Doppler Velocimetry in Prolonged Pregnancy

  • Ray O. Bahado-Singh
  • Maria Segata
  • Chin-Chien Cheng
  • Giancarlo Mari


A comprehensive review of Doppler velocimetry revealed significant variability in the design and conduct of these studies. Areas of variability include differences in ultrasound machines used, Doppler modality (continuous value vs pulsed Doppler), Doppler indices used, and definition of prolonged pregnancy and precision of pregnancy dating. The Doppler technique requires experience and precision that are difficult to ensure and maintain across different trials. The extreme variability observed is likely to overwhelm any small or moderate correlation between Doppler measurements and outcomes, should they exist. The generally small size of the study samples and the near universal lack of power analysis for studies with negative results represent significant additional hurdles. Properly designed and sufficiently powered trials would therefore still be of benefit. An interesting empirical observation was that umbilical Doppler velocimetry appeared to better predict outcome in prolonged pregnancy when compared with the standard antenatal tests such as NST and fluid volume assessment. This is certainly an observation that merits further investigation.


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  1. 1.
    Clausson B, Cnattingius S, Axelsson (199) Outcommes of post-term births: the role of fetal growth restriction. Obstetric Gynecol 94:758–762Google Scholar
  2. 2.
    Naeye R (1978) Causes of perinatal mortality excess in prolonged gestations. Am J Epidemiol 108:429–433PubMedGoogle Scholar
  3. 3.
    ACOG Practice Patterns (1997) Management of post-term pregnancy. #6, OctoberGoogle Scholar
  4. 4.
    Alfirevic Z, Nielson JP (1995) Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. Am J Obstet Gynecol 172:1379PubMedCrossRefGoogle Scholar
  5. 5.
    Rightmire DA, Campbell S (1987) Fetal and maternal Doppler blood flow parameters in post-term pregnancies. Obstet Gynecol 69:891–894PubMedGoogle Scholar
  6. 6.
    Guidetti DA, Divon MY, Cavalieri RI, Langer O, Mekatz IR (1987) Fetal umbilical artery flow velocimetry in postdate pregnancies. Am J Obstet Gynecol 57:1521–1523Google Scholar
  7. 7.
    Battaglia C, Larocca E, Lanzani A, Coukos G, Genazzni AR (1991) Doppler velocimetry in prolong2ed pregnancy. Obstet Gynecol 77:213–216PubMedGoogle Scholar
  8. 8.
    Fischer R, Kuhlman KA, Depp R, Wapner RJ (1991) Doppler evaluation of umbilical and uterine arcuate arteries in postdates pregnancy. Obstet Gynecol 78:363–368PubMedGoogle Scholar
  9. 9.
    Malcus P, Maršál K, Persson PH (1991) Fetal and uteroplacental blood flow in prolonged pregnancies. A clinical study. Ultrasound Obstet Gynecol 1:40–45PubMedCrossRefGoogle Scholar
  10. 10.
    Pearce J, McParland PI (1991) A comparison of Doppler flow velocity waveforms, amniotic fluid columns, and non-stress test as a means of monitoring postdates pregnancies. Obstet Gynecol 77:204–208PubMedCrossRefGoogle Scholar
  11. 11.
    Stokes HJ, Roberts RV, Newnham JP (1991) Doppler flow velocity waveform analysis in postdate pregnancies. Aust NZ J Obstet Gynecol 31:27–30CrossRefGoogle Scholar
  12. 12.
    Weiner Z, Reichler A, Zlozover M, Mendelson A, Thaler I (1993) The value of Doppler ultrasonography in prolonged pregnancies. Eur J Obstet Gynecol Reprod Biol 48:93–97PubMedCrossRefGoogle Scholar
  13. 13.
    Anteby EY, Tadmor O, Revel A, Yagel S (1994) Post-term pregnancies with normal cardiotocographs and amniotic fluid columns: the role of Doppler evaluation in predicting perinatal outcome. Eur J Obstet Gynecol Reprod Biol 54:93–98PubMedCrossRefGoogle Scholar
  14. 14.
    Zimmerman P, Alback T, Kiskinen J, Vaalamo R, Tumala R, Ranta T (1995) Doppler flow velocimetry of the umbilical artery, uteroplacental arteries and fetal middle cerebral artery in prolonged pregnancy. Ultrasound Obstet Gynecol 5:189–197Google Scholar
  15. 15.
    Olofsson P, Salden P, Maršĺ K (1996) Fetal and uteroplacental circulatory changes in pregnancies proceeding beyond 43 weeks. Early Hum Dev 46:1–13PubMedCrossRefGoogle Scholar
  16. 16.
    Block BSB, Llanas AJ, Creasy RK (1984) Responses of growth retarded fetus to acute hypokemia. Am J Obstet Gynecol 148:878–883PubMedGoogle Scholar
  17. 17.
    Devine PA, Bracero LA, Lysikiewicz A, Evans R, Womack S, Byrne DW (1994) Middle cerebral to umbilical artery Doppler ratio in postdate pregnancies. Obstet Gynecol 84:856–860PubMedGoogle Scholar
  18. 18.
    Bahado-Singh R, Kovanchi E, Jeffres A, Oz U, Deren O, Copel J, Mari G (1999) The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 180:750–756PubMedGoogle Scholar
  19. 19.
    Weiner Z, Farmakides G, Schulman H, Casale A Itskovitz-Eldor J (1996) Central and peripheral haemodynamic changes in post-term fetuses: correlation with oligohydramnios and abnormal fetal heart rate pattern. Br J Obstet Gynecol 103:541–546Google Scholar
  20. 20.
    Bar-Hava I, Divon MY, Sardo M, Barnhard Y (1995) Is olighydramnios in post-term pregnancy associated with redistribution of fetal blood flow? Am J Obstet Gynecol 173:1523–1527PubMedGoogle Scholar
  21. 21.
    Selam B, Koksal R, Ozcan T (2000) Fetal arterial and venous Doppler parameters in the interpretation of oligohydramnios in post-term pregnancies. Ultrasound Obstet Gynecol 15:403–406PubMedCrossRefGoogle Scholar
  22. 22.
    Brar HS, Horenstein J, Medearis AL, Platt LD, Phelan JP, Paul RH (1989) Cerebral, umbilical, and uterine resistance using Doppler velocimetry in post-term pregnancy. J Ultrasound Med 8:187–191PubMedGoogle Scholar
  23. 23.
    Olofsson P, Saldeen P, Maršál K (1997) Association between a low umbilical artery pulsatility index and fetal distress in very prolonged pregnancies. Eur J Obstet Gynecol Reprod Biol 73:23–29PubMedCrossRefGoogle Scholar
  24. 24.
    Weiner Z, Farmakides G, Barnhard Y, Bar-Hava I, Divon MY (1996) Doppler study of fetal cardiac function in prolonged pregnancies. Obstet Gynecol 88:200–202PubMedCrossRefGoogle Scholar
  25. 25.
    Arduini D, Rizzo G (1991) Fetal renal artery velocity wavelength and amniotic fluid volume in growth-retarded and post-term fetuses. Obstet Gynecol 77:370–373PubMedGoogle Scholar
  26. 26.
    Robillard J, Weitzman R, Burmeister L, Smith FG Jr (1981) Developmental aspects of renal response to hypoxemia in the fetal lamb in utero. Circ Res 48:128–130PubMedGoogle Scholar
  27. 27.
    Veille J, Penry M, Mueller-Heubach E (1993) Fetal renal pulsed Doppler waveform in prolonged pregnancies. Am J Obstet Gynecol 169:882–884PubMedGoogle Scholar
  28. 28.
    Batten DG, Hellman J, Hernandez MJ, Maisels MJ (1983) Regional cerebral blood flow, cerebral blood velocity and pulsatility index in newborn dogs. Pediatr Res 17:908–912Google Scholar
  29. 30.
    Oz AV, Holub B, Mendilcioglu I, Mari G, Bahado-Singh RO (2002) Renal artery Doppler investigation of the etiology of oligohydramnios in post-term pregnancy. Obstet Gynecol 100:715–718PubMedCrossRefGoogle Scholar
  30. 30.
    Fox H (1997) Aging of the placental. Arch Dis Child 77:165–170Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Ray O. Bahado-Singh
    • 1
  • Maria Segata
    • 1
  • Chin-Chien Cheng
    • 1
  • Giancarlo Mari
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of Obstetrics and GynecologyHutzel Hospital/Wayne State UniversityDetroitUSA

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