title: Progression of Doppler changes in early-onset small for gestational age fetuses. How frequent are the different progression sequences?
abstract: OBJECTIVE
  To evaluate the progression of Doppler abnormalities in early-onset fetal smallness (SGA).
  
  
  METHODS
  A total of 948 Doppler examinations of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV), belonging to 405 early-onset SGA fetuses, were studied, evaluating the sequences of Doppler progression, the interval examination-labor at which Doppler became abnormal and the cumulative sum of Doppler anomalies in relation with labor proximity.
  
  
  RESULTS
  The most frequent sequences were that in which only the UA pulsatility index (PI) became abnormal (42.1%) and that in which an abnormal UA PI appeared first, followed by an abnormal MCA PI (24.2%). In general, 71.3% of the fetuses followed the classical progression sequence UA→MCA→DV, mostly in the early stages of growth restriction (84.1%). In addition, the UA PI was the first parameter to be affected (9 weeks before delivery), followed by the MCA PI and the DV PIV (1 and 0 weeks). Finally, the UA PI began to sum anomalies 5 weeks before delivery, while the MCA and DV did it at 3 and 1 weeks before the pregnancy ended.
  
  
  CONCLUSIONS
  In early-onset SGA fetuses, Doppler progression tends to follow a predictable order, with sequential changes in the umbilical, cerebral and DV impedances.
authors.affiliation: a Servicio de Obstetricia , Hospital Universitario y Politécnico La Fe , Valencia , Spain.
authors.forename: José
authors.initials: J
authors.lastname: Morales-Roselló
authors.affiliation: b Fetal Medicine Unit , St George's Hospital , London , UK.
authors.forename: Asma
authors.initials: A
authors.lastname: Khalil
authors.affiliation: c Unidad de bioestadística , Instituto de Investigación Sanitaria La Fe , Valencia , Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Fornés-Ferrer
authors.affiliation: d Grupo Bioelectrónica (I3BH) , Universidad Politécnica , Valencia , Spain.
authors.forename: José
authors.initials: J
authors.lastname: Alberola-Rubio
authors.affiliation: c Unidad de bioestadística , Instituto de Investigación Sanitaria La Fe , Valencia , Spain.
authors.forename: David
authors.initials: D
authors.lastname: Hervas-Marín
authors.affiliation: e Servicio de Epidemiología , Hospital Universitario y Politécnico La Fe , Valencia , Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Peralta Llorens
authors.affiliation: e Servicio de Epidemiología , Hospital Universitario y Politécnico La Fe , Valencia , Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Perales-Marín
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
keywords: Early-onset fetal growth restriction; ductus venosus; fetal hemodynamics; fetal middle cerebral artery; small-for-gestational-age; umbilical artery