Abstract
This second part on Doppler sonography in prenatal medicine and obstetrics reviews
its clinical applications. While this has not become the initially anticipated screening
tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies.
For example, the sonography-based determination of uterine artery blood flow indices
is an important parameter for the first trimester multimodal preeclampsia risk assessment,
increasing accuracy and providing indication for the prophylactic treatment with aspirin.
It also has significant implications for the diagnosis and surveillance of growth-restricted
fetuses in the second and third trimesters through Doppler-sonographic analysis of
umbilical artery, middle cerebral artery and ductus venosus. Here, especially the
hemodynamics of the ductus venosus provides a critical criterium for birth management
of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination
of maximum blood flow velocity of the middle cerebral artery is a central parameter
in fetal diagnosis of anemia which has been significantly improved by this analysis.
However, it is important to note that the mentioned improvements can only be achieved
through highest methodological quality. Importantly, all these analyses are also applied
to twins and higher order multiples. Here, for the differential diagnosis of specific
complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has
become indispensable. To conclude, the successful application of Doppler sonography
requires both exact methodology and precise pathophysiological interpretation of the
data.
Key words
dopplersonography - fetal surveillance - guideline - clinical application
