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Comprehensive assessment of fetal wellbeing: which Doppler tests should be performed?

机译：胎儿健康的综合评估：应进行哪些多普勒检查？

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PURPOSE OF REVIEW: Doppler applications in pregnancy are expanding exponentially. Flow velocity waveforms provide important information 12 weeks to term, from maternal vessels, placental circulation and fetal systemic vessels, with implications for both mother and fetus. As applications proliferate, awareness of the complexity of fetal and placental circulations, in normal pregnancy and in sequential responses to compromise, has also grown. The necessary data are now available to establish core values in Doppler evaluation for at-risk pregnancies. RECENT FINDINGS: Uterine arteries depict maternal vascular effects of the invading placenta, predicting the frequency and severity of pre-eclampsia and intrauterine growth restriction. New evidence suggests early treatment based on this principle, significantly reduces these impacts. Umbilical artery Doppler reflects downstream placental vascular resistance, strongly correlated with intrauterine growth restriction and the multisystem effects of placental deficiency. Abnormalities are progressive, with reduction, loss, and finally a reversal of diastolic flow. When umbilical arteries become abnormal, the differentiation of fetal status requires Doppler information from systemic vessels. Middle cerebral artery changes begin when the redistribution of cardiac output reflects rising placental resistance, demonstrating 'brain sparing' when cerebrovascular dilation occurs. In the compromised intrauterine growth retarded fetus, precordial veins illustrate fetal cardiac function, changing as the respiratory status declines. This Doppler information is combined with biophysical profile scoring to determine the need for and timing of intervention. SUMMARY: Doppler evaluation of at-risk pregnancies provides crucial prognostic and diagnostic detail about placentation and fetal adaptation. What has been research detail is now becoming the standard of care, in comprehensive fetal-maternal assessment.
机译：审查目的：怀孕中的多普勒应用呈指数增长。流速波形提供了从产妇血管，胎盘循环和胎儿全身血管到足足十二周的重要信息，对母亲和胎儿都有影响。随着应用的激增，人们对胎儿和胎盘循环的复杂性，正常怀孕以及对妥协的顺序反应的认识也逐渐提高。现在有必要的数据可用于建立多普勒评估中高危妊娠的核心价值。最近的发现：子宫动脉描绘了侵袭性胎盘的母亲血管效应，预测了先兆子痫和子宫内生长受限的频率和严重程度。新证据表明，基于此原理的早期治疗可大大减少这些影响。脐动脉多普勒反应反映了下游胎盘血管阻力，与子宫内生长受限和胎盘缺乏的多系统作用密切相关。异常是渐进的，减少，丢失，最终逆转舒张血流。当脐动脉异常时，胎儿状态的分化需要来自全身血管的多普勒信息。当心输出量的重新分布反映出胎盘阻力增加时，大脑中动脉开始改变，这表明当脑血管扩张时“脑保护”。在胎儿宫内发育迟缓受损的胎儿中，心前静脉显示出胎儿的心脏功能，随着呼吸状态的下降而改变。该多普勒信息与生物物理特征评分相结合，以确定干预的必要性和时机。摘要：多普勒评估有风险的怀孕提供了有关胎盘和胎儿适应性的重要预后和诊断细节。研究细节已经成为全面的胎儿-母亲评估中的护理标准。

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