Fetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column.

Abstract

Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the "aortoumbilical column". Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.