OBJECTIVES: Our objectives were two-fold: 1) to determine the frequency of discordant umbilical artery Doppler systolic to diastolic (S/D) ratios in the individual umbilical arteries of growth-restricted fetuses and 2) to examine the impact of the frequency of discordance on clinical outcomes. METHODS: This was a prospective, observational study of growth-restricted fetuses. Doppler velocimetry was performed weekly and two S/D ratios were obtained for each fetal umbilical artery. Inter-artery discordance was defined as a difference in measurement categories (i.e., normal, elevated, absent, reversed) between the arteries. The number of abnormal measurements per visit was summed to 0-4 out of 4 values. A composite average number of abnormal Doppler measurements was calculated and fetuses were stratified based on degree of average number of abnormalities in increments of 25%: 0-<25%, 25-<50%, 50-<75%, and 75-100% abnormality. RESULTS: Of a total 241 fetuses (1762 visits), 110 (45.6%) had abnormal UAD flow and 189 (66%) demonstrated discordance. Abnormal values were noted in only one artery in 53% (n=151) of visits. Fetuses with any abnormal Doppler testing had smaller birthweights compared to fetuses with consistently normal testing (2485g vs 2623g, p <0.01); birthweight decreased as composite average of abnormal measurements increased (p = 0.03). CONCLUSION: The majority (66%) of fetuses with abnormal testing demonstrated UAD discordance. Up to 53% of fetuses could have been misdiagnosed if only one artery was tested. Fetuses with a higher frequency of Doppler abnormalities had lower birthweights. We propose obtaining two measurements from each umbilical artery in growth-restricted fetuses.
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1. American College of Obstetricians and Gynecologists. ACOG practice bulletin 134: Fetal growth restriction. Obstet Gynecol. 2013;121(5):1122-1133.
2. Society for Maternal-Fetal Medicine Publications Committee Berkley E Chauhan SP Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012;206(4):300-308.
3. Baschat AA. Doppler application in the delivery timing of the preterm growth-restricted fetus: Another step in the right direction. Ultrasound Obstet Gynecol. 2004;23(2):111-118. doi:
3. Baschat AA. Doppler application in the delivery timing of the preterm growth-restricted fetus: Another step in the right direction. Ultrasound Obstet Gynecol. 2004;23(2):111-118. doi: 10.1002/uog.989 [doi].)| false
4. Baschat AA, Weiner CP. Umbilical artery doppler screening for detection of the small fetus in need of antepartum surveillance. Am J Obstet Gynecol. 2000;182(1 Pt 1):154-158. doi: S000293780068225X [pii].)| false
11. Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol. 1985;151(3):333-337. doi: 0002-9378(85)90298-4 [pii].)| false
12. American Institute of Ultrasound in Medicine. AIUM practice parameter for the performance of Fetal echocardiography . 2013:2/14/2018.
13. Forouzan I Cohen AW Arger P. Measurement of systolic-diastolic ratio in the umbilical artery by continuous-wave and pulsed-wave doppler ultrasound: Comparison at different sites. Obstet Gynecol. 1991;77(2):209-212.
14. Mari G. Doppler ultrasonography in obstetrics: From the diagnosis of fetal anemia to the treatment of intrauterine growth-restricted fetuses. Am J Obstet Gynecol. 2009;200(6):613.e1-613.e9. doi:
14. Mari G. Doppler ultrasonography in obstetrics: From the diagnosis of fetal anemia to the treatment of intrauterine growth-restricted fetuses. Am J Obstet Gynecol. 2009;200(6):613.e1-613.e9. doi: 10.1016/j.ajog.2008.10.054 [doi].)| false
15. 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(3):937-944. doi:
15. 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(3):937-944. doi: S0002937804010373 [pii].)| false
16. Maggio L Dahlke JD Mendez-Figueroa H Albright CM Chauhan SP Wenstrom KD. Perinatal outcomes with normal compared with elevated umbilical artery systolic-to-diastolic ratios in fetal growth restriction. Obstet Gyencol. 2015;125(4):863-69.
17. Raio L Ghezzi F di Naro E et al. In-utero characterization of the blood flow in the hyrtl anastomosis. Placenta. 2001;22(6):597-601. doi: