This document discusses intrauterine growth restriction, fetal doppler, and macrosomia. It defines these conditions and outlines their causes, diagnostic techniques like doppler ultrasonography, and implications. Doppler uses ultrasound to measure blood flow and has been used since 1977 to study umbilical artery flow velocity. It is useful for assessing fetal well-being and risk of complications like neonatal intensive care unit admissions or brain injuries. The document also details ultrasound findings and considerations for at-risk growth-restricted or large fetuses.

1. MAGDY ABDELRAHMAN MOHAMED
Lecturer of OB/GYN
2015

2. Intrauterine growth restriction.
Fetal doppler.
Macrosomia.

4.  Fetal weight below 10th percentile for
gestational age.
 Incidence: 3-5%.
 1st suspicion due to decrease fundal level
below expected from gestational age.

5. Types:
 Symetrical.
Asymetrical.

6. Etiology:
 Fetal.
Maternal.
 Placental.

7.  Fetal doppler.
 BPP.
 NST & contraction stress test.
WHY
Take decision of termination at proper time.

9.  The Doppler effect was first described by
Christian Johann Doppler (1803–1853).
 First use of Doppler ultrasonography to study
flow velocity in the fetal umbilical artery
was reported in 1977.

10.  Echoes from stationary tissues are the same
from pulse to pulse.
 Echoes from moving objects exhibit slight
differences in the time for the signal to be
returned to the receiver.

11. pulse repetition frequency
(T2 –T1) phase shift with known beam / flow angle
can calculate flow velocity .
T1
T2

12. the angle q between the beam and the
direction of flow becomes smaller.
q
The angle of insonation
Flow velocity
Factors affecting doppler frequency

15. Umbilical artery.
Uterine artery.
Middle cerebral artery.

17. Benefit of Umbilical Artery Evaluation
Less experienced operators can achieve
highly reproducible results with simple,
inexpensive continuous-wave equipment .

18. With advancing gestation,
umbilical arterial Doppler
waveforms demonstrate a
progressive rise in the
end-diastolic velocity and
a decrease in the
pulsatility index.
Umbilical artery

19. S/D ratio:
2-3 in 2nd & 3rd trimester
PI :
1.5 – 2.0 in 2nd trimester
1.0 – 1.5 in 3rd trimester
RI:
Decreases with gest. In
late 2nd and 3rd it is around
0.5

20.  Risk to Neonate
 More admissions to NICU
 Increase ICH
 Increase Anemia
 Increase Hypoglycemia
 Increase long term permanent neurological damage
High Resistance
Reversal of Diastole

21.  Cordocentesis was carried out in 39 IUGR fetuses
80% Hypoxic
46% Acidemic
Absent / Reverse
Diastolic Flow
12% Hypoxic
00% Acidemic
Positive Diastolic
Flow

22. Umbilical artery 90% more sensitive
than CTG.
Interval between absence of end
diastolic flow & onset of late
deceleration was 3-12 days.

24. REFLECTS : TROPHOBLASTIC INVASION
END POINTS :
 ELEVATED RESISTIVE INDICES (> 2 SD).
 PERSISTENT DIASTOLIC NOTCHING.

26. UTERINE ARTERY
Normal
impedance to
flow the uterine
arteries in 1st
trimester.
Normal
impedance to
flow the uterine
arteries in early
2nd trimester.
Normal
impedance to
flow the uterine
arteries in late
2nd and 3rd

27. Normal uterine artery Doppler Abnormal uterine artery Doppler
Abnormal Uterine Artery
Doppler Velocimetry

29. Peak systolic velocity can be used in
diagnosis of fetal anemia.

31. Def:
 Fetal weight more than 90th
percentile.
 > 4000 gm.

32. Risk factor:
 Diabetes.
 obesity.
 High parity.
 Prolonged pregnancy.
 Previous history of macrosomia.
 Excessive weight gain during pregnancy.

33. Diagnosis:
Estimated fetal weight.
AC > 90th percentile.
Increased S.C. fat thickness.