Can a Multisite UA Doppler Score Better Predict FGR?
Accurate fetal surveillance remains essential when managing pregnancies with fetal growth restriction. Recently, researchers introduced a novel approach called UA Doppler scoring to refine risk assessment. Therefore, clinicians can better evaluate hemodynamics across multiple anatomical cord segments. In this article, we examine how multisite evaluation enhances prenatal decision-making.
The Rationale Behind Multisite UA Doppler Scoring
Standard protocols typically measure blood velocity at a single cord location. However, placental resistance often varies along the length of the umbilical cord. Furthermore, hemodynamic alterations may appear earlier at specific segments. Consequently, evaluating both umbilical arteries across multiple anatomical sites provides a more comprehensive picture. Specifically, this modified method examines the perivesical segment, free loop, and placental insertion site bilaterally. Thus, clinicians assign numerical points based on present, absent, or reversed end-diastolic flow across all six locations.
Study Findings and Perinatal Outcomes
A prospective cohort study evaluated 251 pregnancies complicated by early-onset or late-onset fetal growth restriction. Notably, researchers stratified patients based on a cumulative score cutoff of three points. As a result, neonates with scores of three or higher experienced significantly higher rates of composite adverse perinatal outcomes. Additionally, higher scores strongly correlated with preterm delivery and increased neonatal intensive care admissions. Multivariable analysis confirmed that the scoring system remained an independent predictor of adverse outcomes. Moreover, higher score categories demonstrated a direct linear relationship with progressive fetoplacental deterioration.
Clinical Implications for Practice
Managing fetal growth restriction requires balancing the risks of prematurity against the danger of intrauterine hypoxia. Therefore, this multisite scoring tool offers refined risk stratification for high-risk pregnancies. In particular, it assists obstetricians in identifying fetuses that require closer antenatal monitoring. However, clinicians should integrate these findings alongside ductus venosus Doppler and biophysical profiles. Ultimately, future multicenter trials will clarify whether adopting this comprehensive protocol improves long-term neonatal health.
Frequently Asked Questions
Q1: What anatomical sites are evaluated in this scoring system?
The protocol evaluates six predefined sites, including the perivesical segment, the free loop, and the placental insertion for both umbilical arteries.
Q2: How does the score correlate with neonatal outcomes?
Specifically, a score of three or higher is independently associated with preterm delivery, intensive care admission, and composite adverse perinatal outcomes.
Q3: Can this scoring method be applied to both early and late fetal growth restriction?
Yes, the study validated this scoring system in both early-onset and late-onset growth restriction cohorts.
References
- Bulan DD et al. Modified umbilical artery Doppler scoring system based on multisite assessment: association with perinatal outcome in early and late fetal growth restriction. Ultrasound Obstet Gynecol. 2026 Sep undefined. doi: 10.1002/uog.70319. PMID: 42640180.
- Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(2):298-312. doi: 10.1002/uog.22134. PMID: 32738107.
- Molloholli M, Napolitano R, Ohuma EO, et al. Image-scoring system for umbilical and uterine artery pulsed-wave Doppler ultrasound measurement. Ultrasound Obstet Gynecol. 2019;54(2):236-242. doi: 10.1002/uog.20177. PMID: 30421832.
