Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
OBSTETRIC COLOUR DOPPLER
DOPPLER HISTORY
• First use of doppler
ultrasonography to study flow velocity
in fetal umbilical artery was
reported in 19...
DOPPLER WAVEFORM ANALYSIS
• Doppler ultrasound waveforms reflect blood velocity.
• Doppler waveforms however, also provide...
• The angle of insonation: the Doppler frequency increases as the
Doppler ultrasound beam becomes more aligned to the flow...
• The essential condition for the assessment of true velocity depends on the
angle between the ultrasound beam and the dir...
• 1. Systolic-to-diastolic (S/D) ratio = Peak systolic velocity/End diastolic
velocity (PSV/EDV)
• 2. Resistive index (RI)...
• These three indices provide information on vascular impedance, which is
not the same as vascular resistance.
• In fact, ...
• For example,if we assess the PI(or the RI or S/D ratio) at the level of the
MCA in fetuses appropriate for gestational a...
PULSATILE AND CONTINUOUS FLOW
• Blood flow velocity of the fetal vascular system can be either pulsatile or
continuous.
• ...
Umbilical artery and umbilical vein.
The umbilical vein has a constant velocity, whereas the umbilical artery
(UA) is puls...
NORMAL ARTERIAL WAVEFORM IN THE SAME
PATIENT
UTEROPLACENTAL CIRCULATION-ANATOMY
• The blood supply to the uterus comes mainly from the uterine
arteries, with a small c...
• Radial vessels then give rise to the basal and spiral arteries, which
nourish the myometrium and decidua during pregnanc...
VESSELS NEED TO BE EXAMINED
• Umbilical artery
• Middle cerebral artery
• Uterine artery
• Ductus venosus
• IVC
• Umbilica...
UMBILICAL ARTERY
• The umbilical artery was the first fetal vessel to be evaluated by
Doppler velocimetry.
• Placental blood is assessed by...
• UA waveforms are slightly different at the fetal abdominal wall and at the
placental insertion,with indices higher at th...
• The transducer, is placed on the mother’s abdomen overlying the
fetus and is systematically manipulated to obtain the ch...
• The middle cerebral artery is the vessel of choice to assess the fetal cerebral
circulation because it is easy to identi...
BRAIN SPARING EFFECT
• IUGR is associated with increased blood flow to the fetal brain.
This increase in blood flow during...
• The uterine arterial blood flow in non pregnant women is 50 mL per minute
and increases to over 700 ml per minute in the...
• The uterine artery waveform by the mid–second trimester is characterized by
high end diastolic velocities (EDVs) with co...
• If the end diastolic flow does not increase throughout pregnancy, or if a small
notch is detected at the beginning of di...
• The ductus venosus originates from the umbilical vein
•
• The diameter of the ductus venosus measure approximately one-
...
• The ductus venosus can be visualized in its full length in a mid-
sagittal longitudinal section of the fetal trunk.
•
• ...
• The DV waveform has a biphasic pattern characterized by two peaks: the
“S”, or peak systolic velocity (PSV), which corre...
• In AGA fetuses,there is forward flow at the DV, and the PI for veins ([S - D]/A)
decreases with advancing gestation.
• I...
• The IVC, before its entrance into the right atrium, has a triphasic pulsatile
pattern.
• The first forward wave begins t...
• In healthy fetuses, a significant decrease of the reversed flow during atrial
contraction is present with advancing gest...
FIGURE 43-22. ABNORMAL INFERIOR VENA CAVA WAVEFORM.
THESE VALUES WERE OBTAINED 48 HOURS BEFORE
INTRAUTERINE
FETAL DEMISE.
UMBILICAL VEIN
• Normal flow in the free-floating umbilical vein is monophasic.
• Fetuses with pulsation in the umbilical vein in the sec...
FIGURE 43-19. ABNORMAL UMBILICAL VEIN WAVEFORMS. A, SINGLE PULSATION. B, DOUBLE
PULSATION. WAVEFORMS OBTAINED CLOSE TO THE...
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Obstetric Colour Doppler Study
Upcoming SlideShare
Loading in …5
×

Obstetric Colour Doppler Study

1,729 views

Published on

An Approach to Obstetric Colour Doppler Study- Basic points for all sonologists.

Published in: Health & Medicine
  • Login to see the comments

Obstetric Colour Doppler Study

  1. 1. OBSTETRIC COLOUR DOPPLER
  2. 2. DOPPLER HISTORY • First use of doppler ultrasonography to study flow velocity in fetal umbilical artery was reported in 1977.
  3. 3. DOPPLER WAVEFORM ANALYSIS • Doppler ultrasound waveforms reflect blood velocity. • Doppler waveforms however, also provide information on various aspect of blood flow in circulation,including the presence and direction of flow,velocity profile and impedence to the flow.
  4. 4. • The angle of insonation: the Doppler frequency increases as the Doppler ultrasound beam becomes more aligned to the flow direction (the angle between the beam and the direction of flow becomes smaller). • • This is of the utmost importance in the use of Doppler ultrasound.
  5. 5. • The essential condition for the assessment of true velocity depends on the angle between the ultrasound beam and the direction of the blood flow, which needs to be as close as possible to 0 degrees. • As the incident angle increases ,blood velocity is progressively underestimated; therefore the angle-independent indices are used.
  6. 6. • 1. Systolic-to-diastolic (S/D) ratio = Peak systolic velocity/End diastolic velocity (PSV/EDV) • 2. Resistive index (RI) = (PSV - EDV)/PSV • 3. Pulsatility index (PI) = (PSV - EDV)/Mean velocity
  7. 7. • These three indices provide information on vascular impedance, which is not the same as vascular resistance. • In fact, impedance has a more extensive meaning than resistance, because it depends on vascular resistance,preload, heart rate, and cardiac contractility. • By calculating one of these indices and therefore estimating the vascular resistance, we can obtain information on the amount of blood flow.
  8. 8. • For example,if we assess the PI(or the RI or S/D ratio) at the level of the MCA in fetuses appropriate for gestational age (AGA) and in growth restricted fetuses at the same gestational age, the IUGR fetuses will have a lower PI value at the MCA than the AGA fetuses. • • Our interpretation is that in IUGR fetuses,there is a lower vascular resistance at the MCA than in AGA fetuses. This suggests an increased blood flow to the brain.
  9. 9. PULSATILE AND CONTINUOUS FLOW • Blood flow velocity of the fetal vascular system can be either pulsatile or continuous. • The arteries always have a pulsatile pattern, whereas the veins have either a pulsatile or a continuous pattern
  10. 10. Umbilical artery and umbilical vein. The umbilical vein has a constant velocity, whereas the umbilical artery (UA) is pulsatile because it reflects the systole and diastole of the cardiac cycle. In this case, the umbilical artery blood was directed away from the transducer and therefore arterial flow is represented below the baseline.
  11. 11. NORMAL ARTERIAL WAVEFORM IN THE SAME PATIENT
  12. 12. UTEROPLACENTAL CIRCULATION-ANATOMY • The blood supply to the uterus comes mainly from the uterine arteries, with a small contribution from the ovarian arteries. • • These vessels give rise to arcuate arteries that run circumferentially round the uterus. • The radial arteries arise from the arcuate vessels and penetrate into the outer third of the myometrium.
  13. 13. • Radial vessels then give rise to the basal and spiral arteries, which nourish the myometrium and decidua during pregnancy. • • Spiral arteries are responsible for 10-12 fold increase in blood flow during pregnancy.
  14. 14. VESSELS NEED TO BE EXAMINED • Umbilical artery • Middle cerebral artery • Uterine artery • Ductus venosus • IVC • Umbilical vein
  15. 15. UMBILICAL ARTERY
  16. 16. • The umbilical artery was the first fetal vessel to be evaluated by Doppler velocimetry. • Placental blood is assessed by studying the umbilical artery. • Flow velocity waveforms from the umbilical cord have a characteristic saw-tooth appearance of arterial flow in one direction and continuous umbilical venous blood flow in the other.
  17. 17. • UA waveforms are slightly different at the fetal abdominal wall and at the placental insertion,with indices higher at the wall than the insertion. • However, the difference is minimal, so it is not important to obtain the waveforms always at the same level.
  18. 18. • The transducer, is placed on the mother’s abdomen overlying the fetus and is systematically manipulated to obtain the characteristic waveforms from the umbilical artery. • In practice, the UA is best examined in a segment of free floating umbilical cord.
  19. 19. • The middle cerebral artery is the vessel of choice to assess the fetal cerebral circulation because it is easy to identify, is highly reproducible, and provides information on the brain-sparing effect. • MCA can be studied easily with an angle of 0 degrees between the ultrasound beam and the direction of blood flow providing information on the true velocity of the blood flow. • • The MCA should be sampled soon after its origin from the ICA.
  20. 20. BRAIN SPARING EFFECT • IUGR is associated with increased blood flow to the fetal brain. This increase in blood flow during diastole can be demonstrated by Doppler ultrasound of the MCA. • This effect is termed the brain-sparing effect and is demonstrated by a lower value of the MCA PI .
  21. 21. • The uterine arterial blood flow in non pregnant women is 50 mL per minute and increases to over 700 ml per minute in the third trimester of pregnancy. • Each uterine artery should be sampled soon after the crossing of the iliac vessels. •
  22. 22. • The uterine artery waveform by the mid–second trimester is characterized by high end diastolic velocities (EDVs) with continuous forward blood flow throughout diastole. • With advancing gestation,the degree of end diastolic flow typically increases. • Thus the diastolic component of uterine artery Doppler waveform is transformed during normal pregnancy from one of low peak flow velocity and an early diastolic notch, to one of high flow velocity and an early diastolic notch.
  23. 23. • If the end diastolic flow does not increase throughout pregnancy, or if a small notch is detected at the beginning of diastole, the fetus is at high risk for developing IUGR. • Diastolic blood flow may be absent or even reversed with extreme degrees of placental dysfunction.
  24. 24. • The ductus venosus originates from the umbilical vein • • The diameter of the ductus venosus measure approximately one- third of that of the umbilical vein. • • It courses posteriorly and in a cephalad direction, with increasing steepness in the same sagittal plane as the original direction of the umbilical vein,and enters the inferior vena cava just below the diaphragm.
  25. 25. • The ductus venosus can be visualized in its full length in a mid- sagittal longitudinal section of the fetal trunk. • • In an oblique transverse section through the upper abdomen, its origin from the umbilical vein can be found where color Doppler indicates high velocities compared to the umbilical vein. • The blood flow velocity accelerates due to the narrow lumen of the ductus venosus, the maximum inner width of the narrowest portion being 2 mm
  26. 26. • The DV waveform has a biphasic pattern characterized by two peaks: the “S”, or peak systolic velocity (PSV), which corresponds to the highest velocity of the blood in systole. • It is followed by a period of decreased velocity called isovolumetric relaxation (IRV); and the “D”, which corresponds to the rapid filling of the ventricles that is followed by the “A wave,” which corresponds to atrial contraction.
  27. 27. • In AGA fetuses,there is forward flow at the DV, and the PI for veins ([S - D]/A) decreases with advancing gestation. • In growth-restricted fetuses, the PI increases in the DV, and in the most severe cases, there is A wave of reversed flow.
  28. 28. • The IVC, before its entrance into the right atrium, has a triphasic pulsatile pattern. • The first forward wave begins to increase with atrial relaxation,reaches a peak during ventricular systole, and then falls at the end of ventricular systole. • The second forward wave occurs during early diastole, and the third wave, characterized by reversed flow, is present in late diastole with atrial contraction.
  29. 29. • In healthy fetuses, a significant decrease of the reversed flow during atrial contraction is present with advancing gestation. • In IUGR fetuses the IVC is characterized by an increase in reversed flow during atrial contraction.
  30. 30. FIGURE 43-22. ABNORMAL INFERIOR VENA CAVA WAVEFORM. THESE VALUES WERE OBTAINED 48 HOURS BEFORE INTRAUTERINE FETAL DEMISE.
  31. 31. UMBILICAL VEIN
  32. 32. • Normal flow in the free-floating umbilical vein is monophasic. • Fetuses with pulsation in the umbilical vein in the second and third trimesters have a higher morbidity and mortality, even in the setting of normal UA blood flow.
  33. 33. FIGURE 43-19. ABNORMAL UMBILICAL VEIN WAVEFORMS. A, SINGLE PULSATION. B, DOUBLE PULSATION. WAVEFORMS OBTAINED CLOSE TO THE ORIGIN OF THE DUCTUS VENOSUS 48 HOURS BEFORE FETAL DEMISE. C, DOUBLE PULSATION; SAME CASE AS B. WAVEFORMS OBTAINED BETWEEN THE ORIGIN OF THE DUCTUS VENOSUS AND THE UMBILICUS. D, REVERSED FLOW. FETUS DIED WITHIN 24 HOURS OF THIS FINDING.

×