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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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Review Article

Fetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column

Author(s): De Almeida Ana Beatriz*, Morais Ana Rita, Ferreira Miguel, Gaio Ana Rita and Guedes-Martins Luís

Volume 20, Issue 1, 2024

Published on: 10 October, 2023

Article ID: e101023222022 Pages: 14

DOI: 10.2174/011573403X255256230919061018

Price: $65

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Abstract

Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the “aortoumbilical column”. Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.

Keywords: Cardiovascular system, doppler ultrasound, fetal descending aorta, umbilical artery, flow velocity waveform, aortoumbilical column.

Graphical Abstract

[1]
Künzel W, Jovanovic V. Grüβner S, Colling T. Blood flow velocity in the fetal abdominal aorta and in the umbilical artery in uncomplicated pregnancies. Eur J Obstet Gynecol Reprod Biol 1992; 47(1): 31-40.
[http://dx.doi.org/10.1016/0028-2243(92)90211-G] [PMID: 1426509]
[2]
Ursem NTC, Clark EB, Keller BB, Hop WCJ, Wladimiroff JW. Assessment of fetal heart rate variability and velocity variability by Doppler velocimetry of the descending aorta at 10-20 weeks of gestation. Ultrasound Obstet Gynecol 1999; 14(6): 397-401.
[http://dx.doi.org/10.1046/j.1469-0705.1999.14060397.x] [PMID: 10658278]
[3]
Bilardo CM, Campbell S, Nicolaides KH. Mean blood velocities and flow impedance in the fetal descending thoracic aorta and common carotid artery in normal pregnancy. Early Hum Dev 1988; 18(2-3): 213-21.
[http://dx.doi.org/10.1016/0378-3782(88)90058-8] [PMID: 3224584]
[4]
Huisman TWA, Stewart PA, Wladimiroff JW. Doppler assessment of the normal early fetal circulation. Ultrasound Obstet Gynecol 1992; 2(4): 300-5.
[http://dx.doi.org/10.1046/j.1469-0705.1992.02040300.x] [PMID: 12796960]
[5]
Griffin D, Bilardo K, Masini L, et al. Doppler blood flow waveforms in the descending thoracic aorta of the human fetus. BJOG 1984; 91(10): 997-1006.
[http://dx.doi.org/10.1111/j.1471-0528.1984.tb03678.x] [PMID: 6386040]
[6]
Guedes-Martins L, Cunha A, Saraiva J, et al. Foetal aortic flow velocity waveforms in healthy and hypertensive pregnant women. Cardiovasc Ultrasound 2014; 12(1): 1-9.
[http://dx.doi.org/10.1186/1476-7120-12-1] [PMID: 24468128]
[7]
Acharya G, Gui Y, Cnota W, Huhta J, Wloch A. Human embryonic cardiovascular function. Acta Obstet Gynecol Scand 2016; 95(6): 621-8.
[http://dx.doi.org/10.1111/aogs.12860] [PMID: 26830850]
[8]
Dangel J. Changing physiology in the first- to third-trimester foetal circulation. Cardiol Young 2014; 24(S2): 13-8.
[http://dx.doi.org/10.1017/S1047951114001395] [PMID: 25303047]
[9]
Ribatti D, Nico B, Crivellato E. The development of the vascular system: A historical overview. Methods Mol Biol 2015; 1214: 1-14.
[http://dx.doi.org/10.1007/978-1-4939-1462-3_1] [PMID: 25468595]
[10]
Jones EAV. The initiation of blood flow and flow induced events in early vascular development. Semin Cell Dev Biol 2011; 22(9): 1028-35.
[http://dx.doi.org/10.1016/j.semcdb.2011.09.020] [PMID: 22001248]
[11]
Blum Y, Belting HG, Ellertsdottir E, Herwig L, Lüders F, Affolter M. Complex cell rearrangements during intersegmental vessel sprouting and vessel fusion in the zebrafish embryo. Dev Biol 2008; 316(2): 312-22.
[http://dx.doi.org/10.1016/j.ydbio.2008.01.038] [PMID: 18342303]
[12]
Sato Y. Dorsal aorta formation: Separate origins, lateral-to-medial migration, and remodeling. Dev Growth Differ 2013; 55(1): 113-29.
[http://dx.doi.org/10.1111/dgd.12010] [PMID: 23294360]
[13]
Sadler TW. Langman’s Medical Embriology. (13th ed.), Rio de Janeiro: Guanabara Koogan 2015.
[14]
Murillo H, Lane MJ, Punn R, Fleischmann D, Restrepo CS. Imaging of the aorta: Embryology and anatomy. Semin Ultrasound CT MR 2012; 33(3): 169-90.
[http://dx.doi.org/10.1053/j.sult.2012.01.013] [PMID: 22624964]
[15]
Moore KL, Persaud TV. The Developing Human: Clinically Oriented Embryology. (8th ed.), Philadelphia: WB Saunders 2012.
[16]
Mäkikallio K, Tekay A, Jouppila P. Yolk sac and umbilicoplacental hemodynamics during early human embryonic development. Ultrasound Obstet Gynecol 1999; 14(3): 175-9.
[http://dx.doi.org/10.1046/j.1469-0705.1999.14030175.x] [PMID: 10550876]
[17]
Linask KK, Han M, Bravo-Valenzuela NJM. Changes in vitelline and utero-placental hemodynamics: Implications for cardiovascular development. Front Physiol 2014; 5(390): 390.
[http://dx.doi.org/10.3389/fphys.2014.00390] [PMID: 25426076]
[18]
Persutte WH, Hobbins J. Single umbilical artery: A clinical enigma in modern prenatal diagnosis. Ultrasound Obstet Gynecol 1995; 6(3): 216-29.
[http://dx.doi.org/10.1046/j.1469-0705.1995.06030216.x] [PMID: 8521073]
[19]
Hegazy AA. Anatomy and embryology of umbilicus in newborns: A review and clinical correlations. Front Med 2016; 10(3): 271-7.
[http://dx.doi.org/10.1007/s11684-016-0457-8] [PMID: 27473223]
[20]
Lemke C, Biedermann U. A persistent vitelline artery in an adult Case report and review of literature. Translational Research in Anatomy 2021; 1-7.
[21]
Monie IW. Genesis of single umbilical artery. Am J Obstet Gynecol 1970; 108(3): 400-5.
[http://dx.doi.org/10.1016/0002-9378(70)90422-9] [PMID: 5530183]
[22]
Thornburg K, Louey S. Uteroplacental circulation and fetal vascular function and development. Curr Vasc Pharmacol 2013; 11(5): 748-57.
[http://dx.doi.org/10.2174/1570161111311050012] [PMID: 24063386]
[23]
Heil J, Bordoni B. Embryology, umbilical cord. Treasure Island, FL: StatPearls Publishing 2021.
[24]
Baschat AA. The fetal circulation and essential organs—a new twist to an old tale. Ultrasound Obstet Gynecol 2006; 27(4): 349-54.
[http://dx.doi.org/10.1002/uog.2762] [PMID: 16565990]
[25]
Kiserud T, Acharya G. The fetal circulation. Prenat Diagn 2004; 24(13): 1049-59.
[http://dx.doi.org/10.1002/pd.1062] [PMID: 15614842]
[26]
Morton SU, Brodsky D. Fetal physiology and the transition to extrauterine life. Clin Perinatol 2016; 43(3): 395-407.
[http://dx.doi.org/10.1016/j.clp.2016.04.001] [PMID: 27524443]
[27]
Burton GJ, Charnock-Jones DS, Jauniaux E. Regulation of vascular growth and function in the human placenta. Reproduction 2009; 138(6): 895-902.
[http://dx.doi.org/10.1530/REP-09-0092] [PMID: 19470597]
[28]
Anderson DF, Faber JJ. Regulation of fetal placental blood flow in the lamb. Am J Physiol 1984; 247(3 Pt 2): R567-74.
[PMID: 6433727]
[29]
Charnock-Jones DS. Soluble flt-1 and the angiopoietins in the development and regulation of placental vasculature. J Anat 2002; 200(6): 607-15.
[http://dx.doi.org/10.1046/j.1469-7580.2002.00063.x] [PMID: 12162728]
[30]
Degner K, Magness RR, Shah DM. Establishment of the human uteroplacental circulation: A historical perspective. Reprod Sci 2017; 24(5): 753-61.
[http://dx.doi.org/10.1177/1933719116669056] [PMID: 27733657]
[31]
Acharya G, Sonesson SE, Flo K, Räsänen J, Odibo A. Hemodynamic aspects of normal human feto-placental (umbilical) circulation. Acta Obstet Gynecol Scand 2016; 95(6): 672-82.
[http://dx.doi.org/10.1111/aogs.12919] [PMID: 27130575]
[32]
Brezinka C. Fetal hemodynamics. J Perinat Med 2001; 29(5): 371-80.
[http://dx.doi.org/10.1515/JPM.2001.053] [PMID: 11723838]
[33]
Kilavuz Ö, Vetter K, Kiserud T, Vetter P. The left portal vein is the watershed of the fetal venous system. J Perinat Med 2003; 31(2): 184-7.
[http://dx.doi.org/10.1515/JPM.2003.025] [PMID: 12747236]
[34]
Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999; 84(2): 139-47.
[http://dx.doi.org/10.1016/S0301-2115(98)00323-6] [PMID: 10428337]
[35]
Haugen G, Kiserud T, Godfrey K, Crozier S, Hanson M. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol 2004; 24(6): 599-605.
[http://dx.doi.org/10.1002/uog.1744] [PMID: 15517551]
[36]
Teshome MK, Najib K, Nwagbara CC, Akinseye OA, Ibebuogu UN. Patent foramen ovale: A comprehensive review. Curr Probl Cardiol 2020; 45(2): 100392.
[http://dx.doi.org/10.1016/j.cpcardiol.2018.08.004] [PMID: 30327131]
[37]
Finnemore A, Groves A. Physiology of the fetal and transitional circulation. Semin Fetal Neonatal Med 2015; 20(4): 210-6.
[http://dx.doi.org/10.1016/j.siny.2015.04.003] [PMID: 25921445]
[38]
Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC. Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 1996; 94(5): 1068-73.
[http://dx.doi.org/10.1161/01.CIR.94.5.1068] [PMID: 8790048]
[39]
Fouron JC. The unrecognized physiological and clinical significance of the fetal aortic isthmus. Ultrasound Obstet Gynecol 2003; 22(5): 441-7.
[http://dx.doi.org/10.1002/uog.911] [PMID: 14618654]
[40]
Chang CP, Wang HI, Wang PH, et al. Umbilical artery Doppler velocimetry in normal pregnancies from 11+0 to 13+6 gestational weeks: A Taiwanese study. Taiwan J Obstet Gynecol 2014; 53(2): 193-6.
[http://dx.doi.org/10.1016/j.tjog.2014.04.012] [PMID: 25017265]
[41]
Griffin D, Teague M. Blood flow in obstetrics using Doppler ultrasound David Griffin. J Med Eng Technol 1988; 12(3): 97-105.
[http://dx.doi.org/10.3109/03091908809030164] [PMID: 3050103]
[42]
Kennedy AM, Woodward PJ. A radiologist’s guide to the performance and interpretation of obstetric doppler US. Radiographics 2019; 39(3): 893-910.
[http://dx.doi.org/10.1148/rg.2019180152] [PMID: 31059392]
[43]
van Vugt JMG, Ruissen CJ, Hoogland HJ, de Haan J. Prospective study of velocity waveforms in the fetal descending thoracic and abdominal aorta in fetuses appropriate for gestational age and in growth-retarded fetuses. Gynecol Obstet Invest 1987; 24(1): 14-22.
[http://dx.doi.org/10.1159/000298769] [PMID: 3623259]
[44]
Arduini D, Rizzo G. Umbilical artery velocity waveforms in early pregnancy: A transvaginal color Doppler study. J Clin Ultrasound 1991; 19(6): 335-9.
[http://dx.doi.org/10.1002/jcu.1870190603] [PMID: 1658052]
[45]
Fitzgerald DE, Stuart B, Drumm JE, Duignan NM. The assessment of the feto-placental circulation with continuous wave doppler ultrasound. Ultrasound Med Biol 1984; 10(3): 371-6.
[http://dx.doi.org/10.1016/0301-5629(84)90171-6] [PMID: 6464222]
[46]
Jouppila P, Kirkinen P. Noninvasive assessment of fetal aortic blood flow in normal and abnormal pregnancies. Clin Obstet Gynecol 1989; 32(4): 703-9.
[http://dx.doi.org/10.1097/00003081-198912000-00011] [PMID: 2692906]
[47]
Acharya G, Wilsgaard T, Berntsen GKR, 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): 937-44.
[http://dx.doi.org/10.1016/j.ajog.2004.09.019] [PMID: 15746695]
[48]
Gudmundsson S, Flo K, Ghosh G, Wilsgaard T, Acharya G. Placental pulsatility index: A new, more sensitive parameter for predicting adverse outcome in pregnancies suspected of fetal growth restriction. Acta Obstet Gynecol Scand 2017; 96(2): 216-22.
[http://dx.doi.org/10.1111/aogs.13060] [PMID: 27858967]
[49]
Almström H, Ekman G, Axelsson O, et al. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet 1992; 340(8825): 936-40.
[http://dx.doi.org/10.1016/0140-6736(92)92818-Z] [PMID: 1357349]
[50]
Thompson RS, Trudinger BJ, Cook CM. A comparison of Doppler ultrasound waveform indices in the umbilical artery—I. Indices derived from the maximum velocity waveform. Ultrasound Med Biol 1986; 12(11): 835-44.
[http://dx.doi.org/10.1016/0301-5629(86)90001-3] [PMID: 2949412]
[51]
Guidelines ISUOG. ISUOG Practice Guidelines: Use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013; 41(2): 233-9.
[http://dx.doi.org/10.1002/uog.12371] [PMID: 23371348]
[52]
Moon AE. Using S/D ratios to predict fetal outcome. J Diagn Med Sonogr 1999; 15(2): 59-64.
[http://dx.doi.org/10.1177/875647939901500201]
[53]
Adamson SL. Arterial pressure, vascular input impedance, and resistance as determinants of pulsatile blood flow in the umbilical artery. Eur J Obstet Gynecol Reprod Biol 1999; 84(2): 119-25.
[http://dx.doi.org/10.1016/S0301-2115(98)00320-0] [PMID: 10428334]
[54]
Martinez JM, Comas C, Ojuel J, et al. The influence of the site of Doppler recording on umbilical artery pulsatility index during the first trimester. Ultrasound Obstet Gynecol 1995; 5(5): 325-7.
[http://dx.doi.org/10.1046/j.1469-0705.1995.05050325.x] [PMID: 7614137]
[55]
Nishihara R, Nakai Y, Tachibana D, Yamamasu S, Iwanaga N, Ishiko O. Effects of different sampling points on evaluation of fetal descending aortic flow. Osaka City Med J 2006; 52(1): 39-45.
[PMID: 16986362]
[56]
Bahlmann F, Wellek S, Reinhardt I, Krummenauer F, Merz E, Welter C. Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies. Ultrasound Obstet Gynecol 2001; 17(1): 42-9.
[http://dx.doi.org/10.1046/j.1469-0705.2001.00306.x] [PMID: 11244655]
[57]
Tonge HM, Wladimiroff JW, Noordam MJ, Van Kooten C. Blood flow velocity waveforms in the descending fetal aorta: Comparison between normal and growth-retarded pregnancies. Obstet Gynecol 1986; 67(6): 851-5.
[http://dx.doi.org/10.1097/00006250-198606000-00022] [PMID: 3517728]
[58]
Ferrazzi E, Bellotti M, Marconi A, Flisi L, Barbera A, Pardi G. Peak velocity of the outflow tract of the aorta: Correlations with acid base status and oxygenation of the growth-retarded fetus. Obstet Gynecol 1995; 85(5): 663-8.
[http://dx.doi.org/10.1016/0029-7844(95)00021-I] [PMID: 7724092]
[59]
Rudolph AM, Heymann MA. The circulation of the fetus in utero. Methods for studying distribution of blood flow, cardiac output and organ blood flow. Circ Res 1967; 21(2): 163-84.
[http://dx.doi.org/10.1161/01.RES.21.2.163] [PMID: 4952708]
[60]
Mercé LT, Barco MJ, Bau S. Color Doppler sonographic assessment of placental circulation in the first trimester of normal pregnancy. J Ultrasound Med 1996; 15(2): 135-42.
[http://dx.doi.org/10.7863/jum.1996.15.2.135] [PMID: 8622190]
[61]
Maršál K, Lindblad A, Lingman G, Eik-Nes SH. Blood flow in the fetal descending aorta; intrinsic factors affecting fetal blood flow, i.e. fetal breathing movements and cardiac arrhythmia. Ultrasound Med Biol 1984; 10(3): 339-48.
[http://dx.doi.org/10.1016/0301-5629(84)90168-6] [PMID: 6464220]
[62]
Jouppila P, Kirkinen P. Blood velocity waveforms of the fetal aorta in normal and hypertensive pregnancies. Obstet Gynecol 1986; 67(6): 856-60.
[http://dx.doi.org/10.1097/00006250-198606000-00023] [PMID: 3517729]
[63]
Malcus P, Andersson J. Marŝál K, Olofsson PÅ. Waveform pattern recognition—A new semiquantitative method for analysis of fetal aortic and umbilical artery blood flow velocity recorded by doppler ultrasound. Ultrasound Med Biol 1991; 17(5): 453-60.
[http://dx.doi.org/10.1016/0301-5629(91)90181-U] [PMID: 1962346]
[64]
Borrell A, Martinez JM, Farre MT, Azulay M, Cararach V, Fortuny A. Reversed end-diastolic flow in first-trimester umbilical artery: An ominous new sign for fetal outcome. Am J Obstet Gynecol 2001; 185(1): 204-7.
[http://dx.doi.org/10.1067/mob.2001.114872] [PMID: 11483929]
[65]
Friedman DM, Ehrlich P, Hoskins IA. Umbilical artery Doppler blood velocity waveforms in normal and abnormal gestations. J Ultrasound Med 1989; 8(7): 375-80.
[http://dx.doi.org/10.7863/jum.1989.8.7.375] [PMID: 2664212]
[66]
van Zalen-Sprock MM, van Vugt JMG, Colenbrander GJ, van Geijn HP. First-trimester uteroplacental and fetal blood flow velocity waveforms in normally developing fetuses: A longitudinal study. Ultrasound Obstet Gynecol 1994; 4(4): 284-8.
[http://dx.doi.org/10.1046/j.1469-0705.1994.04040284.x] [PMID: 12797162]
[67]
Wladimiroff JW, Huisman TWA, Stewart PA. Intracerebral, aortic, and umbilical artery flow velocity waveforms in the late-first-trimester fetus. Am J Obstet Gynecol 1992; 166(1): 46-9.
[http://dx.doi.org/10.1016/0002-9378(92)91827-W] [PMID: 1733217]
[68]
Rudolph AM, Heymann MA, Teramo KAW, Barrett CT, Räihä NCR. Studies on the circulation of the previable human fetus. Pediatr Res 1971; 5(9): 452-65.
[http://dx.doi.org/10.1203/00006450-197109000-00003]
[69]
Guzman ER, Schulman H, Karmel B, Higgins P. Umbilical artery Doppler velocimetry in pregnancies of less than 21 weeks’ duration. J Ultrasound Med 1990; 9(11): 655-9.
[http://dx.doi.org/10.7863/jum.1990.9.11.655] [PMID: 2258998]
[70]
Bonilla-Musoles FM, Ballester MJ, Carrera JM. Doppler Color Transvaginal Barcelona: Scientific and Technical, DL Freemason-Salvat 1992.
[71]
Kirkinen P, Kurmanavichius J, And AH, Huch R. Blood flow velocities in human intraplacental arteries. Acta Obstet Gynecol Scand 1994; 73(3): 220-4.
[http://dx.doi.org/10.3109/00016349409023443] [PMID: 8122502]
[72]
Mehalek KE, Rosenberg J, Berkowitz GS, Chitkara U, Berkowitz RL. Umbilical and uterine artery flow velocity waveforms. Effect of the sampling site on Doppler ratios. J Ultrasound Med 1989; 8(4): 171-6.
[http://dx.doi.org/10.7863/jum.1989.8.4.171] [PMID: 2651698]
[73]
Mine M, Nishio J, Nakai Y, Imanaka M, Ogita S. Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms. Acta Obstet Gynecol Scand 2001; 80(4): 307-10.
[PMID: 11264603]
[74]
Katsura D, Takahashi Y, Shimizu T, et al. Prenatal measurement of umbilical cord length using magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2018; 231: 142-6.
[http://dx.doi.org/10.1016/j.ejogrb.2018.10.037] [PMID: 30388608]
[75]
Soothill P, Bilardo CM, Nicolaides KH, Campbell S. Relation of fetal hypoxia in growth retardation to mean blood velocity in the fetal aorta. Lancet 1986; 328(8516): 1118-20.
[http://dx.doi.org/10.1016/S0140-6736(86)90529-5] [PMID: 2877271]
[76]
Cameron AD, Nicholson SF, Nimrod CA, Harder JR, Davies DM. Doppler waveforms in the fetal aorta and umbilical artery in patients with hypertension in pregnancy. Am J Obstet Gynecol 1988; 158(2): 339-45.
[http://dx.doi.org/10.1016/0002-9378(88)90151-2] [PMID: 2963544]
[77]
Cahill LS, Mercer GV, Jagota D, et al. Doppler ultrasound of the fetal descending aorta: An objective tool to assess placental blood flow resistance in pregnancies with discordant umbilical arteries. J Ultrasound Med 2022; 41(4): 899-905.
[http://dx.doi.org/10.1002/jum.15773] [PMID: 34228375]
[78]
Assali NS, Rauramo L, Peltonen T. Measurement of uterine blood flow and uterine metabolism. Am J Obstet Gynecol 1960; 79(1): 86-98.
[http://dx.doi.org/10.1016/0002-9378(60)90367-7] [PMID: 13794853]
[79]
Ramsey PS, Ramin KD, Ramin SM. Cardiac disease in pregnancy. Am J Perinatol 2001; 18(5): 245-66.
[http://dx.doi.org/10.1055/s-2001-16991] [PMID: 11552178]
[80]
Nicolaides KH, Bilardo CM, Campbell S. Prediction of fetal anemia by measurement of the mean blood velocity in the fetal aorta. Am J Obstet Gynecol 1990; 162(1): 209-12.
[http://dx.doi.org/10.1016/0002-9378(90)90852-X] [PMID: 2105648]
[81]
Steiner H, Schaffer H, Spitzer D, Batka M, Graf AH, Staudach A. The relationship between peak velocity in the fetal descending aorta and hematocrit in rhesus isoimmunization. Obstet Gynecol 1995; 85(5): 659-62.
[http://dx.doi.org/10.1016/0029-7844(95)00034-O] [PMID: 7724091]
[82]
Harrington K, Fayyad A, Nicolaides KH. Predicting the severity of fetal anemia using time-domain measurement of volume flow in the fetal aorta. Ultrasound Obstet Gynecol 2004; 23(5): 437-41.
[http://dx.doi.org/10.1002/uog.1043] [PMID: 15133791]
[83]
Maulik D, Mundy D, Heitmann E, Maulik D. Evidence-based approach to umbilical artery Doppler fetal surveillance in high-risk pregnancies: An update. Clin Obstet Gynecol 2010; 53(4): 869-78.
[http://dx.doi.org/10.1097/GRF.0b013e3181fbb5f5] [PMID: 21048454]
[84]
Maulik D, Yarlagadda P, Youngblood JP, Ciston P. Comparative efficacy of umbilical arterial Doppler indices for predicting adverse perinatal outcome. Am J Obstet Gynecol 1991; 164(6): 1434-40.
[http://dx.doi.org/10.1016/0002-9378(91)91421-R] [PMID: 2048589]
[85]
Divon MY. Umbilical artery Doppler velocimetry: Clinical utility in high-risk pregnancies. Am J Obstet Gynecol 1996; 174(1): 10-4.
[http://dx.doi.org/10.1016/S0002-9378(96)70365-4] [PMID: 8571990]
[86]
Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Libr 2017; 2017(6): CD007529.
[http://dx.doi.org/10.1002/14651858.CD007529.pub4] [PMID: 28613398]
[87]
Rochelson B. The clinical significance of absent end-diastolic velocity in the umbilical artery waveforms. Clin Obstet Gynecol 1989; 32(4): 692-702.
[http://dx.doi.org/10.1097/00003081-198912000-00010] [PMID: 2692905]
[88]
Doppler French Study Group. A randomised controlled trial of Doppler ultrasound velocimetry of the umbilical artery in low risk pregnancies. BJOG 1997; 104(4): 419-24.
[http://dx.doi.org/10.1111/j.1471-0528.1997.tb11492.x] [PMID: 9141577]
[89]
Hlongwane TMAG, Cronje T, Nkosi BSS, Pattinson RC. The prevalence of abnormal Doppler’s of the umbilical artery in a low-risk pregnant population in South Africa. EClinicalMedicine 2021; 34: 100792.
[http://dx.doi.org/10.1016/j.eclinm.2021.100792] [PMID: 33997726]
[90]
Bracero LA, Beneck D, Kirshenbaum N, Peiffer M, Stalter P, Schulman H. Doppler velocimetry and placental disease. Am J Obstet Gynecol 1989; 161(2): 388-93.
[http://dx.doi.org/10.1016/0002-9378(89)90528-0] [PMID: 2669492]
[91]
Giles WB, Trudinger BJ, Baird PJ, Cook CM. Fetal umbilical artery flow velocity waveforms and placental resistance: Pathological correlation. BJOG 1985; 92(1): 31-8.
[http://dx.doi.org/10.1111/j.1471-0528.1985.tb01045.x] [PMID: 3966988]
[92]
Flöck A, Remig I, Müller A, et al. Conflicting umbilical artery Doppler findings in fetuses with trisomy 21. Arch Gynecol Obstet 2015; 292(3): 613-7.
[http://dx.doi.org/10.1007/s00404-015-3703-4] [PMID: 25851498]
[93]
Goffinet F, Paris J, Heim N, Nisand I, Breart G. Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women. Eur J Obstet Gynecol Reprod Biol 1997; 71(1): 11-9.
[http://dx.doi.org/10.1016/S0301-2115(96)02606-1] [PMID: 9031954]
[94]
Gairabekova D, Rosmalen J, Duvekot JJ. Outcome of early‐onset fetal growth restriction with or without abnormal umbilical artery Doppler flow. Acta Obstet Gynecol Scand 2021; 100(8): 1430-8.
[http://dx.doi.org/10.1111/aogs.14142] [PMID: 33690882]
[95]
Torres PJ, Gratacós E, Alonso PL. Umbilical artery Doppler ultrasound predicts low birth weight and fetal death in hypertensive pregnancies. Acta Obstet Gynecol Scand 1995; 74(5): 352-5.
[http://dx.doi.org/10.3109/00016349509024427] [PMID: 7778426]
[96]
Ganer Herman H, Barber E, Gasnier R, et al. Placental pathology and neonatal outcome in small for gestational age pregnancies with and without abnormal umbilical artery Doppler flow. Eur J Obstet Gynecol Reprod Biol 2018; 222: 52-6.
[http://dx.doi.org/10.1016/j.ejogrb.2018.01.009] [PMID: 29408751]
[97]
Martinez Crespo JM, Comas C, Ojuel H, Puerto B, Borrell A, Fortuny A. Umbilical artery pulsatility index in early pregnancies with chromosome anomalies. Br J Obstet Gynaecol 1996; 103(4): 330-4.
[http://dx.doi.org/10.1111/j.1471-0528.1996.tb09737.x] [PMID: 8605129]
[98]
Martinez JM, Borrell A, Antolin E, et al. Combining nuchal translucency with umbilical Doppler velocimetry for detecting fetal trisomies in the first trimester of pregnancy. BJOG 1997; 104(1): 11-4.
[http://dx.doi.org/10.1111/j.1471-0528.1997.tb10640.x] [PMID: 8988688]
[99]
Brown R, Di Luzio L, Gomes C, Nicolaides KH. The umbilical artery pulsatility index in the first trimester: is there an association with increased nuchal translucency or chromosomal abnormality? Ultrasound Obstet Gynecol 1998; 12(4): 244-7.
[http://dx.doi.org/10.1046/j.1469-0705.1998.12040244.x] [PMID: 9819854]
[100]
Maulik D, Lysikiewicz A, Sicuranza G. Umbilical arterial Doppler sonography for fetal surveillance in pregnancies complicated by pregestational diabetes mellitus. J Matern Fetal Neonatal Med 2021; 26: 1-7.
[http://dx.doi.org/10.3109/14767058.2013.752903] [PMID: 12683654]
[101]
Hata T, Inubashiri E, Kanenishi K, et al. Nuchal translucency thickness and fetal cardiac flow velocity in normal fetuses at 11-13 weeks of gestation. Gynecol Obstet Invest 2002; 53(4): 209-13.
[http://dx.doi.org/10.1159/000064565] [PMID: 12186985]
[102]
Ramspek CL, Jager KJ, Dekker FW, Zoccali C, van Diepen M. External validation of prognostic models: What, why, how, when and where? Clin Kidney J 2021; 14(1): 49-58.
[http://dx.doi.org/10.1093/ckj/sfaa188] [PMID: 33564405]
[103]
Ohuma EO, Altman DG. Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts. Stat Med 2019; 38(19): 3527-39.
[http://dx.doi.org/10.1002/sim.8000] [PMID: 30352489]
[104]
Silverwood RJ, Cole TJ. Statistical methods for constructing gestational age‐related reference intervals and centile charts for fetal size. Ultrasound Obstet Gynecol 2007; 29(1): 6-13.
[http://dx.doi.org/10.1002/uog.3911] [PMID: 17200989]
[105]
Altman DG, Chitty LS. Design and analysis of studies to derive charts of fetal size. Ultrasound Obstet Gynecol 1993; 3(6): 378-84.
[http://dx.doi.org/10.1046/j.1469-0705.1993.03060378.x] [PMID: 12797237]
[106]
Altman DG, Chitty LS. Charts of fetal size: 1. Methodology. BJOG 1994; 101(1): 29-34.
[http://dx.doi.org/10.1111/j.1471-0528.1994.tb13006.x] [PMID: 8297864]
[107]
Royston P, Altman DG. Regression using fractional polynomials of continuous covariates: Parsimonious parametric modelling. Appl Stat 1994; 43(3): 429.
[http://dx.doi.org/10.2307/2986270]
[108]
Bellera CA, Hanley JA. A method is presented to plan the required sample size when estimating regression-based reference limits. J Clin Epidemiol 2007; 60(6): 610-5.
[http://dx.doi.org/10.1016/j.jclinepi.2006.09.004] [PMID: 17493520]
[109]
Hanley JA. Simple and multiple linear regression: Sample size considerations. J Clin Epidemiol 2016; 79: 112-9.
[http://dx.doi.org/10.1016/j.jclinepi.2016.05.014] [PMID: 27393156]
[110]
Royston P, Wright EM. How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol 1998; 11(1): 30-8.
[http://dx.doi.org/10.1046/j.1469-0705.1998.11010030.x] [PMID: 9511193]

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