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Doppler Sonography in Early Pregnancy

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First-Trimester Ultrasound

Abstract

This chapter provides a review of the three major areas of the use of Doppler ultrasound imaging for fetal and maternal risk assessment in early pregnancy. Ductus venosus and tricuspid flow assessments have now become an essential part of prenatal diagnostic workup in the first trimester. Uterine artery Doppler offers early prediction of preeclampsia and other pregnancy complications that can lead to prevention of some of these disorders through prophylactic therapeutics such as low-dose aspirin. Further research in this field holds exciting opportunities for improving perinatal care and outcome.

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References

  1. Stuart B, Drumm J, FitzGerald DE, Duignan NM. Fetal blood velocity waveforms in normal pregnancy. Br J Obstet Gynaecol. 1980;87(9):780–5.

    Article  CAS  PubMed  Google Scholar 

  2. Maulik D, Saini VD, Nanda NC, Rosenzweig MS. Doppler evaluation of fetal hemodynamics. Ultrasound Med Biol. 1982;8(6):705–10.

    Article  CAS  PubMed  Google Scholar 

  3. Maulik D. Hemodynamic interpretation of the arterial Doppler waveform. Ultrasound Obstet Gynecol. 1993;3(3):219–27.

    Article  CAS  PubMed  Google Scholar 

  4. Maulik D, Mundy D, Heitmann E, Maulik D. Evidence-based approach to umbilical artery Doppler fetal surveillance in high-risk pregnancies: an update. Clin Obstet Gynecol. 2010;53:869–78.

    Article  PubMed  Google Scholar 

  5. Maulik D, Nanda NC, Saini VD. Fetal Doppler Echocardiography: methods and characterization of normal and abnormal hemodynamics. Am J Cardiol. 1984;53(4):572–8.

    Article  CAS  PubMed  Google Scholar 

  6. Mavrides E, Moscoso G, Carvalho JS, Campbell S, Thilaganathan B. The anatomy of the umbilical, portal and hepatic venous system in the human fetus at 14-19 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18(6):598–604.

    Article  CAS  PubMed  Google Scholar 

  7. Kessler J, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Fetal growth restriction is associated with prioritization of umbilical blood flow to the left hepatic lobe at the expense of the right lobe. Pediatr Res. 2009;66(1):113–7.

    Article  PubMed  Google Scholar 

  8. Kiserud T, Eik-Nes SH, Blaas H-G, Hellevik LR. Ultrasonographic velocimetry of the fetal ductus venosus. Lancet. 1991;338(8780):1412–4.

    Article  CAS  PubMed  Google Scholar 

  9. Kiserud T. Venous hemodynamics. In: Maulik D, Zalud I, editors. Doppler ultrasound in obstetrics and gynecology. 2nd ed. New York, NY: Springer; 2005. p. 57–67.

    Chapter  Google Scholar 

  10. Kiserud T. Physiology of the fetal circulation. Semin Fetal Neonatal Med. 2005;10(6):493–503.

    Article  PubMed  Google Scholar 

  11. Baschat AA. Ductus venosus Doppler for fetal surveillance in high-risk pregnancies. Clin Obstet Gynecol. 2010;53(4):858–68.

    Article  PubMed  Google Scholar 

  12. Kiserud T. Doppler velocimetry of the ductus venosus. In: Maulik D, Zalud I, editors. Doppler ultrasound in obstetrics and gynecology. 2nd ed. New York: Springer; 2005. p. 413–27.

    Chapter  Google Scholar 

  13. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol. 2013;41(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  14. Nelson TR, Fowlkes JB, Abramowicz JS, Church CC. Ultrasound biosafety considerations for the practicing sonographer and sonologist. J Ultrasound Med. 2009;28(2):139–50.

    PubMed  Google Scholar 

  15. Van Splunder P, Huisman TW, DeRidder MA, Wladimiroff JW. Fetal venous and arterial flow velocity wave forms between eight and twenty weeks of gestation. Pediatr Res. 1996;40(1):158–62.

    Article  PubMed  Google Scholar 

  16. Prefumo F, Risso D, Venturini PL, De Biasio P. Reference values for ductus venosus Doppler flow measurements at 10-14 weeks of gestation. Ultrasound Obstet Gynecol. 2002;20(1):42–6.

    Article  CAS  PubMed  Google Scholar 

  17. Kiserud T, Hellevik LR, Eik-Nes SH, Angelsen BA, Blaas HG. Estimation of the pressure gradient across the fetal ductus venosus based on Doppler velocimetry. Ultrasound Med Biol. 1994;20(3):225–32.

    Article  CAS  PubMed  Google Scholar 

  18. de Vries JI, Visser GH, Prechtl HF. The emergence of fetal behaviour. II. Quantitative aspects. Early Hum Dev. 1985;12(2):99–120.

    Article  PubMed  Google Scholar 

  19. Gudmundsson S, Gunnarsson GO, Hokegard KH, Ingemarsson J, Kjellmer I. Venous Doppler velocimetry in relationship to central venous pressure and heart rate during hypoxia in the ovine fetus. J Perinat Med. 1999;27(2):81–90.

    CAS  PubMed  Google Scholar 

  20. Lam YH, Tang MH, Tse HY. Ductus venosus Doppler study in fetuses with homozygous alpha-thalassemia-1 at 12 to 13 weeks of gestation. Ultrasound Obstet Gynecol. 2001;7(1):30–3.

    Article  Google Scholar 

  21. Borrell A, Antolin E, Costa D, Farre MT, Martinez JM, Fortuny A. Abnormal ductus venosus blood flow in trisomy 21 fetuses during early pregnancy. Am J Obstet Gynecol. 1998;179(6 Pt 1):1612–7.

    Article  CAS  PubMed  Google Scholar 

  22. Matias A, Gomes C, Flack N, Montenegro N, Nikolaides KH. Screening for chromosomal defects at 11-14 weeks: the role of ductus venosus blood flow. Ultrasound Obstet Gynecol. 1998;12(6):380–4.

    Article  CAS  PubMed  Google Scholar 

  23. Antolin E, Comas C, Torrents M, Munoz A, Figueras F, Echevarria M, et al. The role of ductus venosus blood flow assessment in screening for chromosomal abnormalities at 10–16 weeks of gestation. Ultrasound Obstet Gynecol. 2001;17(4):295–300.

    Article  CAS  PubMed  Google Scholar 

  24. Murta CG, Moron AF, Avila MA, Weiner CP. Application of ductus venosus Doppler velocimetry for the detection of fetal aneuploidy in the first trimester of pregnancy. Fetal Diagn Ther. 2002;17(5):308–14.

    Article  PubMed  Google Scholar 

  25. Zoppi MA, Putzolu M, Ibba RM, Floris M, Monni G. First trimester ductus venosus velocimetry in relation to nuchal translucency thickness and fetal karyotype. Fetal Diagn Ther. 2002;17(1):52–7.

    Article  PubMed  Google Scholar 

  26. Borrell A, Martinez JM, Seres A, Borobio V, Cararach V, Fortuny A. Ductus venosus assessment at the time of nuchal translucency measurement in the detection of fetal aneuploidy. Prenat Diagn. 2003;23(11):921–6.

    Article  PubMed  Google Scholar 

  27. Toyama JM, Brizot ML, Liao AW, Lopes LM, Nomura RM, Saldanha FA, et al. Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome. Ultrasound Obstet Gynecol. 2004;23(4):341–5.

    Article  CAS  PubMed  Google Scholar 

  28. Prefumo F, Sethna F, Sairam S, Bhide A, Thilaganathan B. First trimester ductus venosus, nasal bones, and Down syndrome in a high-risk population. Obstet Gynecol. 2005;105(6):1348–54.

    Article  PubMed  Google Scholar 

  29. Maiz N, Valencia C, Kagan KO, Wright D, Nicolaides KH. Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation. Ultrasound Obstet Gynecol. 2009;33(5):512–7.

    Article  CAS  PubMed  Google Scholar 

  30. Florjański J, Fuchs T, Zimmer M, Homola W, Pomorski M, Blok D. The role of ductus venosus Doppler flow in the diagnosis of chromosomal abnormalities during the first trimester of pregnancy. Adv Clin Exp Med. 2013;22(3):395–401.

    PubMed  Google Scholar 

  31. Chelemen T, Syngelaki A, Maiz N, Allan L, Nicolaides KH. Contribution of ductus venosus Doppler in first-trimester screening for major cardiac defects. Fetal Diagn Ther. 2011;29(2):127–34.

    Article  PubMed  Google Scholar 

  32. Borrell A, Grande M, Bennasar M, Borobio V, Jimenez JM, Stergiotou I, et al. First-trimester detection of major cardiac defects with the use of ductus venosus blood flow. Ultrasound Obstet Gynecol. 2013;42(1):51–7.

    Article  CAS  PubMed  Google Scholar 

  33. Zidere V, Bellsham-Revell H, Persico N, Allan LD. Comparison of echocardiographic findings in fetuses at less than 15 weeks’ gestation with later cardiac evaluation. Ultrasound Obstet Gynecol. 2013;42(6):679–86.

    Article  CAS  PubMed  Google Scholar 

  34. Huggon IC, DeFigueiredo DB, Allan LD. Tricuspid regurgitation in the diagnosis of chromosomal anomalies in the fetus at 11–14 weeks of gestation. Heart. 2003;89:1071–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Maulik D, Nanda NC, Hsiung MC, Youngblood JP. Doppler color flow mapping of the fetal heart. Angiology. 1986;37(9):628–32.

    Article  CAS  PubMed  Google Scholar 

  36. Gembruch U, Smrcek JM. The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation. Ultrasound Obstet Gynecol. 1997;9(6):374–82.

    Article  CAS  PubMed  Google Scholar 

  37. Makikallio K, Jouppila P, Rasanen J. Human fetal cardiac function during the first trimester of pregnancy. Heart. 2005;91:334–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Rizzo G, Muscatello A, Angelini E, Capponi A. Abnormal cardiac function in fetuses with increased nuchal translucency. Ultrasound Obstet Gynecol. 2003;21(6):539–42.

    Article  CAS  PubMed  Google Scholar 

  39. Lopes LM, Brizot ML, Lopes MA, Ayello VD, Schultz R, Zugaib M. Structural and functional cardiac abnormalities identified prior to 16 weeks’ gestation in fetuses with increased nuchal translucency. Ultrasound Obstet Gynecol. 2003;22(5):470–8.

    Article  CAS  PubMed  Google Scholar 

  40. Falcon O, Faiola S, Huggon I, Allan L, Nicolaides KH. Fetal tricuspid regurgitation at the 11 + 0 to 13 + 6-week scan: association with chromosomal defects and reproducibility of the method. Ultrasound Obstet Gynecol. 2006;27(6):609–12.

    Article  CAS  PubMed  Google Scholar 

  41. Nicolaides KH, Wright D, Poon LC, Syngelaki A, Gil MM. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol. 2013;42(1):41–50.

    Article  CAS  PubMed  Google Scholar 

  42. Schulman H, Fleischer A, Farmakides G, Bracero L, Rochelson B, Grunfeld L. Development of uterine artery compliance in pregnancy as detected by Doppler ultrasound. Am J Obstet Gynecol. 1986;55(5):1031–6.

    Article  Google Scholar 

  43. Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta. 1983;4(4):397–413.

    Article  CAS  PubMed  Google Scholar 

  44. Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu. 1972;1:117–91.

    Google Scholar 

  45. Lyall F, Robson SC, Bulmer JN. Spiral artery remodeling and trophoblast invasion in preeclampsia and fetal growth restriction: relationship to clinical outcome. Hypertension. 2013;62(6):1046–54.

    Article  CAS  PubMed  Google Scholar 

  46. Jurkovic D, Jauniaux E, Kurjak A, Hustin J, Campbell S, Nicolaides KH. Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy. Obstet Gynecol. 1991;77(3):365–9.

    CAS  PubMed  Google Scholar 

  47. Guzman ER, Kontopoulos E, Zalud I. Doppler velocimetry of the uteroplacental circulation. In: Maulik D, Zalud I, editors. Doppler ultrasound in obstetrics and gynecology. 2nd ed. New York, NY: Springer; 2005. p. 227–42.

    Chapter  Google Scholar 

  48. Thaler I, Amin A. Doppler velocimetry of the uteroplacental circulation in early pregnancy. In: Maulik D, Zalud I, editors. Doppler ultrasound in obstetrics and gynecology. 2nd ed. New York, NY: Springer; 2005. p. 255–75.

    Chapter  Google Scholar 

  49. Khalil A, Nicolaides KH. How to record uterine artery Doppler in the first trimester. Ultrasound Obstet Gynecol. 2013;42(4):478–9.

    CAS  PubMed  Google Scholar 

  50. Lefebvre J, Demers S, Bujold E, Nicolaides KH, Girard M, Brassard N, et al. Comparison of two different sites of measurement for transabdominal uterine artery Doppler velocimetry at 11-13 weeks. Ultrasound Obstet Gynecol. 2012;40(3):288–92.

    Article  CAS  PubMed  Google Scholar 

  51. Gomez O, Figueras F, Martinez JM, del Rio M, Palacio M, Eixarch E, et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol. 2006;28(6):802–8.

    Article  CAS  PubMed  Google Scholar 

  52. Kofinas A, Penry M, Greiss F, Meis PJ, Nelson LH. The effect of placental location on uterine artery flow velocity waveforms. Am J Obstet Gynecol. 1988;159(6):1504–8.

    Article  CAS  PubMed  Google Scholar 

  53. Campbell S, Bewley S, Cohen-Overbrook T. Investigation of the uteroplacental circulation by Doppler ultrasound. Semin Perinatol. 1987;11(4):362–8.

    CAS  PubMed  Google Scholar 

  54. Fleischer A, Schulman H, Farmakides G, Bracero L, Grunfeld L, Rochelson B, et al. Uterine artery Doppler velocimetry in pregnant women with hypertension. Am J Obstet Gynecol. 1986;154(4):806–13.

    Article  CAS  PubMed  Google Scholar 

  55. Thaler I, Weiner Z, Itskovitz J. Systolic or diastolic notch in uterine artery blood flow velocity waveforms in hypertensive pregnant patients: relationship to outcome. Obstet Gynecol. 1992;80(2):277–82.

    CAS  PubMed  Google Scholar 

  56. Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18(6):583–6.

    Article  CAS  PubMed  Google Scholar 

  57. Skrastad RB, Hov GG, Blaas HG, Romundstad PR, Salvesen K. A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population. Acta Obstet Gynecol Scand. 2014;93(12):1238–47.

    Article  CAS  PubMed  Google Scholar 

  58. Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ. 2008;178(6):701–11.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Audibert F, Boucoiran I, An N, Aleksandrov N, Delvin E, Bujold E, et al.Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am J Obstet Gynecol. 2010;203(4):383.e1-8.

    Google Scholar 

  60. Goetzinger KR, Zhong Y, Cahill AG, Odibo L, Macones GA, Odibo AO. Efficiency of first-trimester uterine artery Doppler, a-disintegrin and metalloprotease 12, pregnancy-associated plasma protein a, and maternal characteristics in the prediction of preeclampsia. J Ultrasound Med. 2013;32(9):1593–600.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol. 2014;43(5):500–7.

    Article  CAS  PubMed  Google Scholar 

  62. Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol. 2013;41(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  63. Stampalija T, Gyte GML, Alfirevic Z. Utero-placental Doppler ultrasound for improving pregnancy outcome. Cochrane Database Syst Rev. 2010;(9): CD008363.

    Google Scholar 

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Acknowledgement

We appreciate the superb assistance of our lead sonographer Maria Pinon, ARDMS.

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Correspondence to Dev Maulik MD, PhD, FACOG, FRCOG .

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Maulik, D., Bennett, T.L., Porter, B., Babbar, S., Maulik, D. (2016). Doppler Sonography in Early Pregnancy. In: Abramowicz, J. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-20203-7_12

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  • DOI: https://doi.org/10.1007/978-3-319-20203-7_12

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