Did/does anyone have/dad issue with the doppler umbilical artery test?

Mrs.Babbsy

I am juts curious if anyone else is having or had this issue. I have one baby who is showing elevated pressure in her umbilical cord. I know it's like her having high blood pressure and it's not allowing her to gain weight as she should.

I am trying to find stuff online and I can't find anything.

 

Kadyra

I have this problem.  IUGR in the 1st percentile with mildly elevated UA dopplers.  I will try and put some references from my MDconsult account here.

https://www.mdconsult.com/das/book/body/151570248-4/867109201/1528/308.html#4-u1.0-B978-0-443-06930-7..50031-1--cesec29_1424

https://www.mdconsult.com/das/book/body/151570248-4/867109201/1528/116.html#4-u1.0-B978-0-443-06930-7..50013-X--cesec13_585

Basically what it means is this: the placenta is a  low resistance organ under normal circumstances.  it should be easy for nutrients to get through it to the baby/babies.  when your heart is contracting (systole), blood goes through it easily, but it should go through it easily when your heart is filling (diastole). Elevated dopplers are when the umbilical artery pressures become high resistance because of some problem with the placenta (what that is, is difficult to say because there are a bazillion reasons).  The umbilical artery is what takes blood and nutrients to your baby.  So, during your systole, blood goes easily, but during diastole it is tough because of the resistance. What your doctor looks at is a ratio of the velocity of the blood during systole to diastole.  If the velocity during diastole is low, this number will be "elevated."  There are different values depending on how far along you are.  Basically 4 is fine for 28 weeks, 2 is good for 32 weeks and later. 

There are a couple of other terms.  If the resistance is so high that no blood is going through during your diastole, this is called Absent End Diastolic Flow.  They will admit you to the hospital for this and do either continuous monitoring on L&D or intermittent monitoring on antepartum.  If the resistance is so high during your diastole that the placenta is stealing blook from the baby, this is called Reverse End Diastolic Flow.  They will admit you for this (if you're not already admitted) and do continuous monitoring on L&D.  You don't have to be delivered unless your monitoring strip starts to show decelerations or your baby has not grown. 

They can look at other arteries and veins in your baby, but the umbilical artery is where they will start and it is the most accurate with poor growth.  They may look at the MCA (middle cerebral artery), ductus venosis, or umbilical vein if your baby starts to look worse.

You're very right in saying that yes, if your baby has this, it can't grow properly.  Because if its blood flow is compromised, it can't get the nutrients it needs to put on weight.  So you'll get more intensive monitoring.  It's scary, but not the end of the world. 

I just have an elevated S/D ratio.  It should be near 2 for me, and mine is above 4.  I don't have any AEDF or REDF.  Others on this board have had those, and I have taken care of a lot of ladies with those.  You can hang out with elevated S/D ratios for weeks/months or even intermittent AEDF for weeks and come out with a good baby.  These small, stressed-out babies tend to do well in the long run as long as they are watched closely.

HTH!

Mrs.Babbsy

WOW, thank you soooo much. That helps a ton, I assume the placenta issue is that it is supplying 2 babies with nutrients. I am having mono-di twins.

I just don't feel like I am getting a lot of info right now. I don't think I understand the severity of the issue. I wish I knew what the ratio was now. I think I may ask next time the nurse comes in.

I have been admitted to the hospital for the low weight and the umbilical artery flow.

Thanks again! This was very helpful!

Kadyra

You're very welcome.  It's a really hard topic because even in the textbooks the chapters and sections are shorts.  We spend a lot of time on it in lecture, so it gets beaten into our brains.

The placenta basically is where baby's blood and mom's blood come in close contact with each other and exchange oxygen and nutrients (but the blood doesn't actually touch).  If the baby's blood has a hard time reaching the placenta, that's why the baby may struggle to grow.

I look at my placenta on every ultrasound and I glare at it.  Not that it does any good

 GL and I hope everything works out well for you!