Doppler Ultrasound of the Umbilical Artery: Clinical Application

To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives.

Methods

Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information.

Results

The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails.

Conclusion

Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.

Keywords:
doppler; placenta; umbilical artery; fetal surveillance; placental insufficiency

Gestational age (weeks)	Drukker et al.⁷²72 Drukker L, Staines-Urias E, Villar J, Barros FC, CarvalhoM, Munim S, et al. International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project. Am J Obstet Gynecol. 2020;222(06):602.e1-602.e15. Doi: 10.1016/j.ajog.2020.01.012 https://doi.org/10.1016/j.ajog.2020.01.0...	Acharya et al.⁷³73 Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol. 2005;192(03):937-944. Doi: 10.1016/j.ajog.2004.09.019 https://doi.org/10.1016/j.ajog.2004.09.0...	Ciobanu et al.⁷¹71 Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019;53(04): 465-472. Doi: 10.1002/uog.20157 https://doi.org/10.1002/uog.20157...	Srikumar et al.⁷⁵75 Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(03):232-241. Doi: 10.1016/j.mjafi.2016.12.008 https://doi.org/10.1016/j.mjafi.2016.12....	Ayoola et al.⁷⁴74 AyoolaOO, Bulus P, LotoOM, Idowu BM. Normogram of umbilical artery Doppler indices in singleton pregnancies in south-western Nigerian women. J Obstet Gynaecol Res. 2016;42(12): 1694-1698. Doi: 10.1111/jog.13114 https://doi.org/10.1111/jog.13114...	Baschat et al.⁷⁶76 Baschat AA, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol. 2003;21(02):124-127. Doi: 10.1002/uog.20 https://doi.org/10.1002/uog.20...
18				1.62	1.402
19		1.66		1.66	1.395
20		1.62	1.553	1.55	1.388	1.31
21		1.58	1.526	1.53	1.381	1.27
22		1.54	1.499	1.54	1.375	1.28
23		1.5	1.472	1.41	1.368	1.12
24	1.38	1.47	1.446	1.42	1.361	1.21
25	1.37	1.44	1.42	1.31	1.354	1.13
26	1.35	1.41	1.395	1.24	1.348	1.11
27	1.34	1.38	1.371	1.32	1.341	1.07
28	1.32	1.35	1.346	1.33	1.334	1.05
29	1.3	1.32	1.322	1.25	1.327	1.11
30	1.28	1.29	1.299	1.08	1.321	1.04
31	1.26	1.27	1.275	1.12	1.314	0.99
32	1.24	1.25	1.252	1.1	1.307	0.93
33	1.21	1.22	1.229	1.15	1.3	0.92
34	1.19	1.2	1.207	1.2	1.294	0.89
35	1.16	1.18	1.184	1.05	1.287	0.91
36	1.14	1.16	1.162	1.05	1.28	0.93
37	1.11	1.14	1.14	1	1.273	0.95
38	1.08	1.12	1.118	1.08	1.267	0.89
39	1.06	1.1	1.097	0.95	1.26	1.01
40	1.03	1.09	1.075	0.82		0.75
41		1.07	1.053

Gestational age(weeks)	Drukkeret al.⁷²72 Drukker L, Staines-Urias E, Villar J, Barros FC, CarvalhoM, Munim S, et al. International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project. Am J Obstet Gynecol. 2020;222(06):602.e1-602.e15. Doi: 10.1016/j.ajog.2020.01.012 https://doi.org/10.1016/j.ajog.2020.01.0...	Acharyaet al.⁷³73 Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol. 2005;192(03):937-944. Doi: 10.1016/j.ajog.2004.09.019 https://doi.org/10.1016/j.ajog.2004.09.0...	Srikumaret al.⁷⁵75 Srikumar S, Debnath J, Ravikumar R, Bandhu HC, Maurya VK. Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India. 2017;73(03):232-241. Doi: 10.1016/j.mjafi.2016.12.008 https://doi.org/10.1016/j.mjafi.2016.12....	Ayoolaet al.⁷⁴74 AyoolaOO, Bulus P, LotoOM, Idowu BM. Normogram of umbilical artery Doppler indices in singleton pregnancies in south-western Nigerian women. J Obstet Gynaecol Res. 2016;42(12): 1694-1698. Doi: 10.1111/jog.13114 https://doi.org/10.1111/jog.13114...
18			0.9	0.781
19		0.88	0.86	0.778
20		0.87	0.82	0.775
21		0.85	0.84	0.772
22		0.84	0.83	0.769
23		0.83	0.81	0.766
24	0.78	0.82	0.79	0.763
25	0.77	0.81	0.77	0.76
26	0.77	0.8	0.75	0.758
27	0.76	0.79	0.78	0.755
28	0.76	0.78	0.76	0.752
29	0.75	0.77	0.76	0.749
30	0.75	0.76	0.7	0.746
31	0.74	0.76	0.71	0.743
32	0.73	0.75	0.73	0.74
33	0.72	0.74	0.73	0.737
34	0.71	0.73	0.74	0.734
35	0.7	0.72	0.66	0.732
36	0.69	0.71	0.66	0.729
37	0.68	0.7	0.65	0.726
38	0.67	0.7	0.68	0.723
39	0.66	0.69	0.62	0.72
40	0.65	0.68	0.58
41		0.67

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[1] Address for correspondence
Ana Sá Rocha, MD, R. Jorge de Viterbo Ferreira, 228, 4050-313, Porto, Portugal (e-mail: rochasaana@gmail.com).