Doppler assessment of the cardiac and uteroplacental circulations in normal and complicated pregnancies.

Blood flow velocity waveforms were recorded in four sites in the fetal circulation in a series of 271 normal and 71 complicated pregnancies. The sites were the umbilical artery, the uterine artery branches in the placental bed, and distal to the two arterial valves in the heart. The blood flow through the arterial valves was added to estimate combined cardiac output. Normal ranges for values in all sites were established in our own series, and were similar to other published results. Abnormality of the waveform in the umbilical artery proved the most useful predictor of perinatal morbidity. Reversal of the normal pattern of increasing diastolic flow in the umbilical artery with advancing gestation was an important prognostic finding in the pregnancies studied serially. The combined cardiac output did not fall until late in the course of fetal compromise, and low values were seen only with an abnormal umbilical artery tracing.