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Doppler in Obstetrics Farhan Hanif,MD Maternal Fetal Medicine.

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Presentation on theme: "Doppler in Obstetrics Farhan Hanif,MD Maternal Fetal Medicine."— Presentation transcript:

1 Doppler in Obstetrics Farhan Hanif,MD Maternal Fetal Medicine

2 Doppler assessment of the placental and fetal circulation is important tool screening for adverse pregnany outcomes

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5 Angle Dependence

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8 Doppler in IUGR EFW<10 th %ile EFW <2SD above the mean EFW <5 th %ile AC <5 th %ile ACOG defines IUGR as EFW <10thile

9 Compensatory Mechanisms MCA PI Echogenic Bowel AF Fetal Hypoxemia- placental insufficiency Blood flow Redistribution Brain, heart, adrenal Gland Lung, kidney, bowel UA

10 Abnormal Venous Doppler Myocardial dysfunction Pressure in Rt Atrium / Dilatation of DV Decompensation

11 Fetal Hypoxemia / Acidosis Abnormalities in Central Control of FHR “ANS” or Direct Myocardial Depression Abnormalities in Central Control of FHR “ANS” or Direct Myocardial Depression VariabilityBaselineDeceleration

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13 Umbilical artery Abnormal Umbilical vein

14 Abnormal Umbilical artery

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16 MCA waveforms A = Normal B = “Brain sparing effect” Normal Brain Sparing

17 MCA Doppler In Anemia In Anemic fetuses, the PSV will inrease. Obtaining PSV at 0 degrees angle is important in anemic fetuses. Increase False positive rate after 34 weeks

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20 IUGR AGA IUGR S D a

21 Role of Ductus Venosus Baschat et al ultrasound obstet gynecol 2004

22 Temporal Sequence of Cardiovascular changes in IUGR fetuses

23 Ferrazi et al. US Obstet Gynecol 2002; 19: 140-6

24 Doppler Indices and outcomes In complicated pregnancies abnormal Doppler indices are powerful predictors of adverse perinatal outcome;Low Apgar score Nonreassuring fetal status Low pHPresence of thick meconiumAdmission to NICU

25 Doppler Indices and outcomes Reduce perinatal death and unnecessary induction of labor in the preterm growth restricted fetus. A meta-analysis use of Doppler ultrasonography reduced the odds of perinatal death by 38 percent (95% CI 15-55) Alfirevic Z et al Am J Obstet Gynecol 1995

26 Umbilical Artery Absence or reversal of end-diastolic flow in the umbilical artery is suggestive of poor fetal condition, whereas normal or slightly decreased umbilical Doppler flow is rarely associated with significant morbidity Ott WJ J Ultrasound Med 2000

27 IUGR Serial Growth Scan 4 weeks interval Doppler UA and MCA every 1-2 weeks Evaluate MCA at term Doppler UA and MCA If Normal Repeat Doppler in 1-2 weeks If normal ?APFS Consider Delivery at 39 weeks

28 EDF Abnormal Doppler UA and MCA Present DV Normal Growth Scan 2-4 wks Weekly UA, MCA,+/- DV May follow as outpatient BMZ,APFS Consider Delivery at weeks Absent/Reverse Admit Steroids NST q shift and daily BPP Deliver at 32-34wks Abnormal APFS DV EDF Present Ab/Reverse Admit Steroids Continuous monitoring ?Timing of Delivery

29 EGA >30weeks Deliver <30weeks Continuous Monitoring Daily BPP Daily Doppler Evaluate AoA, Valves Deliver for Abnormal BPP,FHT ?Reversed AoA,E:A Ratio Absent or Reversed Flow in the Ductus Venosus

30 Doppler in AGA Fetuses Routine screening with dopplers in AGA fetuses is controversial However, abnormal UA identifies the fetuses at risk in uncomplicated pregnancies as DM Ch HTNSLE Maternal autoimmune Twins Postterm

31 Uterine Artery Doppler

32 First trimester Early 2nd Trimester Late 2nd trimester Uterine Artery Doppler

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34 OutcomeSensitivitySpecificityNPV PE IUGR < IUGR < Prediction of PE

35 StudynConditionOutcome McParland et al100PE ASA 2%, P 19% Bower et al60Severe PE ASA 13%, P 38% Morris et al102PE ASA 8%, P 14% (NS) Prevention

36 Uterine Artery in 1 st trimester 7797 women with singleton pregnancies at 11 to 13 weeks. In 34 women, at < 34 weeks. At a 5% FPR; The sensitivity 94.1 percent The specificity was 94.3 percent

37 Doppler in first Trimester Increases the sensitivity of first trimester screening and decreases the false postivie rate DV reversed flow in DV in first trimester is a risk factor for CHD even in the presence of normal NT Can be used as a part of risk calculation for stillbirth CAN be used as a tool to


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