Doppler measurements of fetal and uteroplacental circulations: relationship with umbilical venous blood gases measured at cordocentesis.
A pulsed Doppler study of the fetal and uteroplacental circulations was performed on 41 pregnant women with small-for-gestational-age and 10 women with appropriate-for-gestational-age fetuses at 19 to 37 weeks' gestation. Blood gases and pH, measured in umbilical venous samples obtained by cordocentesis within 1 hour of the Doppler studies, were correlated individually and as an "asphyxia" index, to the Doppler and ultrasonographic biometric measurements. Although there were significant correlations between the majority of the ultrasonographic biometric and Doppler measurements with the blood gas results, better correlations were found with the ratio of common carotid artery to descending thoracic aorta mean velocity and pulsatility index. The best predictor of asphyxia was an index comprising aortic mean velocity and the common carotid artery pulsatility index. When this index was abnormal, 89% of fetuses had an asphyxia index 1 SD above the mean and 60% 2 SDs above the mean. A normal index was always associated with normal blood gases. The indices representing the inverse relationship of impedance and velocity in the two major vessels that supply the brain and the abdominal viscera provide the best prediction of the fetal condition because they reflect the hemodynamic response to changes in the partial pressure of respiratory gases.