Umbilical Artery Doppler Fetal Surveillance in High-risk Pre

[caryn]

"...It is recommended that umbilical artery Doppler should be the standard of practice in managing high-risk pregnancies complicated with fetal growth restriction and preeclampsia (level A recommendation). However, its use should be integrated with other current fetal monitoring tests (levels B and C recommendation). The overall management should also be guided by additional clinical considerations such as the gestational age, fetal and maternal status, and obstetrical conditions..."

http://www.ncbi.nlm.nih.gov/pubmed/21048454

So in subsequent pregnancies, your docs will likely be doing an ultrasound examination of the uterine arteries, and probably more than one, so they can keep an eye on it. The test is a second-hand way to figure out some things about the depth of implantation of the placenta. It's not a perfect test, which is why they say to couple it to other bits of information, and some people can have iffy Dopplers and good pregnancies or vice versa. Dopplers can also show improvement as the pregnancy progresses. But it is a help for picking out the pregnancies to watch more closely.

There's still no data suggesting Dopplers are of any use whatsoever in a normal low-risk pregnancy, but we're not having those sorts of pregnancies.

[kerisue]

Okay so in my next pregnancy (if there is one) my doc will likely do this. The question is though, if he sees problems, what the heck can he do about it??

[amandamm]

Okay so in my next pregnancy (if there is one) my doc will likely do this. The question is though, if he sees problems, what the heck can he do about it??

I think it just gives them an idea of how likely it is that you might get pre-e.

Can they see ischemic areas in the placenta with this? I am guessing no? My MFM told me that is likely why I got pre-e, and it would likely always happen.

[caryn]

Okay so in my next pregnancy (if there is one) my doc will likely do this. The question is though, if he sees problems, what the heck can he do about it??

Mostly they can do steroids injections to mature the lungs, and move you to a good NICU straightaway if you are not near to one. I bet this will be particularly useful for women in, say, rural Wyoming in winter, who need to relocate to Denver for the remainder of their pregnancies if and only if the pregnancy is beginning to go sideways.

Can they see ischemic areas in the placenta with this? I am guessing no? My MFM told me that is likely why I got pre-e, and it would likely always happen.

I don't think so, although they might be able to guess that the placenta was rather more ischemic if certain patterns turned up in the waveform -- depending on how the signal bounces back, you might be able to pick up dead areas, but I don't know. Ischaemic areas are hard, because they turn up in a whole lot of pregnancies that go very well. The only thing to say about them is something like "perhaps you are more sensitive to ischaemic areas than other women for some reason", which really is just a fancy way of saying "we have no idea... but there is no other obvious reason why you get PE!"

[amandamm]

Can they see ischemic areas in the placenta with this? I am guessing no? My MFM told me that is likely why I got pre-e, and it would likely always happen.

I don't think so, although they might be able to guess that the placenta was rather more ischemic if certain patterns turned up in the waveform -- depending on how the signal bounces back, you might be able to pick up dead areas, but I don't know. Ischaemic areas are hard, because they turn up in a whole lot of pregnancies that go very well. The only thing to say about them is something like "perhaps you are more sensitive to ischaemic areas than other women for some reason", which really is just a fancy way of saying "we have no idea... but there is no other obvious reason why you get PE!"

Really? My MFM told me I had chronic ischemic placental disease (or something like that) and that is why I got pre-e and would likely get it again. I didn't realize that other people got that, and went on to have normal pregnancies! blah!

[caryn]

Really? My MFM told me I had chronic ischemic placental disease (or something like that) and that is why I got pre-e and would likely get it again. I didn't realize that other people got that, and went on to have normal pregnancies! blah!

Well, I was thinking of infarcts, or areas of dead tissue in the placenta that aren't supplied with blood, common even in normal pregnancies and occuring more frequently in preeclamptics. But here's the thing about the term "chronic ischemic placental disease (or something like that)" -- it means the placenta was chronically undersupplied with blood. It is a working description of what happens in preeclampsia, since the placenta is shallowly implanted, but it doesn't really *tell you anything*. Precisely *why* the placenta was chronically undersupplied with blood? Well, it was shallowly implanted... You see where I'm going with this...

[amandamm]

Really? My MFM told me I had chronic ischemic placental disease (or something like that) and that is why I got pre-e and would likely get it again. I didn't realize that other people got that, and went on to have normal pregnancies! blah!

Well, I was thinking of infarcts, or areas of dead tissue in the placenta that aren't supplied with blood, common even in normal pregnancies and occuring more frequently in preeclamptics. But here's the thing about the term "chronic ischemic placental disease (or something like that)" -- it means the placenta was chronically undersupplied with blood. It is a working description of what happens in preeclampsia, since the placenta is shallowly implanted, but it doesn't really *tell you anything*. Precisely *why* the placenta was chronically undersupplied with blood? Well, it was shallowly implanted... You see where I'm going with this...

Unfortunately.

I kinda knew all that... except that they are common in normal pregnancies. oh well.

Thanks!

[angieb]

Is this the same test/monitoring where people mention "notching" ??

[caryn]

Angie, sorry I missed this! Yes, it is.

As I understand it, notching is when after each beat of the maternal heart, the bloodflow drops below the average flow when the heart isn't beating, and then pops back up. Here's some pretty pictures: http://www.centrus.com.br/DiplomaFMF/Se ... ga_01.html

This means that the placenta isn't as deeply implanted, because the flow isn't as steady -- it pulses, and not just *up*, with each maternal heartbeat, but *down* a little bit, which is the notch. And it's because the spiral arteries aren't as "remodeled", as they put it -- the placental cells haven't replaced as much of the artery, so the placenta's shallowly implanted.

I've posted a bunch of recent studies in News where they've looked at this notching when it happens in pregnancies following preeclamptic pregnancies, and it's only thought to be *an* indicator, and not a terribly useful one unless it's coupled to other information, because many women with notching go on to have perfectly normal pregnancies. Absent or reverse diastolic flow are solid indicators for delivery, but notching is very common.

Here are some links to those studies:
http://www.preeclampsia.org/forum/viewtopic.php?t=31603
http://www.preeclampsia.org/forum/viewtopic.php?t=31480

[angieb]

Thanks Caryn! My MFM is having the ultrasound tech look for notching while I'm there anyway, I don't expect for them to find much of anything this next time (Friday @17.5 wks), but I'll be feeling a little better if the next one (@ 20 wks) comes back good and everything else is still going well. (So far things are going better, as my quad screen came back clear this time, since my AFP levels were very elevated with Olivia and they ruled out genetic issues/birth defects.)