Obstetric Doppler Assessment for Placental Insufficiency

Ultrasound scanning guidelines

Umbilical Artery Doppler Umbilical Artery Doppler should be performed when: fetal biometry indicates FGR/I.U.G.R Amniotic fluid volume is reduced Maternal medical conditions related to placental insufficiency including: pre-eclampsic toxemia (PET)/pregnancy-induced hypertension (PIH) hypertension SLE and other auto-immune disorders that complicated pregnacy Maternal diabetes Growth discrepancy in twin pregnancy (significant discrepancy is a 20% difference in EFW or greater than 20mm difference in AC) Assess: Mid cord Pulse Wave spectral trace of the umbilical artery (ideally during fetal apnoea). Obtain an R.I by averaging 5 or more cycles from one trace using an auto-calculation tool, or a single cycle R.I obtained manually (depending on signal quality) Amniotic fluid volume Fetal position and presentation Documentation: Mid cord Pulse Wave spectral trace of the umbilical artery with R.I measurement Amniotic fluid volume (AFI) Presentation

Umbilical Artery Doppler

Umbilical Artery Doppler should be performed when:

Maternal diabetes
Growth discrepancy in twin pregnancy (significant discrepancy is a 20% difference in EFW or greater than 20mm difference in AC)

Assess:

Mid cord Pulse Wave spectral trace of the umbilical artery (ideally during fetal apnoea). Obtain an R.I by averaging 5 or more cycles from one trace using an auto-calculation tool, or a single cycle R.I obtained manually (depending on signal quality)
Amniotic fluid volume
Fetal position and presentation

Documentation:

Middle Cerebral Artery (MCA) Should be obtained if Umbilical Artery Doppler is equivocal or abnormal Assess: Pulse Wave spectral trace obtained in the proximal portion of the MCA. Obtain an R.I. by averaging 5 or more cycles from one trace using an auto calculation tool, or a single cycle R.I obtained manually (depending on signal quality) Documentation: Pulse Wave spectral trace of MCA with R.I. measurement

Middle Cerebral Artery (MCA)

Should be obtained if Umbilical Artery Doppler is equivocal or abnormal

Assess:

Pulse Wave spectral trace obtained in the proximal portion of the MCA. Obtain an R.I. by averaging 5 or more cycles from one trace using an auto calculation tool, or a single cycle R.I obtained manually (depending on signal quality)

Documentation:

Ductus Venosus Doppler (DV) Should be obtained if the MCA or UA are abnormal Assess: Pulse Wave spectral obtained in the distal end of the DV. A single cycle, manual measurement of the S/a ratio should be obtained Documentation Pulse Wave spectral trace of Ductus Venosus with S/a measurement

Ductus Venosus Doppler (DV)

Should be obtained if the MCA or UA are abnormal

Assess:

Pulse Wave spectral obtained in the distal end of the DV. A single cycle, manual measurement of the S/a ratio should be obtained

Documentation

AndyC	Latest page update: made by AndyC , Feb 25 2009, 6:59 AM EST (about this update About This Update Edited by AndyC view changes - complete history)
	Keyword tags: Ductus venosus MCA doppler protocols UA doppler ultrasound More Info: links to this page

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