venous Doppler in fetal disease

2.  Doppler assessment of fetal arteries provides
information on regional blood and giving insights
into the fetal circulatory state in health and
disease.
 Evaluation of cardiovascular status by arterial
Doppler alone is inadequate in fetal disorders with
impaired cardiac function .

3.  Extending Doppler ultrasound assessment to the
fetal venous circulation overcomes some of
these limitations.

5.  Ductus Venosus
 Umbilical vein
 Inferior vena cava

6.  Anatomy
From umbilical vein 1/3 diameter of UV, enters
IVC just below the diaphragm

7.  Sagittal plane of the trunk
 Transverse plane of the upper abdomen with
aliasing of color Doppler

8.  The ductus venosus flow : continuous forward
flow throughout the cardiac cycle
 ventricular systole (S wave)
 ventricular diastole (D wave).
 a reduction in velocity during atrial systole (A
wave)

10.  1- 1st trimester screening for chromosomal
and cardiac anomaly
 2- Grading and management of IUGR
fetuses

11.  FMF guidelines

12.  Reversed a-wave
› At 11-13 weeks reversed a-wave is found in
about:
› Euploid fetuses 3%
› Fetuses with trisomy 21 65%
› Fetuses with trisomy 18 55%
› Fetuses with trisomy 13 55%

13.  The risk of fetal death is increased if:
› The maternal serum PAPP-A is low
› The mother is Black
› The mother is obese
 If the ductus venosus a-wave is reversed
› Monitor fetal growth (scan at 20 and 28 wks)
› Monitor uterine artery PI

14.  Absence or reversal of (A wave) indicates
failure of circulatory compensation to supply
well- oxygenated blood to vital organs.
 identifies fetuses that are at the highest risk of
adverse outcomes at least 1 week before
delivery.


15.  Progressive decrease of the ductus venosus
Doppler index is associated with a high
stillbirth rate.

19.  Ductus venosus
 Umbilical vein
 Inferior vena cava

21. • Umbilical vein pulsations with moderate to severe
notches synchronous with atrial contraction is an
ominous sign in.
* twin-twin transfusion syndrome
* severe IUGR in fetuses with absent-end diastolic
flow in the umbilical arteries
* abnormal fetal heart rates
• Umbilical vein pulsations considered a consequence
of ductus venosus reversed flow.

23. Pulsatile blood flow in the umbilical vein is
considered the dominant factor determining the
interval between the first occurrence of absent end-
diastolic velocities in the umbilical artery (late
Doppler abnormalities) and the development of late
heart rate decelerations and delivery.

24.  Ductus venosus
 Umbilical vein
 Inferior vena cava

26.  Fetal oxygenation depends on blood returning
from the placenta to the fetal heart via the
inferior vena cava
 In compromised fetuses, there will be
a decrease in forward flow during the S and D
waves and accentuated reversed flow in the A
wave.

28.  Ductus venosus
 Umbilical vein
 Inferior vena cava

30.  The decision to deliver
a preterm IUGR fetus
remains one of the great
challenges in obstetrics.

31.  in clinical practice, it is difficult to accurately
estimate the duration of fetal compromise.
 Venous Doppler abnormalities may persist
for a variable period in the preterm IUGR.

32. When To Deliver

33.  Abnormal UA, MCA Doppler →
DV ,IVC, UV Doppler
 Normal venous Doppler wait and repeat
 Abnormal venous Doppler → biophysical
profile score and GA
 Extreme preterm with normal BPP → daily
evaluation
 Abnormal BPP → delivery

34. Thank you