The clinical application of Doppler ultrasound in obstetrics

Key content Current UK guidance advocates the use of uterine artery Doppler for screening and Doppler of the umbilical artery, middle cerebral artery and ductus venosus for surveillance and timing of delivery of the growth-restricted fetus. This article examines available evidence concerning the clinical application of Doppler ultrasound in obstetrics, with the aim of guiding clinicians in its application. With increasing acceptance of the concept of 'inversion of the pyramid of antenatal care', the use of Doppler in the first trimester is also discussed. Learning objectives To understand the physiological mechanisms of umbilical artery, middle cerebral artery, uterine artery, ductus venosus and tricuspid valve Doppler assessments. To appreciate existing clinical evidence for the use of Doppler in specific situations. To understand the clinical application of Doppler ultrasound in specific clinical situations. To appreciate the emerging clinical application of Doppler in the first trimester. Ethical issues Non-tertiary centres may not have access to sonographers or equipment required to perform advanced Doppler ultrasound.