Doppler velocimetry of normal human fetal venous intrapulmonary branches

Objectives To describe the nature of flow velocity waveforms from fetal mid dle and distal venous pulmonary branches in the second half of normal pregn ancy in relation to gestation, and to test repeatability and interrelations hips of flow velocity waveform recordings from proximal, middle and distal venous pulmonary branches. Design Cross-sectional study. Subjects/methods A total of 111 normal singleton pregnancies between 20 and 40 weeks' gestation were studied using a color-coded Doppler ultrasound sy stem. Pulmonary waveforms were obtained at the level of the fetal cardiac f our-chamber view. Repeatability was tested from two recordings at 15-min ti me intervals in 25 separate normal pregnancies. Results The nature of middle and distal venous pulmonary flow velocity wave forms was comparable with that of proximal waveforms. Acceptable repeatabil ity of pulmonary venous flow velocity waveforms with coefficients of variat ion below 15% was established for nearly all velocity parameters and their ratios. A gestational age-dependent change was found for all flow velocity waveform parameters including pulsatility index for veins at both middle an d distal venous levels. Significant inter-pulmonary changes were observed f or nearly all pulmonary venous waveform parameters. Conclusions It is speculated that increase in volume flow and venous pulmon ary pressure gradient plays a role in gestational age-dependent changes, wh ereas changes in vessel diameter and distance between the heart and more di stal venous pulmonary vessels are responsible for inter-pulmonary changes.