Umbilical artery Doppler waveform notching: Is it a marker for cord and placental abnormalities?

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, USA.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine (Impact Factor: 1.54). 09/2002; 21(8):857-60.
Source: PubMed


To evaluate in a prospective, controlled fashion the prevalence of umbilical artery Doppler waveform notching and its association with cord and placental abnormalities.
During a 6-month period, umbilical artery velocity waveforms were prospectively obtained on 1857 pregnancies at greater than 27 weeks' gestation. All pregnant patients with the presence of a persistent fetal umbilical artery waveform notch formed the study population (cases). Control patients, matched for gestational age, with normal umbilical artery waveforms, were selected for comparison (2 controls per case). After delivery, detailed pathologic examination was performed on all umbilical cords and placentas.
The presence of an umbilical artery waveform notch was noted in 29 (1.6%) of 1857 pregnancies. Postnatal placental evaluation showed the presence of an accessory placental lobe in 5 (17%) of 29 cases compared with 1 (1.8%) of 54 controls (P = .018). Overall, the presence of an umbilical artery waveform notch was associated with umbilical cord abnormalities in 21 (72%) of 29 cases compared with 8 (14%) of 54 controls (odds ratio, 15; 95% confidence interval, 4.4-54.4).
Umbilical artery waveform notching appears to be a strong predictor of cord and placental abnormalities. This finding may have important clinical implications.

45 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether an atypical umbilical coiling pattern at prenatal sonography is associated with adverse pregnancy outcome. A targeted sonographic evaluation of the umbilical cord (UC) was performed in 758 women with singleton gestation, and gestational age above 20 weeks. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or an unusual, aperiodic coiling pattern (uncoordinated coiling). Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Pregnancy and neonatal outcomes were investigated. Of the study population, 7 and 16 fetuses had an umbilical cord with uncoordinated coiling and supercoiling respectively. Three umbilical cords had a single umbilical artery. Eight patients delivered before 34 weeks of gestation. Eight fetuses were growth restricted. In seven cases, abnormal sonographic findings were detected (three meconium peritonitis, two severe hydronephrosis and two cardiac anomalies). One fetus affected by trisomy 18 presented multiple anomalies. Perinatal death occurred in three cases. Of the surviving newborns, eight were admitted to NICU. Umbilical artery Doppler waveforms presented a systolic notch in seven (30.4%) cases. The presence of an atypical umbilical cord vascular coiling is associated with an increased risk of unfavourable pregnancy outcome. The identification of an umbilical artery notch at Doppler investigation is frequently associated with an atypical UC coiling pattern.
    Prenatal Diagnosis 01/2005; 25(1):1-6. DOI:10.1002/pd.1043 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Dilatation of the fetal intra-abdominal umbilical vein is a rare entity. It is unclear whether prenatally diagnosed umbilical vein dilatation is associated with an increased risk of fetal anomalies or poor perinatal outcome. Umbilical artery waveform notching may be a predictor of cord abnormalities. It seems reasonable following the baby closely after the diagnosis of both conditions. CASE REPORT AND DISCUSSION: We present here a new case diagnosed by ultrasonography at 30 weeks of gestation with normal fetal outcome and discuss the clinical features and the management of these rare abnormalities.
    Archives of Gynecology and Obstetrics 03/2005; 271(2):160-2. DOI:10.1007/s00404-004-0608-z · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A diastolic notch in the uterine artery Doppler flow velocity waveform (FVW) is associated with an increased uterine vascular impedance, impaired uterine blood flow, and adverse perinatal outcome. Likewise, uterine artery notching combined with an abnormal FVW of the umbilical artery (UA) is considered a predictor of adverse neonatal outcome. Unlike data regarding the uterine artery, data are rare regarding the clinical importance of notching in the UA as an isolated finding. A few case reports have described the association between umbilical cord notching (with or without an abnormal FVW) and cord entanglement in monoamniotic twins, fetal gastroschisis, and fetal intra-abdominal vein dilatation. Recently, Abuhamad et al prospectively evaluated 1857 pregnancies and found UA notching in 29 (1.6%) fetuses. They showed that UA notching is associated with both cord and placental abnormalities, including abnormal cord insertion, cord stricture, and false or true knots in the cord. Furthermore, they suggested that this finding may have important clinical implications, such as cord and placental abnormalities and a high prevalence of nonreassuring fetal heart rate abnormalities during labor. We present a case in which UA notching was detected in an impaired fetus with a single umbilical artery (SUA) whose umbilical cord was wrapped around its body. On the basis of this case and our review of the literature, we recommend increased fetal surveillance whenever FVWs display a notch in the UA.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2005; 24(11):1561-4. · 1.54 Impact Factor
Show more


45 Reads
Available from