Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction.
Intrauterine fetal growth restriction (IUGR) is an important pregnancy complication associated with significant adverse clinical outcome, stillbirth, perinatal morbidity and cerebral palsy. To date, no uniformly accepted management protocol of Doppler surveillance that reduces mortality and cognitive morbidity has emerged. Aortic isthmus (AoI) evaluation has been proposed as a potential monitoring tool for IUGR fetuses. In this review, the current knowledge of the relationship between AoI Doppler velocimetry and preterm fetal growth restriction is reviewed. Relevant technical aspects and reproducibility data are reviewed as we discuss AoI Doppler and its place within the existing repertoire of Doppler assessments in placental insufficiency. The AoI is a link between the right and left ventricles which perfuse the lower and upper body, respectively. The clinical use of AoI waveforms for monitoring fetal deterioration in IUGR has been limited, but preliminary work suggests that abnormal AoI impedance indices are an intermediate step between placental insufficiency-hypoxemia and cardiac decompensation. Further prospective studies correlating AoI indices with arterial and venous Doppler indices and perinatal outcome are required before encorporating this index into clinical practice.
Ultrasound and Fetal Medicine Centre, Coombe Women & Infants University Hospital, Dublin, Ireland. mkennelly@doctors.org.uk
M M
MM
Kennelly
N
N
Farah
M J
MJ
Turner
B
B
Stuart
D001011:Aorta / Q000000981:diagnostic imaging*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000592:standards*; D010927:Placental Insufficiency / Q000000981:diagnostic imaging; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards