Umbilical Artery Flow Velocity Waveforms Research Articles

Changes in Umbilical Artery Doppler Velocimetry After Betamethasone Administration in Pregnancies With Fetal Growth Retardation

Objectives: The administration of betamethasone is associated with increased placental vascular resistance results in the return of the diastolic flow. This study aimed to assess the changes in the flow velocity waveform (FVW) color Doppler in the umbilical artery after the administration of betamethasone in pregnancies with fetal growth retardation (FGR). Materials and Methods: This descriptive-analytical research included all pregnant women who were referred to Al-Zahra teaching hospital and diagnosed with FGR. The eligibility criteria were the impaired umbilical artery FVW color Doppler, qualified for the administration of a fix-dosed Betamethasone, and no fetal abnormalities. The perinatologists performed the FVW color Doppler ultrasonography before and after the administration of betamethasone at intervals of 24, 48, and 96 hours and weeks 1 and 2. FVWs were obtained by pulsed-wave Doppler ultrasonography. Then, neonatal outcomes were recorded based on neonates’ admission documents. Finally, one-way repeated measures ANOVA, Cochran’s Q test, and paired-samples t-test were used to compare Doppler indices before and after betamethasone administration. Results: The mean pulsatility index (PI) and resistance index (RI) of the umbilical artery showed a statistically significant reduction after the administration of betamethasone (P<0.001). The measured umbilical artery PI at two weeks after drug administration predicted the neonatal intensive care unit admission (P = 0.042). Eventually, the results revealed no significant association between the amniotic fluid index (AFI) and betamethasone administration (P = 0.3). Conclusions: In general, betamethasone administration improved the FVWs of the umbilical artery in pregnant women with fetal growth restriction while no association was found between the AFI and betamethasone administration.

Predictive value of fetal renal artery Doppler indices in idiopathic oligohydramnios and polyhydramnios

Objective The aim of this work was to study the relation of renal artery (RA) and umbilical artery (UA) flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by either polyhydramnios or oligohydramnios. Background There is a relation between RA and UA flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by either polyhydramnios or oligohydramnios. Patients and methods All patients were enrolled from patients attending the outpatient clinic of El-Galaa Maternity Teaching Hospital. All patients were matched for maternal age, gestational age, and parity at the time of sonography, comparing RA Doppler indices pulsatility index (PI) and resistance index at 22, 28, and 34 weeks in three groups. Group I consisted of 20 patients of normal amniotic fluid index, group II consisted of 20 patients with oligohydramnios, and group III consisted of 20 patients with polyhydramnios. Results RA PI values were higher in group II than group I at 22 weeks, 28 weeks, and 34 weeks. The PI value at 28 weeks of gestation was statistically significant (P = 0.016). At 28 weeks of gestation, group II also had higher UA PI and resistance index values than group I. Conclusion An increase in RA PI develops in early pregnancy before the development of oligohydramnios. In pregnancies developing polyhydramnios, RA PI was lower.

Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

Umbilical artery serum chitotriosidase concentration in pregnancies complicated by preeclampsia and relationship between chitotriosidase levels and fetal blood flow velocity

Objective: To evaluate the significance of umbilical cord chitotriosidase concentrations in pregnancies with mild preeclampsia and explore the relationship between fetal chitotriosidase levels and fetal blood flow velocity. Method: The study population included control group (n = 40) and study group with mild preeclampsia (n = 40). Umbilical cord blood samples were collected immediately after delivery. Umbilical artery (UA) flow velocity waveform was determined just before delivery. Results: Umbilical cord chitotriosidase levels and UA S/D rate were significantly high in preeclamptic group. Conclusion: Chitotriosidase may be useful biochemical marker of fetal compromise that reflects the severity of fetoplacental blood flow resistance in pregnancies complicated by preeclampsia.

Umbilical cord activin A concentration in pregnancies complicated by mild preeclampsia and relationship between activin A levels and Doppler

To evaluate the significance of umbilical cord activin A concentration in preeclampsia and also explore the relationship between activin A levels and Doppler findings. Methods. The study population was constituted 40 pregnancies complicated with term mild preeclampsia and control group constituted 40 pregnancies with uneventful, term gestation. Umbilical cord blood samples were collected immediately after fetus delivery. Umbilical artery and middle cerebral artery flow velocity waveform were determined just before delivery. Activin A levels were high in preeclamptic group (p<0.0001). Marked increase of umbilical artery S/D rate and pulsatility index (PI)(p<0.0001) and also decrease of middle cerebral artery PI (p<0.05) were detected in preeclamptic group. No significant changes in middle cerebral artery S/D rate were observed between two groups (p>0.05). There were no correlation between Doppler examination and activin A level. Umbilical cord activin A levels reflected directly fetoplacental unit resistance in preeclampsia. <br/><a href=

Examination of the fetal cardiovascular system

Doppler evaluation of the placenta and fetal cardiovascular system is one of the primary surveillance tools in prenatal medicine. By assessing uterine and umbilical arteries, placental development can be documented. This is useful for the prediction of hypertensive maternal disorders and placental dysfunction and fetal growth failure. The umbilical artery flow velocity waveform provides an estimate of villous vascular occlusion in the fetal compartment of the placenta. Middle cerebral artery Doppler is important in studying fetal responses to abnormal oxygenation and fetal anemia. Precordial venous Doppler gives insight into the cardiac effects of many conditions such as fetal growth restriction, twin-twin transfusion syndrome and fetal arrhythmia. Further quantification of these effects requires cardiac Doppler to quantify diastolic and systolic function as well as global myocardial performance. This article reviews important characteristics of arterial and venous Doppler waveform analysis, individual vascular beds and their clinical application in fetal evaluation.

DOPPLER UMBILICAL FLOW WAVEFORMS IN MILD HYPERTENSIVE PREGNANCY

Objective: To assess the relationship between the Doppler umbilical artery flow velocity waveforms (AB ratio) in mild hypertensive pregnancy and the fetal outcome. Materials & Methods: This is prospective study which carried out between January 2004 and January 2005. Doppler examination of the umbilical artery was available for 135 pregnant women within 1 week of delivery. The value of the last Doppler AB ratio was classified into 3 groups: normal (AB ratio is 95th but 99th centile value). Results: Normal AB ratio was found in 91% of mild hypertensive women and 82% of cases were delivered after 36 weeks with average mean birth weight and good Apgar score (more than 6 at one minute). Abnormal ratio was found in 5% of mild hypertensive cases with 40% of them was delivered before 36 weeks with significant admission in the intensive baby care unit. Conclusion: Doppler study can be used as a good tool for assessment of high risk fetus in mild hypertensive women.

Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome

Objectives: To evaluate the effect of intensive fetal surveillance via Doppler ultrasound and fetal non-stress test on the perinatal outcome of pregnant women undergoing an intensified hemofiltration scheme. Methods: Five consecutive pregnancies of women undergoing intensified hemodialysis were analyzed due to the following parameters: maternal background, hemodialysis schedule during pregnancy, blood pressure, occurrence of fetal complications, occurrence of obstetric complications, gestational week at delivery, mode of delivery, and newborn outcome and follow-up. Results: All pregnancies resulted in a live birth, mean gestational age was 32 weeks. Intrauterine growth restriction occurred in 4 fetuses, pathological umbilical artery flow velocity waveforms in 2. The mean birth weight was 1,764 g (range 1,274–2,465 g). Cesarean section was performed in 3 patients because of fetal distress. None of the patients developed severe complications like pre-eclampsia. Conclusions: Although intensified dialysis enables the maintenance of stable uteroplacental and fetal perfusion, intensive fetal monitoring is mandatory to reduce perinatal morbidity and mortality in pregnant women on maintenance dialysis.

Evaluation of the use of umbilical artery Doppler flow studies and outcome of pregnancies at a secondary hospital

Objective. To investigate the use of a personal computer (PC)-based, continuous-wave Doppler machine by a trained midwife at a secondary hospital to assess umbilical artery flow velocity waveforms (FVW) in referred women.Methods. Pregnant women referred for suspected poor fetal growth were evaluated from June 2002 through December 2004. The Umbiflow® apparatus, consisting of a Pentium 3 PC with an ultrasound transducer plugged into the USB port and software, was used to analyze the FVW of the umbilical artery. Pregnancies in which the resistance index (RI) was <75th percentile (P75) were not further evaluated for fetal well-being unless the clinical condition of the mother changed. Pregnancies with an RI ≥P75 were followed up according to a specific protocol. Primary end points were intrauterine death and intrauterine growth restriction.Results. A total of 572 singleton pregnancies were followed up. Significantly more infants were small-for-gestational-age when the RI was >P95 (55.6%) than those between P75 and P95 (41.2%) or <P75 (27.2%). Perinatal mortality rates were 13.2, 39.1 and 41.7 for women with RIs <P75, P75–95 and >P95, respectively.Conclusions. A normal Doppler FVW of the umbilical artery is less likely to be followed by perinatal death.

Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform

Our purpose was to evaluate the hemodynamic significance of fetal inferior vena cava (IVC) flow velocity waveform indices during fetal development in relation to the diameter pulse waveform. Doppler ultrasound and a phase locked loop echo tracking system were used to measure flow velocity waveform and diameter pulse waveform, respectively. Twenty-seven normal singleton pregnancies were examined from 20 weeks until term at 4-week intervals. The diameter pulse waveform consisted of four waves (A, X, V, and Y waves). The A value (end-diastolic diameter) was associated with the end-diastolic pressure, which causes reverse flow during right atrial contraction. In normal fetuses, a weight-related lower end-diastolic diameter suggested that the end-diastolic pressure was decreased. Except for a positive correlation between the percent reverse flow during atrial contraction and the A value per unit fetal weight, no correlations were found between diameter waveform indices and blood flow velocity waveform indices. The peak velocity index of the velocity waveform significantly correlated with the umbilical artery flow velocity waveform systolic/diastolic ratio. The fetal IVC velocity waveform indices did not yield unequivocal information as to changes in central venous pressure, for which purpose the diameter pulse waveform analysis would seem to be the only available method.

Doppler, Cardiotocography, and Biophysical Profile Changes in Growth-Restricted Fetuses

To assess from diagnosis to delivery the Doppler studies of the umbilical artery, middle cerebral artery, umbilical vein, ductus venosus, and amniotic fluid index of fetuses with idiopathic growth restriction. A total of 145 singleton growth-restricted fetuses with abnormal umbilical artery pulsatility indexes were studied. Cesarean delivery was performed because of abnormal biophysical profile or nonreassuring fetal heart rate pattern. There were 4 fetal and 50 neonatal deaths. Two growth-restricted groups were identified: Group A (n = 44) included fetuses in whom all measures became abnormal preceding an abnormal biophysical profile or nonreassuring nonstress test. Group B (n = 101) included fetuses in whom 1 or more measures were normal at the time of cesarean delivery. There was no statistically significant difference in perinatal morbidity and mortality between the 2 groups. Neonatal death was increased in fetuses with umbilical artery reversed flow (odds ratio 2.34, 95% confidence interval 1.16-4.73; P < .05) and ductus venosus reversed flow (odds ratio 4.18, 95% confidence interval 2.01-8.69; P < .05). A significant correlation was also found between low birth weight and adverse perinatal outcome. In fetuses with idiopathic growth restriction, 1) low birth weight, 2) umbilical artery reversed flow, and 3) ductus venosus absent or reversed flow are associated with an increased perinatal morbidity and mortality.

Betamethasone-Associated Changes in Umbilical Artery Flow Velocity Waveforms in Multiple Pregnancies With Umbilical Artery Absent End Diastolic Flow

Glucocorticoids reportedly temporarily restore the flow velocity waveform in the umbilical artery in singleton pregnancies in which there is no end diastolic flow in this vessel. The present study asked whether similar changes take place in multiple pregnancies when 1 fetus has absent end diastolic flow in the umbilical artery. Twenty-four twin or triplet pregnancies complicated by umbilical artery absent end diastolic flow in 1 of the fetuses were accessed in the years 1996–2002. All women received 2 doses of 11.4 mg betamethasone at a 24-hour interval in an attempt to prevent preterm delivery. They were admitted to the hospital for intensive fetal observation that included daily ultrasound studies of the umbilical artery flow velocity waveform. Six cases diagnosed as twin-to-twin transfusion were excluded. Sixteen of the remaining pregnancies were twins, half of them monochorionic diamniotic, and half dichorionic diamniotic. Two trichorionic triplets completed the study population. Only 1 fetus in each pregnancy had an absent umbilical artery flow velocity waveform; the cofetuses all had normal waveforms. Three women had gestational hypertension and 1 each had insulin-dependent diabetes and essential hypertension. The diagnosis was made at a median gestational age of 210.5 days. Betamethasone treatment was accompanied by a return of end diastolic flow in 9 of the 18 pregnancies; it persisted for a median time of 5 days. No deliveries took place before end diastolic flow stopped. Neither chorionicity nor gestational age at diagnosis influenced the response to betamethasone. All cofetuses had forward end diastolic flow within the normal range for gestational age. Median birth weight was significantly lower when end diastolic flow did not respond to betamethasone (1172 g vs. 1793 g). As is the case for singleton pregnancies, betamethasone treatment is associated with a transient return of umbilical artery end diastolic blood flow in affected fetuses of multiple pregnancies.

Abnormal Umbilical Artery Doppler Waveforms and Cord Blood Inhibin A and Inhibin B Levels

Inhibin A and inhibin B are glycoprotein hormones produced by human placenta and by several fetal organs during pregnancy. They are secreted in maternal circulation in increasing amounts from early until term pregnancy, and in umbilical cord blood levels are significantly lower than in maternal serum and do not differ from mid-pregnancy to term gestation. In the present study, we aimed to determine whether secretion of inhibin A and inhibin B into the fetal circulation is increased in pregnancies complicated by umbilical-placental vascular insufficiency. A group of women (n = 13) with abnormal Doppler umbilical artery flow velocimetry and a group of control women (n = 11) with uncomplicated term pregnancies and normal umbilical artery flow velocity waveforms were studied. In each woman, inhibin A and inhibin B concentrations were estimated in umbilical cord artery and vein. In the two groups of women, mean inhibin A levels did not differ between umbilical cord artery and vein. In addition, no difference was retrieved both in umbilical cord artery and vein values between healthy controls and patients with abnormal Doppler umbilical artery flow velocimetry. On the contrary, inhibin B levels were significantly higher in samples from umbilical cord vein than artery, in both groups of pregnant women (both p < 0.001). However, women with abnormal Doppler umbilical artery flow velocimetry had inhibin B levels significantly higher than healthy controls (p = 0.005) only in the umbilical cord artery, but not in the vein. In the presence of abnormal Doppler umbilical artery flow velocity, the concentrations of inhibin B are increased in the arterial umbilical circulation, suggesting that inhibin B is released from multiple fetal sources as a response to hypoxemic stress. As inhibins may affect the hypothalamus-pituitary-adrenal axis which plays an important role in the mechanisms of adaptations to the post-natal life, inhibin B in fetal circulation might then be beneficial to a fetus whose intrauterine survival is threatened by impaired umbilical-placental blood flow.

The Doppler Assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy

Objective To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies. Design A prospective randomised controlled multicentre trial of women with twin pregnancies. Setting Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia. Population Pregnant women with twin pregnancies. Methods Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise. Main outcome measures Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention-to-treat. Results There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group ( n = 264), which was 11/1000 live births, and the Doppler group ( n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01–1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance. Conclusions In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.

The Doppler Assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy

To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies. A prospective randomised controlled multicentre trial of women with twin pregnancies. Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia. Pregnant women with twin pregnancies. Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise. Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention-to-treat. There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group (n = 264), which was 11/1000 live births, and the Doppler group (n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01-1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance. In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.

Changes in Umbilical Artery Flow Velocity Waveforms Following Maternal Administration of Betamethasone

In a retrospective cohort study we have previously shown that administration of betamethasone to women with a pregnancy complicated by absent end-diastolic flow in the umbilical artery (UA) is associated with altered UA flow velocity waveforms. To examine this phenomenon further we undertook a prospective study of 30 similar singleton pregnancies. Umbilical artery FVWs were recorded before and after betamethasone administration using real-time pulsed wave colour flow Doppler. The results of this prospective cohort were similar to those of the retrospective study allowing pooling of the data. Of the 55 total pregnancies with umbilical artery AEDF studied betamethasone administration was associated with the return of end-diastolic flow in 39 (71 per cent; 95 per centCI: 59–83 per cent). The median (range) duration of this change was 3 (1–10) days. There is no evidence that this change has either a beneficial or detrimental effect on foetal health. Administration of betamethasone to women with a pregnancy complicated by umbilical artery AEDF is associated with the transient return of end-diastolic flow in most cases. While the mechanisms underlying this effect are yet to be fully elucidated it has implications for foetal surveillance in these high-risk pregnancies.

Decreased vascularization and cell proliferation in placentas of intrauterine growth–restricted fetuses with abnormal umbilical artery flow velocity waveforms

Objective: The purpose of this study was to compare the morphologic features of placentas in severe intrauterine fetal growth restriction with abnormal umbilical artery blood flow velocity waveforms and normal gestation. Study Design: Immunohistochemical methods were used to evaluate cell proliferation, vascular density, and α-smooth muscle actin expression by stromal cells in a group of 9 age-matched intrauterine growth–restricted and control placentas at 25 to 41 weeks of gestation. Results: Fewer MIB1-positive nuclei were observed in both trophoblast and stromal cell populations in intrauterine growth restriction, which indicates fewer cells in cycle. Furthermore, a greatly reduced vascular density was observed, along with higher levels of α-smooth muscle actin expression in stromal cells. Conclusion: Intrauterine growth–restricted placentas show reduced cell proliferation in both trophoblast and stromal cell compartments. Peripheral villous vascularization is highly reduced. (Am J Obstet Gynecol 2002;187:764-9.)

Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone.

To determine the timing of the onset of the umbilical artery flow velocity waveform changes following maternal administration of betamethasone in pregnancies complicated by umbilical artery absent end-diastolic flow, and to explore whether these changes are associated with flow velocity waveform changes in other fetoplacental vessels. This was a prospective study of 12 women with pregnancies complicated by umbilical artery absent end-diastolic flow. Flow velocity waveforms were recorded from the umbilical artery, fetal middle cerebral artery, renal artery, aorta and ductus venosus, before and after maternal betamethasone administration, using real-time pulsed wave Doppler. In all 12 pregnancies, the administration of maternal betamethasone was followed by the return of end-diastolic flow within 24 h. End-diastolic flow was first observed at 4 h and was present in all women studied at 8 h. In addition, there was a statistically significant decrease in the pulsatility index in the fetal aorta at 8 h and the middle cerebral artery at 24 h. No change was observed in the ductus venosus or the renal artery flow velocity waveforms. The findings suggest that, in pregnancies complicated by absent end-diastolic flow in the umbilical artery, maternally administered betamethasone induces a return in umbilical artery end-diastolic flow as early as 4 h, along with widespread vasodilatation throughout the fetoplacental vasculature.

Cyclic changes in the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy

Objective: To determine the effect of arterio-arterial anastomosis on the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy. Subjects: Thirty-three women with mono-chorionic, di-amniotic twin pregnancy. Methods: Pulsed Doppler ultrasonographic examination was performed every 4 weeks to obtain umbilical arterial flow velocity waveforms in both two fetuses. Results: In five of the women, cyclic flow changes in the umbilical arterial flow were detected in the smaller fetus. All of these twins had arterio-arterial anastomosis on the surface of the placenta. Conclusion: The fetuses in mono-chorionic and di-amniotic twin gestation who showed cyclic changes in umbilical arterial flow had arterio-arterial anastomosis. But, this characteristic flow was not observed every time.

Diagnosis and prognostic value Doppler flow velocity waveform in high risk pregnancies

Objective: To determine whether Doppler umbilical artery flow velocity waveforms (FVW) would improve the clinical management and reduce the prenatal morbidity or not, in cases of high risk pregnancies.Methods: A total of 160 pregnant women of 28 weeks or more gestational age were included in this study. The age of the cases were from 20‐ to 30‐year‐old and their gravidity ranged from gravida 1 to 5. The cases were classified into two groups. Low risk group, not associated with medical or obstetric complications and includes 70 cases. High risk groups include, the other 90 cases, such as the following: mild pre‐eclampsia (20), severe pre‐eclampsia (15), diabetes mellitus (10), postdated pregnancy (15), previous one or more cesarean section (15), rheumatic heart (4), decreased perception of fetal movement (3), bronchial asthma (2), Rh incompatibility (2) and previous IUFD. All of them were subjected to thorough general and obstetric examination, investigations, ultrasonic examination, biophysical profile scoring and Doppler umbilical artery FVW study. The cases of low risk group were examined every 2 weeks, while high risk ones, were examined every week or twice weekly according to the results of the previous examination.Results: There is a highly significant difference between values of umbilical artery FVW indices in low and high risk group. Doppler has specificity 92.8% in cases of low risk group while has sensitivity 52.8% and specificity 55.6% in cases of high risk group and it is more sensitive than biophysical profile. Doppler of umbilical artery is very beneficial in cases of pre‐eclampsia, where its sensitivity 78.5% and its specificity 52%.Conclusion: There is a strong association between abnormal FVW and adverse fetal outcome. The Doppler will identify a group of fetuses truly at risk, where intensive fetal monitoring or delivery will be required.