12. MCA
Does not predict more than umb A alone
-ve predictive value
Worsening of hypoxia – normalisation of
previously abn MCA doppler
MCA – PSV remains abnormal as fetus
decompensates
15. VENOUS DOPPLER
Reversed ‘a’ wave backflow in venous
circulation leads to pulsations in umbilical vein &
reversed flow in IVC - foetal right heart faliure.
Associated with metabolic acidosis
Venous doppler evaluation most beneficial in
early onset IUGR
16. DOPPLER INDICES < PNM
Doppler
Parameter
Increased UA resistance
Absent UA EDF
Decreased MCA
Reversed UA EDF
IAUV Pulsations
Abnormal DV a-wave
Perinatal
Mortality
5.6%
11-13%
21%
20-24%
35%
30-38%
17. ANTEPARTUM SURVEILLANCE EARLY
N umblical
art
Uterine art.
notching Elevated
doppler
index
Brain
sparing
N MCA
N DV
N UV
DOPP
LER
FHR –delayed maturation
AFV – no changes
BPS – delayed maturation of
18. ANTEPARTUM SURVEILLANCE LATE
Umb art.
AREDF
DV elevated
index
Loss of
variability
Umb V- pulsatile
flow
Absent/rever
sed a wave
Late
deceleratio
n
oligohydram
nios
anhydramni
os
Declining
activity
Loss of tone
Loss of
movement
Loss of
breathing
DOPP
LER
AFV
FHR
BP
S
19. MANAGEMENT
Rest stress, quit smoking
Low dose aspirin
Antenatal corticosteroids – word of
caution
Doppler waveform abn precede abn in
BPP & NST by several weeks
22. GRIT TRIAL
500 Women
• Randomized
• A / R EDF in UA
• Immediate Vs Delayed Delivery
Outcome
• No difference in perinatal
mortality
• At 2 years no difference in
neurological outcome > 31
wks
23. GRIT TRIAL
< 31 wks immediate
delivery in disability(14%
vs 5 %)
GA is the greatest
determinant of intact
survival
Awaiting TRUFFLE study
results
24. ALGORITHM
DECREASED EDF
NST Bi weekly
BPP weekly
UA doppler weekly
Fetal growth every 3 weeks
AREDF
Hospitalisation
Frequent / continuous fetal monitoring
Steroids
MCA doppler weekly
DV doppler every 3-4 days
BPP daily
FGR > 24 wks
UMBLICAL
ART DOPPLER
25. MODE OF DELIVERY
UA EDF normal OCT
successful induction of
labour
A / RED EDF ----- LSCS
