Recent UK guidance advocates use of the ductus venosus in the timing of delivery of the growth restricted fetus. Ductus venosus doppler has a moderate predictive accuracy for determining peri-natal outcome. We are awaiting the official results from TRUFFLE which will hopefully offer further guidance. Additionally many obstetricians are not trained in the acquisition of this doppler and correct acquisition is vital for interpretation and management. Hence, what is the consensus; should we use it? The evidence seems to say so, but what implications does this have for the layout of obstetric care and in reality are obstetricians using it as a tool to time delivery?
I agree with UK guidance recommendation. Ductus venosus Doppler is more significant then umbilical artery Dopler, particularly when gestational age is less than 32 weeks. Official results o TRUFFLE study were not conclusive, unfortunately. The appropriate acquisition of Ductus venosus Doppler is directly proportionell with the number of the measurements performed. We obstetricions/fetalmedicine experts must reach this competence level. Ductus venosus Doppler combined with short time variability on CTG is the best method for the timing of delivery, in my opinion.
Ti learn how to measure it, you could go to fetal medicine foundation web page,there' s a short on line educational movie
I think we definitely should implement the use of Doppler flow of the DV. IT is useful not only in IUGR fetuses but also much earlier in pregnancy- both as a predictor to chromosomal abnormalities as well as for cong heart defects.
In my opinion DV is not helpfull as isolated Dopplerparameter. The old fashioned idea of an step to step change of UA > MCA > DV seems to be not true (Unterscheider J et al. AJOG 2013 539e1) . There are multiple combinations of changes in the Doppler Parameters and we have to check the follow up of all of them including growth, Amnion Fluid, BPP and the cerebro placental ratio.
DV is sometimes difficult to measure in a IUGR Fetus an there is a risk for a false positive "reversed flow" by measuring the liver vessels. You need training and supervison.
Thanks Johannes this is what I was trying to get at with my point. I think that to those who are not trained formally in DV assessment, the IVC or hepatic waveform can be falsely interpreted in this situation hence DV should not be routinely used in obstetric practice until more evidence RE the temporal sequence is established
DV clearly has a role to play not only in IUGR but as mentioned earlier in the first trimester as a marker of fetal aneuploidy and congenital heart disease. In the follow-up of severe IUGR, complicated mono-ch twins. Training is part of the key in assessing DV accurately and avoiding confusion with adjacent vessels. Pregnancies with such complications that justify DV assessment should be followed in maternal fetal medicine centres where these skills should be established.
At the moment there is no evidence that ductus venosus Doppler study is advisable is advisable for the tim,ing of the delivery in hypoxaemic IUGR fetuses. It i susrprising that after a long time since the end of case sollection there are no answers from the TRUFFLE study.Anyway we must remember that this study only regrds premature pregnancy .
DV assessment has not caught on in the US because of issues mentioned previously.
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