ABSTRACT
Introduction Doppler examination of venous volume flow was introduced almost 40 years ago1-3; it has since provided valuable physiological information but so far not progressed to become a common clinical tool. The assessment of venous pulsations4-6 has become part of the fetal hemodynamic evaluation. Both the chronic challenge of intrauterine growth restriction (IUGR) due to placental compromise and its final stages with cardiac decompensation are examples of how changes in fetal hemodynamics are reflected in the fetal veins. With reason, we believe that the venous velocity pattern is a more instantaneous indicator for hemodynamic performance than is the umbilical artery velocity pattern. In this chapter, the ductus venosus and umbilical vein are used to illustrate general mechanisms operating in the precordial and peripheral fetal veins, and some distributional patterns of IUGR are discussed.
Physiological background We focus on the common clinical problem of IUGR due to placental hemodynamic compromise, but also keep in mind that a variety of other causes of altered growth may be associated with modified circulatory development and hemodynamic responses (e.g., malformations, chromosomal aberrations, metabolic disorders, infections, radiation, teratogens, drugs, smoking, alcohol, and malnutrition).
