Doppler Technology
At this point in time, other factors—such as lack of fetal growth and changes in amniotic fluid volume—are also usually apparent, leaving umbilical artery Doppler without singular, populationwide benefit.
On the other hand, when umbilical artery Doppler, uterine artery Doppler, maternal blood pressure, and biochemical markers are combined, we have the ability to more precisely predict the maternal and fetal ramifications of placental insufficiency. In other words, Doppler by itself is not sufficient, but it will likely be a key component in a multifactorial assessment.
Doppler in 2007
We are on the verge, I believe, of accepting first- and early-second-trimester Doppler—DV Doppler in the context of NT screening, uterine and umbilical artery Doppler screening for placental disease—and putting them into practice.
Every ultrasound machine capable of doing fetal measurements and assessing fetal anatomy comes with Doppler capabilities, so access to technology is no longer a pertinent issue. The last 5 years have brought dramatic change in the application of Doppler ultrasound within ob.gyn. residencies as well.
Methodologies need to be standardized, and the issues of advanced training, certification, and quality control will be an ongoing focus of discussion and debate. Within the next 10 years, however, Doppler assessment will be not only an established tool but also a routine part of the first-trimester evaluation, even in low-risk populations.
Right now, it is no longer acceptable to use fetal heart rate testing alone, or fetal heart rate testing with biophysical profile scores, in managing the IUGR fetus. Current management should include detailed Doppler evaluation of multiple vessels in the fetal circulation.
Corresponding intrauterine treatment for placental insufficiency is less than optimal, but its development is positive. Work is underway, for example, on ways to alter maternal blood flow, address nutritional aspects, and deliver oxygen, and all these approaches are showing promise in assisting placental development once problems are detected. If these measures prove effective, the role of Doppler will continue to expand.
