Doppler sonography. Initial longitudinal studies confirm that the changes in Doppler flow indices that occur in cases of severe, chronic placental insufficiency resemble a progressive cascade of pathology that culminates in the delivery of a severely compromised, hypotrophic infant instruments are used, good clinical judgment combined with flexibility and individualization are the key elements in achieving the best fetal outcome pends on various criteria such as prematurity, degree of fetal compromise, maternal indication, and the prediction of fetal intrapartum stress. Doppler sonography and other biophysical assessments can provide a good impression of the stress toler­ance of the compromised fetus (see above), which may still allow for a vaginal delivery in many cases. An awareness of the preexisting deficits in placental function can optimize peri­natal management and help prevent fetal injuries setting for the delivery thus depends on the expected degree of intrapartum and postpartum fetal compromise. Delivery at a perinatal center is generally recommended.