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Pulsed Doppler ultrasound was used in the differential diagnosis of 22 cases suspected of bilateral malformations of the foetal kidneys. In cases of kidney malformations, the pulsatility indices (PI) of the umbilical artery and the foetal aorta were in the normal range. In cases showing pathological PI values of both vessels, we found a severe intrauterine growth (IUGR) retardation with oligohydramnion. These results underline the importance of pulsed Doppler as a non invasive means in the management of oligohydramnions to differentiate among bilateral kidney malformations and IUGR.

Analysis of foetal haemodynamics using Doppler ultrasound is widely applicable in obstetrics in assessing foetal well-being. To evaluate the parameters of foetal circulation we examined 205 pregnant women to ascertain normal velocity ranges of the foetal internal carotid artery and the foetal renal artery. By establishing the ratio between the pulsatility indices of the foetal internal carotid artery, the foetal aorta and the renal artery of the foetus, standards of these were obtained. From this it seems to be possible to gain information on the extent and degree of the centralisation of foetal blood circulation.

Blood flow velocity waveforms were recorded between the 20th and 40th week of gestation from the umbilical and fetal aorta (n = 230 each) in 130 uncomplicated pregnancies. The S/D ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. In the umbilical artery the indices showed a significant decrease in the observation interval. In the fetal aorta we could not register any significant change of these indices. All values are presented as reference curves. The importance of the Doppler assessment of the circulation in these vessels for the management of high-risk pregnancy is emphasized.

Using pulsed Doppler, blood flow in the cerebral arteries was measured to assess the fetal central circulation. The Pulsatility-Index (PI) was calculated as a qualitative parameter of flow velocity waveforms. In 418 normal singleton pregnancies we performed 558 measurements between the 27th and 40th week of gestation to get normal range values of the PI. The curve shows a small decrease in the observed interval. In cases of an intrauterine hypoxia the resistance of the central vessels decrease to render the distribution of the fetal blood volume. The result of this is a centralisation of the fetal circulation. 131 high risk pregnancies were investigated and in 21 cases such a centralisation was registered. The fetal outcome of these fetuses was significantly worse compared with fetuses having a normal central flow resistance. We found for example a higher rate of caesarean sections because of fetal distress when the Pulsatility-Index was below the 5th percentile. The sensitivity of the method in prediction caesarean section for fetal distress was 59.3%, the specifity 95.3%.

Using the results of 2,130 assessments with pulsed wave Doppler-ultrasound we established an indication catalogue which reflect the availability in cases of high specificity of the method. The paper shows the modus of fetal monitoring by inclusion of the other obstetrical investigations in consequence of the Doppler-assessment and the frequency of repetition of it.

The Doppler sonography enable as a new non-invasive procedure the assessment of the uteroplacental circulation. 209 blood flow measurements (pulsed wave Doppler) were recorded between the 20th and 40th weeks of gestation from the arcuate arteries in 130 women with uncomplicated pregnancy. The S/D Ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. These Indices show throughout the observation time persisting low values which reflect the optimal uteroplacental circulation in a system with low downstream impedance. We found that the S/D Ratio and the RI are appropriate parameters in the qualitative analysis of the uteroplacental perfusion. On the other side we could demonstrate that the PI depends on the maternal heart rate which explains the high variability of the values. Therefore is the PI not appropriate for the impedance measurements in uteroplacental vessels.

In prenatal diagnosis besides radiographic methods there is a growing trend towards the use of invasive diagnostic techniques. These techniques have proved to be suitable for early detection of genetically determined conditions, diseases, and malformations of different origin. Invasive examination techniques were applied to 1.104 cases of prenatal diagnosis at Humboldt-University, Berlin, School of Medicine (Charité), Department of Gynaecology and Obstetrics, from January 1st, 1985, up to September 30th, 1987. In this paper importance and possible applications of these methods have been reported.

Reported in this paper are twelve cases of ventral schistasis transferred for cooperative prenatal assessment, diagnosis, and therapy to the Berlin Charité Hospital of Gynaecology and Obstetrics in 1985 and 1986. Concomitant malformations were recorded from eight in ten omphaloceles. Three of these children were delivered on full term by spontaneous parturition or caesarean section. They were surgically treated immediately after birth. Gastroschisis was recorded from two pregnancies with ventral schistasis. No generally valid recommendation can be given for approach to ventral schistasis. The approach should rather be interdisciplinary and should be preceded by careful diagnosis. Parents should be involved in decision-making.

The use of flowmetry of the foetal renal artery offers a diagnostic improvement by analysing intrauterine centralisation of the foetal circulation. We used the examination results of 82 pregnant women, who were in intensive prenatal care, to check the prediction of foetal distress using the flowmetry of the renal artery. In foetuses showing an increased flow resistance of the aorta and a pathological flow of the renal artery, the rate of caesarian section, necessitated by foetal distress, was 63.6%. By the forming of quotients from the pulsatility indices of the internal carotid artery and the aorta on the one hand, and the renal artery and the internal carotid artery on the other hand, it seems to be possible to get information about the severity of the centralisation of the foetal circulation by existence of an intrauterine hypoxia. The rate of the operative delivery as a consequence of a foetal distress rises from 6.6% with normal PI quotients to 83.4% if both quotients are outside the double standard deviation.

The patient was referred to hospital in the 29th week of gestation owing to polyhydramnions. Ultrasonography revealed isolated left-sided hypertrophy (from foetal chest to the lower extremity) with subcutaneous lymph cysts. Amniocentesis for genetic examination revealed a chromosomal disorder showing homozygous t(13q, 14q) translocation. This extremely rare anomaly could be explained only and was finally proven by a father-daughter incest. The authors underline the necessity of karyotyping as well as the ultrasonic exclusion of foetal malformations in patients with polyhydramnions.

Reported in this paper is a case of premature termination of pregnancy in the 29th week because of sonographically diagnosed multiple malformations of the fetus. Holoprosencephaly, omphalocele, polyspleny syndrome, double-outlet right ventricle, and several skeletal malformations were established by pathologico-anatomic investigations. Possible correlation between these malformations are discussed in some details.

The premature closure of the ductus arteriosus (pcDA) due to maternal tocolysis with indomethacin in the 34th week of gestation was diagnosed in a twin pregnancy. The pcDA was detected using Doppler 24 hours before both fetuses developed pleural effusion. Pathologic waveforms in the fetal aorta with end-diastolic zero-flow were registered. A no-delay caesarean section with optimal neonatologic intensive care were successful for the survival of the neonates. The authors postulate, that the amount of pcDA as a cause of NIHF is higher than generally supposed. Furthermore a tocolysis with indomethacin should not be performed after the 34th week of gestation.

Early detection of fetal malformations has become possible owing to the availability of highly advanced ultrasound systems. Majority of malformations, 30 per cent, has been recordable from urinary system. This system is early of access for the examiner, so that even sophisticated diagnosis of malformation is possible. High accuracy diagnosis has been increasingly helpful in forecasting pregnancy prognosis. Hence, with adequate perinatological management, it will be possible to influence on perinatal morbidity and mortality positively. 70 fetuses with malformations of kidneys and to urinary system have been observed in the context of this study. An assessment was made of diagnostic efficiency, postpartum development and long-range prognosis. Recommendations are derived from the above mentioned findings for perinatological approach in cases of diagnosed malformations of kidneys and the other urinary system.

The measurement of fetal and maternal blood flow velocities by Doppler-ultrasound is the first noninvasive method of studying utero-feto-placental haemodynamics. The pulsed Doppler is used by many observers to diagnose variations in the tissue resistance in certain clinical situations. The Doppler-ultrasound get the main importance in cases of intrauterine growth retardation, pregnancy induced hypertension, pregnancies in combination with diabetes mellitus and in cases of intrauterine hypoxia. This paper gives an overview about the clinical range of Doppler-velocimetry-investigations.

The paper gives an overview of the application in obstetrics of Doppler-ultrasound for blood flow measurements. Both usual methods, the continuous-wave and the pulsed Doppler are compared, including the safety aspects of the investigation. The advantages and disadvantages of quantitative and qualitative analysis of the Doppler spectrum are discussed and the necessary terms as Pulse Repetition Frequency (PRF), High Pass Filter (HPF), sample volume, aliasing and Doppler spectrum explained. The vessels of interest and the clinical importance they reflect are demonstrated. The importance of this new non-invasive mean in the assessment of utero-feto-placental haemodynamics is underlined.