58. Salvesen KÅ, Hem E, Sundgot-Borgen J. Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2012;46(4):279–83.

    Article  Google Scholar 

  59. de Oliveria Melo AS, Silva JL, Tavares JS, Barros VO, Leite DF, Amorim MM. Effect of a physical exercise program during pregnancy on uteroplacental and fetal blood flow and fetal growth: a randomized controlled trial. Obstet Gynecol. 2012;120(2 Part 1):302–10.

    Article  Google Scholar 

  60. Babbar S, Hill JB, Williams KB, Pinon M, Chauhan SP, Maulik D. Acute feTal behavioral response to prenatal yoga: a single, blinded, randomized controlled trial (TRY yoga). Am J Obstet Gynecol. 2016;214(3):399–e1.

    Article  Google Scholar 

  61. Morrow RJ, Ritchie JK, Bull SB. Fetal and maternal hemodynamic responses to exercise in pregnancy assessed by Doppler ultrasonography. Am J Obstet Gynecol. 1989;160(1):138–40.

    Article  CAS  Google Scholar 

  62. Kennelly MM, Geary M, McCaffrey N, McLoughlin P, Staines A, McKenna P. Exercise-related changes in umbilical and uterine artery waveforms as assessed by Doppler ultrasound scans. AJOG. 2002;187(3):661–6.

    Article  Google Scholar 

  63. Preissl H. Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review. BMJ Open Sport Exerc Med. 2020;6(1):e000658.

    Article  Google Scholar 

  64. Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019;53:465–72.

    Article  CAS  Google Scholar 

  65. Flatley C, Kumar S, Greer RM. Reference centiles for the middle cerebral artery and umbilical artery pulsatility index and cerebro-placental ratio from a low-risk population–a generalised additive model for location, shape and scale (GAMLSS) approach. J Matern Fetal Neonatal Med. 2019;32(14):2338–45.

    Article  Google Scholar 

  66. Oros D, Ruiz-Martinez S, Staines-Urias E, Conde-Agudelo A, Villar J, Fabre E, Papageorghiou AT. Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review. Ultrasound Obstet Gynecol. 2019;53(4):454–64.

    Article  CAS  Google Scholar 

  67. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. J Am Med Assoc. 2000;283:2008–12.

    Article  CAS  Google Scholar 

  68. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  Google Scholar 

  69. Drukker L, Staines-Urias E, Villar J, Barros FC, Carvalho M, Munim S, McGready R, Nosten F, Berkley JA, Norris SA, Uauy R. International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project. Am J Obstet Gynecol. 2020;222:602.e1–15.

    Article  Google Scholar 

  70. Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Ismail LC, Lambert A, Jaffer YA, Bertino E, Gravett MG, Purwar M, Noble JA. International standards for fetal growth based on serial ultrasound measurements: the fetal growth longitudinal study of the INTERGROWTH-21st project. Lancet. 2014;384(9946):869–79.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dev Maulik .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Maulik, D., Schrufer-Poland, T., Williams, E.M. (2023). Umbilical Doppler Velocimetry: Normative Data and Diagnostic Efficacy. In: Maulik, D., Lees, C.C. (eds) Doppler Ultrasound in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-06189-9_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-06189-9_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-06188-2

  • Online ISBN: 978-3-031-06189-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics