[Clinical value of a decrease in diastolic flow in obstetric Doppler sonography]

Abstract

Doppler ultrasound in obstetrics is being increasingly accepted in foetal surveillance. For clinical practice, a good correlation between Doppler findings and biochemical data such as blood gas analysis and lactate as a metabolical parameter, would be desirable. To clarify this question, these results have to be compared. Prepartal Doppler results which are correlated with postpartal blood gas analyses of umbilical vessels cannot be a satisfactory criterion due to the influence of labour on these parameters. Therefore, we depend on results from foetal blood sampling procedure. The five cases presented here should be a contribution to this discussion. In summary it can be concluded, that in cases of a highly pathological Doppler analysis in the umbilical artery, intrauterine growth retardation must be expected. If there is an acidosis in the foetal organism, it can be assessed via the foetal carotid findings. This, therefore is our contribution to the discussion on the indication for Caesarean section in cases of absent diastolic flow: Absence of diastolic flow in the umbilical artery and foetal aorta only without centralisation by increased perfusion in the foetal carotid, is, in our opinion, not an indication for Caesarean section. We believe, that foetal acidosis confirmed by foetal blood gas analysis indicated by the Doppler result, is an efficient completion of obstetrical management in risk pregnancies. Any further decision on conservative management or termination of pregnancy can be taken more easily on the basis of biochemical data, especially in situations, where conventional methods of foetal surveillance cannot clarify the perinatal risk sufficiently.