Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5817_Библиотеки_им_академика_М_И_Перельмана-1.pdf
Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow and Fetal Vessels
Displaying the Fetal Aorta
1
Fig. 6.17 Display of fetal aorta. Error: The B-mode display is indistinct. The curve is incomplete. The faulty choice of a too high
wall filter leads to an erroneous impression of zero flow.
Fig. 6.19 Fetal aorta. The vessel has been examined in the
center of the display, rendering the recording of the spectrum
unproductive.
Fig. 6.18 Display of fetal aorta. Error: Angle ca. 80°. Result:
The RI of the curve displayed will be abnormal by being falsely
elevated, since the Doppler angle is not 쏝60°.
Fig. 6.20 Fetal aorta displayed with an obtuse Doppler angle.
RI: 76 %, unremarkable. The correct examination appears at the
left margin of the display.
74
a b
Fig. 6.21 a Fetal aorta. The sample duration has been set too
high, with the result that the diastole cannot be viewed and
noted. The tracing does not lie on the baseline, indicating faulty
filter setting.
c
Fig. 6.21 c In this display the baseline is set too high and has
been corrected upward in error. The result is that systole has
been cut off and the peaks appear at the bottom of the display.
Fig. 6.21 b The filter error has been insufficiently corrected
and the record of the Doppler spectrum is even more blurry
than in
tion of the Doppler angle.
Fig. 6.21 d The baseline has been corrected to its proper level.
The filter is still too high; the B-mode image blurry.
6.21a. The B-mode image does not allow an evalua-
Fig
d
Possible Sources of Error in Doppler Ultrasound Examinations of Maternal and Fetal Vessels
Fig. 6.22 Fetal aorta. Error: Strong background noise blurs the
contour of the Doppler spectrum. Correction: Reduced amplification.
Fig. 6.24 Fetal aorta. Error: Tracing shows reverse flow. Faulty
angle, resulting in falsely showing reverse flow in the vessel. Diastole can only be presumed at the upper margin of the display.
Correction: Inversion, adaptation of the PRF, correction of the
angle of incidence.
Fig. 6.23 Fetal aorta. Error: The waveform tracing shows
reverse flow. Systole lacks homogeneity. A venous vessel is seen
in forward flow. B-mode image shows a poorly selected Doppler
angle. Correction: Invert the angle.
Basic Concepts
Fig. 6.25 Doppler signal in the fetal aorta during arrhythmia.
Doppler parameters in this situation are inadmissible. Conclusions are only valid for orientation.
Fig. 6.26 Fetal aorta. Error: Angle reading in the B-mode
image is incorrect. 60° was set, but this does not follow the ac-
tual course of the aorta. The spectrum is inverted; baseline shift
has not been utilized.
Fig. 6.27 Fetal aorta: Error: Sample duration set too high. Systole cannot be delimited. Angle not set optimally. Correction:
Reduce sample rate, if necessary raise PRF.
75
1
Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow and Fetal Vessels
Displaying the Middle Cerebral Artery
Fig. 6.28 Middle cerebral a. with diastolic flow. The result is a
low RI of 74%. The angle is correctly acute.
Fig. 6.29 a Middle cerebral a. Correct display: Optimal angle,
PRF, and sample duration set correctly. Systole and diastole well
displayed. RI unremarkable.
76
a
Fig. 6.29 b Incorrect display. Spectrum inverted, baseline
shifted in wrong direction, systolic peaks appear at the upper
margin of the display.
b
Fig. 6.29 c Baseline and direction of flow incorrect. Correction:
Shift baseline downward and invert.
c
Complete Series of Doppler Ultrasound Examinations, Including Displays of Maternal Uterine
Complete Series of Doppler Ultrasound Examinations, Including Displays of Maternal Uterine and Fetal Peripheral and Central Vessels
a b
Basic Concepts
c d
Fig. 6.30 a Uterine a. with normal flow.
Fig. 6.30 b Same uterine a. as in Fig.
sulting in the absence of a visible spectrum. Doppler parame-
ters cannot be measured.
a b
Fig. 6.31 a Umbilical a. Angle of incidence of the Doppler
angle cannot be discerned. Characteristic sawtooth profile; ele-
vated RI.
6.30a. PRF too low, re-
Fig. 6.30 c PRF for the vessel in
now displayed.
Fig. 6.30 d Normal flow profile of the contralateral uterine a.
in the same patient.
Fig. 6.30b raised. Spectrum is
Fig. 6.31 b Spectrum of the same umbilical a. as in Fig. 6.31a
photographed in line with the flow. The tracing appears blurry,
because the image was not fixed.
6.31 c Same umbilical a. as in Fig. 6.31a, b. Different coil
Fig.
of umbilical cord; different Doppler angle.
77
c
Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow and Fetal Vessels
1
d
f
h
Fig. 6.31d-h Coils of the umbilical cord of a fetus under
various conditions.
Fig. 6.31 i Reverse flow. Spectrum appears inverted; Doppler
parameters cannot be obtained.
e
g
78
i
Fig. 6.32 a Fetal aorta. Angle 쏜60°; B-mode image display of
vessel appears suboptimal.
Fig. 6.32 b Fetal aorta. Optimal angle; the aorta is now more
clearly discernable.
Complete Series of Doppler Ultrasound Examinations, Including Displays of Maternal Uterine
Fig. 6.33 a Optimal setting to display and evaluate the middle
cerebral a.
Fig. 6.33 b Middle cerebral a. with normal flow pattern. The
vessel was examined correctly, using a very acute angle.
Basic Concepts
79
Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow and Fetal Vessels
Basic Concepts: References
80
1
Physical and Technical Fundamentals of Ultrasound and Doppler Ultrasound
AIUM Bioeffects Committee. Bioeffects considerations for safety of
diagnostic ultrasound. Ultrasound Med. 1988; 7.
Benson RC. Handbook of Obstetrics and Gynecology. Lange Medical
Publications; 1977.
Dobrinski P, Krakau G, Vogel A. Physik für Ingenieure. Stuttgart: B.G.
Teubner; 1988.
Fehske W. Praxis der konventionellen und farbkodierten Doppler-
Echokardiographie. Bern: Hans Huber Verlag; 1988.
Klews PM. Color velocity imaging − Ein Vergleich der Verfahren zur
farbkodierten Sonographie. Röntgenstrahlen. 1991; 65.
Lizzi FL. New Developments in Ultrasonic Transducers and Trans-
ducers Systems. SPIE − The International Society for Optical Engineers. 1992; Vol. 1733.
Morneburg H. Bildgebende Systeme für die medizinische Diagnostik.
Erlangen: Publicis MCD Verlag; 1995.
Müller FS, Krünes U, Mutze S, Overhoff M. Ultraschall-Angiographie
versus Farbdoppler − Physikalische Grundlagen. Dialyse-J. 1995;
52.
Pauerstein CJ. Clinical Obstetrics. New York: John Wiley & Sons; 1987.
Perlemann J. Physikalische Plaudereien. Leipzig: Urania-Verlag;
1963.
Schmailzl KJG. Ultrasound in Cardiology. Oxford: Blackwell Science
1994.
Indices for the Evaluation of Doppler Sonograms
Baker DW. Applications of pulsed Doppler techniques. Radiol Clin
North Am. 1980; 18:79−103.
Favre Y, Vetter K, Huch R, Huch A. Vélocimétrie Doppler de l’aorte
lors d’incompatibilité sanguine maternofetale. J Gynecol Obstet
Reprod Bio 1989; 18:740−746.
Findel H, Sohn C. Dopplersonographie in der Geburtshilfe. Berlin:
Springer; 1989.
Gill RW. Pulsed Doppler with b-mode imaging for quantitative blood
flow measurement. Ultrasound Med Biol. 1979; 5:223−235.
Gonser M. Ein neues Verfahren zur Formbewertung von Pulswel-
lenkurven in der Geburtshilfe − mathematische Herleitung und
pathophysiologische Bedeutung. Ultraschall Klin Prax. 1986;Suppl
1:95.
Gonser M. Proposal of a unified description of blood flow parame-
ters, based on analogy between acoustic field and velocity field,
with application to fetal blood flow measurement. Echocardiography. 1989; 6:339−345.
Gonser M, Römer VM, Pfeiffer KH. Comparison of waveform evalua-
tion indices and proposal of new ones − an approach to flow pattern recognition and discrimination. In: Sheldon CD, Evans DH,
Salvage JR (eds) Obstetric and neonatal blood flow. Biol Engng Soc
Conf Prod. 1987; 2:32−36.
Gosling RG. Extraction of physiological information from spectrum-
analysed Doppler-shifted continuous-wave ultrasound signals obtained non-invasively from the arterial system. In: Hill DW, Watson BW (eds). IEE medical electronics monographs 18−22, vol 4.
Stevenage: Peter Peregrinus; 1976:73−125.
Gosling RG, King DH. Ultrasonic angiology. In: Harcus AW, Adamson
L (eds). Arteries and veins. Edinburgh London New York: Churchill
Livingstone; 1975:61−98.
Gosling RG, Dunbar G, King DH, et al. The quantitative analysis of
occlusive peripheral arterial disease by a non-intrusive ultrasonic
technique. Angiology 1971; 22:52−55.
Johnston KW, Kassam M, Koers J, Cobbold RSC, MacHattie D. Com-
parative study of four methods for quantifying Doppler ultrasound
waveforms from the femoral artery. Ultrasound Med Biol 1984;
10:1−12.
Kassam MS, Cobbold RSC, Johnston KW, Graham CM. Method for
estimating the Doppler mean velocity waveform. Ultrasound Med
Biol. 1982; 8:537−544.
Laurin J. Intra-uterine growth retardation. A clinical and ultrasonic
investigation of diagnosis and fetal surveillance. Thesis, University
of Malmö, 1987.
Lingman G, Maršál K. Fetal central blood circulation in the third
trimester of normal pregnancy − a longitudinal study. II. Aortic
blood velocity waveform. Early Hum Dev. 1986; 13:151−159.
Maršál K. Laurin J, Lindblad A, Lingman G. Blood flow in the fetal de-
scending aorta. Semin Prinatol. 1987; 11:322−334.
Moore KL, Persaud TVN, Embryology. 4th ed. Stuttgart: Schattauer;
1996.
Pourcelot L. Applications cliniques de L’examenDoppler transcutane.
INSERM Colloq. 1974; 34:213−240.
Stuart B, Drumm J, FitzGerald DE, Duignan NM. Fetal blood velocity
waveforms in normal pregnancy. Br J Obstet Gynaecol. 1980;
87:780−785.
Thompson RS, Trudinger BJ, Cook CM. Doppler ultrasound
waveforms in the fetal umbilical artery: Quantative analysis tech-
nique. Ultrasound Med Biol. 1985; 11:707−718.
Thompson RS, Trudinger BJ, Cook C. A comparison of Doppler ultra-
sound waveform indices in the umbilical artery. I. Indices derived
from the maximum velocity waveform. Ultrasound Med Biol.
1986; 12:835−844.
Vetter K. Dopplersonographie in der Schwangerschaft. 1991; VCH-
Verlagsgesellschaft Weinheim: 1991.
Voigt HJ. Diagnostic and clinical significance of Doppler ultrasound
in obstetrics Thesis, University of Erlangen, Germany 1991.
Blood Flow Analysis During Pregnancy
Alahuhta S, Rasanen J, Jouppila R et al. Effects of extradural bupiva-
caine with adrenaline for caesarean section on uteroplacental and
fetal circulation. Br J Anaesth. 1991a; 67:678−682.
Alahuhta S, Rasanen J, Jouppila R et al. Uteroplacental and fetal
haemodynamics during extradural aneasthesia for caesarean section. Br J Anaesth. 1991b; 66:319−323.
Alahuhta S, Rasanen J, Jouppila P et al. Epidural sufentanil and
bupivacaine for labor analgesia and Doppler velocimetry of the
umbilical and uterine ateries. Anesthesiology 1993; 78:231−236.
Arabin B, Bergmann PL, Saling E. Qualitative Analyse von Blutfluß-
spektren uteroplazentarer Gefäße, der Nabelarterie, der fetalen
Aorta und der fetalen Arteria carotis communis in normaler
Schwangerschaft. Ultraschall Klin Prax. 1987; 2:114−119.
Arbenz U, Real F. Echocardiographic findings of megaloaorta in
neonates. Annual Meeting of the Association of European Pediatric
Cardiologists, Dubrovnik 1986.
Arduini D, Rizzo G, Romanini C. Changes of pulsatility index from
fetal vessels preceding the onset of late decelerations in growthretarded fetuses. Obstet Gynecol. 1992; 79:605−610.
Battaglia C, Artini PG, Galli PA et al. Absent or reversed end-diastolic
flow in umbilical artery and severe intrauterine growth retardation. An omious association. Acta Obstet Scand. 1993; 72:167−171.
Becker V. Morphologische Reaktionsweise der Plazenta. In: Becker V,
Schiebler TH, Kubli F (Hrsg). Die Plazenta des Menschen. Stuttgart:
Thieme; 1981:252−261.
Borell V, Fernström I, Ohlson L, Wiqvist N. Influence of uterine con-
tractions on the uteroplacental blood flow at term. Am J Obstet Gynecol. 1965; 93:44−57.
Brar HS, Platt LD. Epidemiological evaluation of prenatal screening
procedures. Am J Obstet Gynecol. 1988; 159:559−561.
Brosens IA. Morphological changes in the uteroplacental bed in preg-
nancy hypertension. Clin Obstet Gynaecol. 1977; 4:573−593.
Campbell S. Nitric oxide: its role in the development of the utero-
placental circulation. 3rd World Congress on Ultrasound in Obstetrics and Gynecology, Las Vegas 1993.
Campbell S, Cohen-Overbeek T. Doppler investigation of the utero-
placental circulation during pregnancy. In: Maulik D, McNellis D
(eds) Doppler ultrasound measurement of maternal-fetal
hemodynamics. Perinatology Press, Ithaca, 1987; pp 147−166 (Reproductive and perinatal medicine, vol 8).
Campbell S, Diaz-Recasens J, Griffin DR et al. (1983). New Doppler
technique for assessing uteroplacental blood flow. Lancet 1 675−
677.
Chaoui R, Hoffmann H, Zienert A et al. Clinical significance and fetal
outcome in end-diastolic decreased flow in the umbilical artery
and/or fetal aorta: analysis of 51 cases. Geburtshilfe Frauenheilk.
1991; 51:532−539.
Cohen-Overbek T, Pearce JM, Campbell S. The antenatal assessment
of utero-placental and feto-placental blood flow using Doppler ultrasound. Ultrasound Med Miol. 1985; 11:329−339.
Conners G, Gillis S, Hunse C et al. The interaction of behavioural state,
heart rate and resistance index in the human fetus. J Dev Physiol.
1991; 15:331−336.
Duggan PM, McCowan LM, Stewart AW. Antihypertensive drug ef-
fects on placental flow velocity waveforms in pregnant women
Complete Series of Doppler Ultrasound Examinations, Including Displays of Maternal Uterine
with severe hypertension. Aust N Z J Obstet Gynaecol. 1992;
32:335−338.
Fairlie FM, Lang GD, Lowe GG, Walker JJ. Umbilical artery flow ve-
locity waveforms and cord blood viscosity. Am J Perinatol. 1991;
8:239−243.
Fendel H. Die gepulste Dopplersonographie in der Diagnostik der
Risikoschwangeschaft. Habilitationsschrift, Universität Aachen
1986.
Fendel H, Sohn C. Dopplersonographie in der Geburtshilfe. Berlin:
Springer; 1989.
Fendel H, Fendel M, Pauen A et al. Doppleruntersuchungen des ar-
teriellen uterinen Flows während der Wehentätigkeit. Z Geburtshilfe Perinatol. 1984; 188:64−67.
Fendel H, Pauen A, Jung H. Blood flow measurement during labor. In:
Jung H, Fendel H (eds) Doppler techniques in abstetrics. Stuttgart:
Thieme; 1986:
Fendel H, Fettweis P, Billet O et al. Doppleruntersuchungen des ar-
teriellen utero-feto-plazentaren Blutflusses vor und während der
Geburt. Z Geburtshilfe Perinatol. 1987; 191:121−129.
Fischer RL, Kuhlman KA; Depp R, Wapner RJ. Doppler evaluation of
umbilical and uterine-arcuate arteries in the postdates pregnancy.
Obstet Gynecol. 1991; 78:363−368.
FitzGerald DE, Stuart B, Drumm JE, Duignan NM. Assessment of the
feto-placental circulation with continuous wave Doppler ultrasound. Ultrasound Med Biol. 1984; 10:371−376.
Fleischer A , SchulmanH, Farmakides G et al. Uterine artery Doppler
velocimetry in pregnant women with hypertension. Am J Obstet
Gynecol. 1986; 154:806−813.
Fleischer A, Anyaegbunam AA, Schulman H et al. Uterine and umbili-
cal artery velocimetry during normal labor. Am J Obstet Gynecol.
1987; 157:40−43.
Fouron JC, Teyssier G, Shalaby L et al. Fetal central blood flow altera-
tions in human fetuses with umbilical artery reverse diastolic flow.
Am J Perinatol. 1993; 10:197−207.
Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity
waveforms and placental resistance; pathological correlation. Br J
Obstet Gynaecol. 1985; 92:31−38.
Giles WB, Lah FX, Trudinger BJ. The effect of epidural aneasthesia for
caesarean section on maternal uterine and fetal umbilical artery
blood flow velocity waveforms.Br J Obstet Gynaecol. 1987; 94:55−
59.
Giles WB, Trudinger B, Cook C, Connelly A. Placental microvascular
changes in twin pregnancies with abnormal umbilical artery
waveforms. Obstet Gynecol. 1993; 81:556−559.
Gonser M. Umbilical venous flow pulsations. Ultrasound Obstet
Gynecol. 1992; 2:108.
Graca LM, Clode N, Cardoso CG et al. Doppler flowmetry of feto-ma-
ternal circulation. III. Absent and reverse diastolic flow in the
umbilical artery. Acta Med Port. 1991; 4:127−130.
Gudmundsson S, Huhta JC, Wood DC et al. Venous Doppler ultra-
sonography in the fetus with nonimmune hydrops. Am J Obstet
Gynecol. 1991; 164:33−37.
Hackett G, Cohen-Overbeek T, Campbell S. The clinical value of blood
flow studies in obstetric management. In: Jung H, Fendel H (eds)
Doppler techniques in obstetrics. Stuttgart: Thieme; 1986.
Hadi HA, Malette JQ, Strickland D. The clinical significance of reverse
umbilical artery flow velocity waveforms in preterm growth retarded fetuses. Am J Obstet Gynecol. 1991; 164:413.
Harper MA, Murnaghan GA. Discordant umbilical artery time ve-
locity waveforms due to major placental infarction. 5th International Congress of the International Society for the Study of Hypertension in Pregnancy, Nottingham, 1986a; p 10.
Harper MA, Murnaghan GA. Response of fetal umbilical artery time
velocity waveforms to antihypertensive drugs. 5th International
Congress of the International Society for the Study of Hypertension in Pregnancy, Nottingham 1986b; p 15.
Hitschold T, Müntefering H, Berle P. Dopplersonographie der A.
umbilicalis zur Beurteilung des fetoplazentaren Gefäßbaumes: ein
prospektiver histologischer Vergleich. Ultraschall Med. 1992;
13:162−165.
Hitschold T, Weiss E, Beck T et al. Low target birth weight or growth
retardation? Umbilical Doppler flow velocity waveforms and
histometic analysis of fetoplacental vascular tree. Am J Obstet Gynecol 1993; 168:1260−1264.
Indik JH, Chen V, Reed KL. Antenatal screening for intrauterine
growth retardation with umbilical artery Doppler ultrasonography. Obstet Gynecol. 1991; 77:551−557.
Janbu T, Koss KS, Nesheim B-I, Wesche J. Blood velocities in the
uterine artery in humans during labour. Acta Physiol Scand. 1985;
124:153−161.
Jauniaux E, Jurkovic D, Campbell S, Hustin J. Doppler ultrasono-
graphic features of the developing placental circulation: correla-
pp.
45−53.
tion with anatomic findings. Am J Obstet Gynecol. 1992; 166:585−
587.
Jensen A, Bamford OS, Dawes GS et al. Changes in organ blood flow
between high and low voltage electrocortical activity and during
isocapnic hypoxia in intact and brain stem transected fetal lambs.
In: Jones CT, Nathanielsz PW (eds) The physiological development
of the fetus and newborn. London: Academic; 1985:605−610.
Jimenez E, Vogel M, Arabin B et al. Plazenta und Dopplersonogra-
phie: Eine vergleichende klininisch-morphologische Untersuchung. In: Dudenhausen JW, Saling E (Hrsg). Perinatale Medizin,
Bd. 12. Stuttgart: Thieme; 1988.
Jouppila P, Kirkinen P. Umbilical vein blood flow in the human fetus
in cases maternal and fetal anemia and uterine bleeding. Ultrasound Med Biol. 1984; 10:365−370.
Jouppila P. Kirkinen P. The effect of labetalol and metoprolol on the
placenta and fetal hemodynamics. In: Jung H, Fendel H (eds) Doppler techniques in obestetrics. Stuttgart: Thieme; 1986.
Jouppila P, Kirkinen P, Koivula A, Ylikorkala O. Effects of dihy-
dralazine infusion on the fetoplacental blood flow and maternal
prostanoids. Obstet Gynecol. 1985a; 65:115−118.
Jouppila P, Kirkinen P, Koivula A, Ylikorkala O. Failure of exogenous
prostacylin to change placental and fetal blood flow in preeclampsia. Am J Obstet Gynaecol. 1985b; 151:661−665.
Jouppila P, Kirkinen P, Koivula A, Ylikorkala O. Labetalol does not
alter the placental and fetal blood flow or maternal prostanoids in
pre-ecplampsia. Br J Obstet Gynaecol. 1986; 93:543−547.
Kaplan S, Assali NS. Disorders of circulation. In: Assali NS, Brinkman
CR (eds) Pathophysiology of gestation, vol 3. Academic, New York:
Academica; 1972.
Kirkinen P, Müller R, Huch R, Huch A. Blood flow velocity waveforms
in human fetal intracranial arteries. Obstet Gynecol. 1987; 70:617−
621.
Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR. Ultrasonographic ve-
locimetry of the fetal ductus venosus. Lancet. 1991; 338:1412−
1414.
Kiserud T,Eik-Nes SH, Hellevik LR, Blaas HG. Ductus venosus − a ling-
itudinal Doppler velocimetric study of the human fetus. J Matern
Fetal Invest. 1992; 2:5−11.
Lindblad A, Maršál K, Vernersson E, Renck H. Fetal circulation during
epidural analgesia for caesarean section. Br Med J. 1984;
288:1329−1330.
Lindblad A, Bernow J, Maršál K. Obstetric analgesia and fetal aortic
blood flow during labour. Br J Obstet Gynaecol. 1987; 94:306−311.
Lingman G, Maršál K. Circulatory effects of fetal cardiac arrhythmias.
Pediatr Cardiol. 1986a; 7:67−74.
Lingman G, Maršál K. Fetal central blood circulation in the third
trimester of normal pregnancy − a longitudinal study. I. Aortic and
umbilical blood flow. Early Hum Dev. 1986b; 13:137−150.
Lingman G, Maršál K. Fetal central blood circulation in the third
trimester of normal pregnancy − a longitudinal study. II. Aortic
blood velocity waveform. Early Hum Dev. 1986c; 13:151−159.
Lingman G, Maršál K. Fetal cardiac arrhythmias: Doppler assess-
ment. Semin Perinatol. 1987; 11:357−361.
Lingman G. Laurin J, Maršál K. Circulatory changes in fetuses with
imminent asphyxia. Biol Neonate. 1986; 49:66−73.
Lunell NO, Garoff L, Grunewald C et al. Isradipine, a new calcium
antagonist: effects on maternal and fetal hemodynamics. J Cardiovasc Pharmacol. 1991; 8, Suppl 3:37−40.
Malcus P, Maršál K, Persson P-H. Fetal and uteroplacental blood flow
in prolonged pregnancies. A clinical study. Ultrasound Obstet
Gynecol. 1991; 1:40−45.
Mari G, Moise KJJ, Deter RL et al. Doppler assessment of the pul-
satility index in the cerebral circulation of the human fetus. Am J
Obstet Gynecol. 1989; 160:698−703.
Mari G, Wasserstrum N, Kirshon B. Reduction in the middle cerebral
artery pulsatility index after decompression of polyhydramnios in
twin gestation. Am J Perinatol. 1992; 9:381−384.
Mari G, Kirshon B, Abuhamad A. Fetal renal artery flow velocity
waveforms in normal pregnancies and pregnancies complicated
by polyhdramnios and oligohydramnios. Obstet Gynecol. 1993;
81:560−564.
Maršál K, Laurin J, Lindblad A, Lingman G. Blood flow in the fetal de-
scending aorta. Semin Perinatol. 1987; 11:322−334.
Marx G, Patel S, Berman JA et al. Umbilical blood flow velocity
waveforms in different maternal positions and with epidural analgesia. Obstet Gynecol. 1986; 68:61−64.
McCowan LM, Mullen BM, Ritchie K. Umbilical artery flow velocity
waveforms and the placental vascular bed. Am J Obstet Gynecol.
1987; 157:900−902.
Meyenburg M, Bartnicki J, Saling E. The effect of maternal oxygen ad-
ministration on fetal and maternal blood flow values using
Doppler ultrasonography. J Perinat Med. 1991; 19:185−190.
Basic Concepts
81
Common Errors in the Doppler Ultrasound Display of Uterine Blood Flow and Fetal Vessels
1
Milliez J, Blanchard D, Diebold B et al. Etude par l’echographie Dop-
pler de la circulation placentaire du foetus de mère normale et hypertendue. Presse Med. 1983; 12:1649−1653.
Moll W, Nienartowicz A, Hess H, Lenz A. Blood flow regulation in the
uteroplacental arteries. Trophoblast Res. 1988; 3:83−96.
Montan S, Liedholm H, Lingman G et al. Fetal and uteroplacental
heamodynamics during shortterm atenolol treatment of hypertension in pregnancy. Br J Obstet Gynaecol. 1987; 94:317−317.
Montan S, Anandakumar C, Arulkumaran S et al. Effects of methyl-
dopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension. Am J Obstet Gynecol. 1993; 168:152−156.
Muijsers GJ, van Huisseling H, Hasaart TH. The effect of selective
umbilical embolization on the common umbilical artery pulsatility index and umbilical vascular restistance in fetal sheep. J Dev
Physiol. 1991; 15:259−267.
Murakami M, Kanzaki T, Utsu M, Chiba Y. Changes in the umbilical
venous blood flow of human fetus in labor. Acta Obstet Gynaecol
Jpn. 1985; 37:776−782.
Nijhuis JG, Prechtl HFR, Martin CBJ, Bots RSGM. Are there behavioural
states in the human fetus? Early Hum Dev. 1982; 6:177−195.
Nordenvall M, Ullberg U, Laurin J et al. Placental morphology in rela-
tion to umbilical artery blood velocity waveforms. Eur J Obstet Gynecol Reprod Biol. 1991; 40:179−190.
Park YK, Hidaka A. Effect of left-lateral position on maternal
hemodynamics during ritodrine treatment in comparison with
supine position. Nippon Sanka Fujinka Gakkai Zasshi. 1991;
43:655−662.
Patton DE, Lee W, Miller J, Jones M. Maternal, uteroplacental, and fe-
toplacental hemodynamic and Doppler velocimetric changes
during epidural anesthesia in normal labor. Obstet Gynecol. 1991;
77:17−19.
Pijnenborg R, Dixon HG, Robertson WB, Brosens I. Trophoblastic in-
vasion of human decidua from 8 to 18 weeks of pregnancy.
Placenta. 1980; 1:3−19.
Pijpers L, Wladimiroff JW, McGhie J. Effect of short-term maternal
exercise on maternal and fetal cardiovascular dynamics. Br J
Obstet Gynaecol. 1984; 91:1081−1086.
Ramos SE, Devoe LD, Wakefield ML et al. The effects of epidural anes-
thesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor.
Obstet Gynecol. 1991; 77:20−26.
Rayburn WF, Anderson JC, Smith CV, Appel LL. Uterine and fetal Dop-
pler flow changes after intravaginal prostaglandin E2 therapy for
cervical ripening. Am J Obstet Gynecol. 1991; 165:125−126.
Reed KL, Sahn DJ, Scagnelli S et al. Doppler echocardiographic studies
of diastolic function in the human fetal heart: changes during
gestation. J Am Coll Cardiol. 1986; 8:391−395.
Reed KL, Anderson CF, Shenker L. Changes in intracardiac Doppler
blood flow velocities in fetuses with absent umbilical artery diastolic flow. Am J Obstet Gynecol. 1987; 157:774−779.
Rizzo G, Arduini D, Romanini C. Inferior vena cava flow velocity
waveforms in appropriate- and small-for-gestational-age fetuses.
Am J Obstet Gynecol. 1992; 166:1271−1280.
Schmidt W, Ruhle W, Ertan AK et al. Doppler-Ultraschall − Perinatol-
ogische Daten von Fällen mit enddiastolischem Block und Reverse
Flow. Geburtshilfe Frauenheilkd. 1991; 51:288−292.
Sheppard BL, Bonnar J. Uteroplacental arteries and hypertensive
pregnancy. In: Bonnar J (e d) Pregnancy hypertension. Lancaster:
MIT Press; 1980:213−219.
Sorensen TK, Hendricks S, Easterling TR et al. Effect of orthostatic
stress on umbilicar Doppler waveforms in normal and hypertensive pregnancies. Am J Obstet Gynecol. 1992; 167:643−647.
Steel SA, Pearce JM, Nash G et al. Correlation between Doppler flow
velocity waveforms and cord blood viscosity. Br J Obstet Gynaecol.
1989; 96:1168−1172.
Stokes HJ, Roberts RV, Newnham JP. Doppler Flow velocity waveform
analysis in postdate pregnancies. Aust N Z J Obstet Gynaecol. 1991;
31:27−30.
Stuart B, FitzGerald DE, Duignan NM. Fetal blood velocity waveforms
in uncomplicated labour. Br J Obstet Gynaecol. 1981; 88:865−869.
Tonge HM, Wladimiroff JW, Noordam MJ, Stewart PA. Fetal cardiac
arrhythmias and their effect on volume blood flow in descending
aorta of human fetus. JCU. 1986; 14:607−612.
Toppozada M, Medhat I, Sallam H et al. Improving placental blood
flow in pre-eclampsia with prostaglandin A1. Acta Obstet Gynecol
Scand. 1992; 71:22−27.
Trudinger BJ. The umbilical circulation. Semin Perinatol. 1987;
11:311−321.
Trudinger BJ, Giles WB, Cook CM. Flow velocity waveforms in the
meternal uteroplacental and fetal umbilical placental circulations.
Am J Obstet Gynecol. 1985; 152:155−163.
Ueno N. Studies on fetal middle cerebral artery blood flow velocity
waveforms in the intrapartum period. Nippon Sanka Fujinka Gak-
kai Zasshi. 1992; 44:97−104.
Vaha EK, Pirhonen J, Seppanen A, Erkkola R. Doppler flow measure-
ment of uterine and umbilical arteries in heat stress during late
pregnancy. Am J Perinatol. 1991; 8:385−389.
Van der Mooren K, Wladimiroff JW, Stijnen T.Effect of fetal breathing
movements on fetal cardiac homodynamics. Ultrasound Med Biol.
1991; 17:787−790.
Van Eyck J, Wladimiroff J, Noordam MJ et al. The blood flow velocity
waveformin the fetal descending aorta; its relationship to fetal behavioural states in normal pregnancy at 37−38 weeks. Early Hum
Dev. 1985; 12:137−143.
Van Eyck J, Wladimiroff JW, van den Wijngaard JAGW et al. The blood
flow velocity waveform in the fetal internal carotid and umbilical
artery; its relation to fetal hehavioural states in normal pregnancy
at 37−38 weeks. Br J Obstet Gynaecol. 1987; 94:736−741.
Veille JC, Penry M. Effects of maternal administration of 3% carbon
dioxide on umbilical artery and fetal renal and middle cerebral
artery Doppler waveforms. Am J Obstet Gynecol. 1992; 167:1668−
1671.
Vetter K. Dopplersonographie in der Schwangerschaft. Weinheim:
VCH; 1991.
Vetter K, Baer S, Fallenstein F et al. Differenzierung von Hypertonien
in der Schwangerschaft durch Doppler-Blutflußmessung. In:
Dudenhausen JW, Saling E (Hrsg) Perinatale Medizin, Bd. 11. Stutt-
gart: Thieme; 1986.
Vetter K, Favre Y, Suter T et al. Doppler-sonographisch ermittelte
spezifisch hämodynamische Veränderungen im Kreislauf von
Feten in den letzten 4 Wochen vor Geburt. Z Geburtshilfe Perinatol. 1989; 93:215−218.
Vetter K, Mock C, Huch R, Huch A. Dopplersonographisch ermittelte
Blutströmung bei großen Feten. In: Fendel H, Funk A, Jung H (Hrsg)
Pränatale Dopplerdiagnostik. Steinkopff, Darmstadt: Steinkopff;
1992:105−108.
Voigt HJ, Becker V. Doppler flow measurements and histomor-
phology of the placental bed in uteroplacental insufficiency. J Perinat Med. 1992; 20:139−147.
Vyas S, Nicolaides KH, Campbell S. Renal artery flow-velocity
waveformsin normal and hypoxemic fetuses. Am J Obstet Gynecol.
1989; 161:168−172.
Vyas S, Campbell S, Bower S, Nicolaides KH. Maternal abdominal
pressure alters fetal cerebral blood flow. Br J Obstet Gynaecol.
1990; 97:740−747.
Weiner Z, Reichler A, Zlozover M et al. The value of Doppler ultra-
sonography in prolonged pregnancies. Eur J Obstet Gynecol Reprod Biol. 1993; 48:93−97.
Weiss E, Hitschold T, Berle P. Umbilical artery blood flow velocity
waveforms during variable deceleration of the fetal heart rate. Am
J Obstet Gynecol. 1991; 164:534−540.
Wladimiroff JW. Doppler assessment of fetal cerebral circulation. 1st
Congress of the International Perinatal Doppler Society, Kansas
City, 1988.
Wladimiroff JW, VanBel F. Fetal and neonatal cerebral blood flow.
Semin Perinatol. 1987; 11:335−346.
Wladimiroff JW, Huisman TW, Stewart PA, Stijnen T. Normal fetal
Doppler inferior vena cava, transtricuspid, and umbilical artery
flow velocity waveforms between 11 and 16weeks’ gestation. Am J
Obstet Gynecol. 1992; 166:921−924.
Wright PM, Iftikhar M, Fitzpatrick KT et al. Vasopressor therapy for
hypotension during epidural anesthesia for cesarean section: effects on maternal and fetal flow velocity ratios. Anesth Analg.
1992; 75:56−63.
Zimmermann R, Eichhorn K-H, Huch P, Huch R. Zusammenhang
zwischen verminderter Fruchtwassermenge und Dopplerspektren
fetaler Gefäße am Termin. Geburtshilfe Frauenheilk. 1993; 53:479−
482.
82
Obstetric Applications of Doppler Ultrasound
Obstetric Applications of Doppler Ultrasound
blubber
83