Doppler echocardiographic characterization of the fetus in distress

Doppler echocardiography has become an integral component to the assessment of fetal hemodynamic status, and can be utilized to assess fetuses with cardiovascular compromise due to a variety of cardiac and non-cardiac causes. As many of the conditions associated with fetal cardiac compromise now have fetal therapeutic options, understanding and identifying fetal cardiac dysfunction in the current era assumes even greater importance, because accurate description of cardiac natural history should become an important component in determining patient selection and timing of intervention.There are now a number of Doppler indices that can be readily obtained on fetal echocardiography which describe systolic and diastolic cardiac function. Classically, Doppler characterization of systemic venous and arterial flow—in the inferior vena cava, ductus venosus, umbilical vein and artery, and middle cerebral artery—have been utilized to identify changes associated with elevations of central venous pressure and changes in vascular flow distribution. More recently, the Doppler myocardial performance index has emerged as a promising new index for assessment of global systolic and diastolic ventricular function. Doppler myocardial tissue imaging is a new modality that also offers significant potential for assessing both fetal systolic and diastolic ventricular function.It is the purpose of this chapter to review the various Doppler methods of assessing fetal cardiovascular status, describe the changes in these indices that are characteristic of fetal cardiac compromise, and offer a clinical approach to the comprehensive assessment of fetal cardiovascular function.