THE CURRENT STATUS OF DOPPLER SONOGRAPHY IN OBSTETRICS

Searches for clinical applications of Doppler ultrasound in feto-mater nal medicine continue. Currently, there are three main areas of intere st: Doppler velocimetry of the umbilical artery, uterine artery and th e fetal circulation (cerebral and venous blood flow studies), Evidence from randomized trials suggests that if women with suspected intra-ut erine growth retardation or pre-eclampsia are offered Doppler studies of the umbilical artery, a clinically important reduction in perinatal mortality may be expected. On the other hand, screening of low-risk w omen either by umbilical artery Doppler or uterine artery Doppler is u nlikely to be cost-effective. The study of other fetal vessels provide s a fascinating insight into vascular changes that occur in fetal comp romise, but it is not known whether the use of these tests will actual ly reduce perinatal mortality and morbidity. None of the Doppler indic es used so far, including the middle-cerebral artery to umbilical arte ry ratio, has been able to match the performance characteristics of um bilical artery Doppler. Until clear evidence emerges on its benefit or otherwise, comprehensive fetal assessment by Doppler ultrasound shoul d be used for research purposes only and results of these tests should not be used to guide clinical practice.