Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

Rashmi L., Ashish Bhattacharjee


Background: Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy. The aim of this study was to study the umbilical artery Doppler velocimetry in predicting the fetal outcome in high risk pregnancy. This is a prospective study done over a period of 1 year in Silchar Medical College and Hospital from 1st September 2011 to 31st August 2012. 100 women with singleton pregnancy with high risk admitted in SMCH were subjected to umbilical artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria.

Methods: 100 women with high risk pregnancy were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n = 79; 79%), the low-end diastolic flow group (n = 19; 19%) and the group with absent/reversed diastolic flow (n = 2; 2%).

Results: Mothers with abnormal velocimetry had more number of caesarean sections than those with normal velocimetry. The diagnosis to delivery interval, gestational age at delivery and average birth weight were comparatively lower with higher incidence of admission to neonatal intensive care unit in foetuses with abnormal umbilical Doppler velocimetry. Sensitivity, specificity, positive and negative predictive values of Doppler for detecting abnormal fetal outcome were 43%, 83%, 33% and 88% respectively. Statistical analysis used: sensitivity, specificity and predictive values.

Conclusions: Fetuses with normal flow velocimetry are at lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower than that of neonates with normal velocimetry. Doppler velocimetry studies of umbilical artery can provide the obstetrician important information regarding fetal wellbeing to help him improve fetal outcome. 


Doppler velocimetry, High risk pregnancy, Umbilical artery

Full Text:



Ekholm E. Hemodynamic measures in prediction of pre-eclampsia. Acta Obstetricia Et Gynecologica Scandinavica. 1997;76:101-3.

Grunewald C. Biochemical prediction of pre-eclampsia. Acta Obstet Gynecol Scand. 1997;76:104-7.

Gagnon R, Van den Hof M. Diagnostic imaging committee, executive and council of the society of Obstetricians and Gynaecologists of Canada. The use of fetal Doppler in obstetrics. J Obstet Gynaecol Can. 2003;25:601-14.

Brar HS, Platt LD. Reverse end-diastolic flow velocity on umbilical artery velocimetry in high-risk pregnancies: an ominous finding with adverse pregnancy outcome. Am J Obstet Gynecol. 1998;159:559-61.

Tyrrell S, Obaid AH, Lilfora RJ. Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth. Obstet Gynecol. 1989;74:332-7.

Fleischer A, Schulman H, Farmakides G, Bracero L, Randolph BG. Umbilical artery velocity waveforms and intrauterine growth ratardation. Am J Obstet Gynaecol. 1985;151:502-5.

Trudinger BJ, Giles WB, Cook CM, Bombardieri J Collins LE. Fetal umbilical artery flow velocity wave forms and placental resistance clinical significance. Br J Obstet Gynaecol. 1985;92:23-30.

Newnham JP, Patterson LL, James IR, Diepeveen DA, Reid SE. An evaluation of the efficacy of Doppler flow velocity waveform analysis as a screening test in pregnancy. Am J Obstet Gynecol. 1990;162(2):403-10.

Abramowicz JS, Warso SL, Sherer DM, Levy DL, Wood Value of random single Doppler study of the umbilical predicting preinatal outcome. J ultrasound Med. 1991;28:327-30.

Bohem FH, Gabbe SG. Putting it all together. Clinical Obstet Gynecol. 2002;45:1063-8.

Divon MY, Ferber A. Doppler evaluation of fetus. Cinlical Obstet Gynecol. 2002;45:1015-25.

Maulik D. Doppler ultrasound velocimetry for fetal surveillance. Clinical Obste Gynecol. 1995;38:91-11.

Rochelson B, Schulman H, Fleischer A. The clinical significance of Doppler umbilical artery velocimetry in the small for gestation fetus. Am J Obstet Gynecol. 1987;156:1223-6.

Malhotra N, Chanana C, Kumar S. Comparison of perinatal outcome of growth restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006;60:311-7.

Berkowitz GS, Chitkara U, J Rosenberg. Sonographic estimation of fetal weight and Doppler analysis of umbilical artery velocimetry in the prediction of intrauterine growth retardation: a prospective study. Am J Obstet Gynecol. 1988;158:1149-53.

Alfervic Z, Neilson JP. Doppler ultrasonography in high risk pregnancies: systemic review and meta-analysis. Am J Obstet Gynecol. 1995;172:1379-87.

Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy. Cochrane Database Syst Rev. 2000;2.

Fliesher AC, Romero R, Manning FA, Jeanty P, James AE. The principles and practice of ultrasonography in Obstetrics and Gynaecology, 5th edn. Prentice Hall; 1996.

McCowan LM, Harding JE, Stewart AW. Umbilical artery Doppler studies in small for gestational age babies reflect disease severity. Br J Obstet Gynecol 2000;107:916-25.

Trudinger BJ, Giles WB, Cook CM. Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations. Am J Obstet Gynecol. 1985;152:155-63.

Fleischer A, Schulman H, Farmakides G. Umbilical artery velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol. 1985;151:502-5

Vergani P, Anderotti C, Roncaglia N. Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 weeks gestation or beyond. Am J Obstet Gynecol. 2003;189:1007-11.

Seyam YS, Al-Mahmeid MS, Al-Tamimi HK. Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome. Int J Obstet Gynecol 2002;77:131-7.

Brodszki J, Hernandez-Andrade E, Gudmundsson S. Can the degree of retrograde diastolic flow in the abnormal umbilical artery flow velocity waveforms predict pregnancy outcome? Ultrasound Obstet Gynecol. 2002;19:229-34.

Madazli R. Prognostic factors for survival of growth-restricted fetuses with absent end-diastolic velocity in the umbilical artery. J Perinatol. 2002;22:286-90.

Yoon Bh, Lee CM, Kim SW. An abnormal umbilical artery waveform; a strong and independent predictor of adverse perinatal outcome in patients with pre eclampsia. Am J Obstet Gynaecol. 1994;171:713-21.

Soregaroli M, Bonera R, Danti L. Prognostic role of umbilical artery Doppler velocimetry in growthrestricted fetuses. J Matern Fetal Neonatal Med. 2002;11:199-203.

Baschat AA, Weiner CP. Umbilical artery Doppler screening for the detection of the small fetus in need of ante-partum surveillance. Am J Obstet Gynecol 2000;182:154-8

Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;2:CD000073.

Hecher K, Campbell S, Doyle P. Assessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation: Arterial, intracardiac and venous blood flow velocity studies. Circ. 1995;91:129-38.

Beattie RB, Dornan JC, Antenatal screening for intrauternine growth retardation with umbilical artery Dopple ultrasnography. Br Med J. 1989;298;631-5.

Anyaegbunam A, Brustman L, Langer O. A longitudinal evaluation of the efficacy of umbilical Doppler velocimetry in the diagnosis of intrauterine growth retardation. Int J Gynaecol Obstet. 1991;34:121-5.