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544 D. Arduini, G. Rizzo<br />

the condition of IUGR fetuses can be accurately assessed<br />

by sequential studies of Doppler waveforms<br />

from various vascular areas. Therefore the optimal<br />

timing of delivery to prevent intrauterine injury may<br />

be guided by combining multivessel Doppler ultrasounds.<br />

Combining Doppler, composite biophysical<br />

profile, and/or computerized fetal heart rate analysis<br />

will provide significant early indication for action in<br />

the management of severe IUGR fetuses.<br />

References<br />

1. Dobson PC, Abell DA, Beisher NA (1981) Mortality<br />

and morbidity of fetal growth retardation. Aust NZ J<br />

Obstet Gynaecol 21:69±72<br />

2. McIntire DD, Bloom SL, Casey BM, Leveno KJ (1999)<br />

Birth weight in relation to morbidity and mortality<br />

among newborn infants. N Engl J Med 340:1234±1238<br />

3. Wladimiroff JW (1991) Review of the etiology, diagnostic<br />

technique and management of IUGR, and the clinical<br />

application of Doppler in the assessment of placental<br />

blood flow. J Perinat Med 19:11±13<br />

4. Editorial (1992) Doppler ultrasound in obstetrics. Lancet<br />

339:1083±1084<br />

5. Nicolaides KH, Rizzo G, Hecher K (2000) Doppler<br />

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6. Visser GHA, Bekedam DJ, Ribbert LSM (1990) Changes<br />

in antepartum heart rate patterns with progressive fetal<br />

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in IUGR fetuses ± a review. Placenta<br />

23[Suppl A]:S136±141<br />

8. Schulman H, Fleisher A, Farmakides G et al (1986) Development<br />

of uterine artery compliance in pregnancy<br />

as detected by ultrasound. Am J Obstet Gynecol<br />

155:1031±1036<br />

9. Harrington K, Cooper D, Carpenter RG, Lees C, Hecher<br />

K, Campbell S (1996) Doppler ultrasound of uterine arteries:<br />

the importance of bilateral notching in the prediction<br />

of pre-eclampsia, placental abruption, or delivery<br />

of small for gestational age baby. Ultrasound Obstet<br />

Gynecol 7:182±188<br />

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11. Bracero LA, Beneck D, Kirshenbaum N et al (1989)<br />

Doppler velocimetry and placental disease. Am J Obstet<br />

Gynecol 161:388±393<br />

12. Todros T, Sciarrone A, Piccoli E, Guiot C, Kaufmann P,<br />

Kingdom J (1999) Umbilical Doppler waveforms and placental<br />

villous angiogenesis in pregnancies complicated<br />

by fetal growth restriction. Obstet Gynecol 93: 499±503<br />

13. Steel SA, Pearce JM, Nash G et al (1991) Correlation<br />

between the results of Doppler velocimetry with spectral<br />

analysis and the viscosity of cord blood. Rev Fr<br />

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14. Fairle FM, Lang GD, Lowe GG, Walker JJ (1991) Umbilical<br />

artery flow velocity waveforms and cord blood<br />

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15. Campbell S, Vyas S, Nicolaides KH (1991) Doppler investigation<br />

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19:21±26<br />

16. Arduini D, Rizzo G, Romanini C (1992) Changes of<br />

pulsatility index from fetal vessels preceding the onset<br />

of late decelerations in growth retarded fetuses. Obstet<br />

Gynecol 79:605±610<br />

17. Harrington K, Thompson MO, Carpenter RG, Nguyen<br />

M, Campbell S (1999) Doppler fetal circulation in pregnancies<br />

complicated by pre-eclampsia or delivery of a<br />

small for gestational age baby: 2. Longitudinal analysis.<br />

Br J Obstet Gynaecol 106:453±466<br />

18. Peeters LLH, Sheldon RF, Jones MD, Makowsky EI,<br />

Meschia G (1979) Blood flow to fetal organ as a function<br />

of arterial oxygen content. Am J Obstet Gynecol<br />

135:637±646<br />

19. Harrington KF, Campbell S, Bewley S, Bower S (1991)<br />

Doppler velocimetry studies of the uterine artery in<br />

the early prediction of preeclampsia and intra-uterine<br />

growth retardation. Eur J Obstet Gynecol Reprod Biol<br />

42[Suppl]:S14±S20<br />

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Doppler flow velocity waveforms and neonatal<br />

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22. Rizzo G, Arduini D, Romanini C (1992) Doppler echocardiographic<br />

assessment of fetal cardiac function.<br />

Ultrasound Obstet Gynecol 2:434±445<br />

23. Reed KL, Appleton CP, Anderson CF, Shenker L, Sahn<br />

DJ (1990) Doppler studies of vena cava flows in human<br />

fetuses: insights into normal and abnormal cardiac<br />

physiology. Circulation 81:498±505<br />

24. Visser GHA, Stitger RH, Bruinse HW (1991) Management<br />

of the growth-retarded fetus. Eur J Obstet Gynecol<br />

Reprod Biol 42:S73±S78<br />

25. Reuss ML, Rudolph AM (1980) Distribution and recirculation<br />

of umbilical and systemic venous blood flow<br />

in fetal lambs during hypoxia. J Dev Physiol 2:71±84<br />

26. Burns PN (1987) Doppler flow estimations in the fetal<br />

and maternal circulations: principles, techniques and<br />

some limitations. In: Maulik D, McNellis D (eds) Doppler<br />

ultrasound measurement of maternal-fetal hemodynamics.<br />

Perinatology Press, Ithaca, NY, pp 43±78<br />

27. Comstock CH, Riggs T, Lee W, Kirk J (1991) Pulmonary<br />

to aorta diameter ratio in the normal and abnormal<br />

fetal heart. Am J Obstet Gynecol 165:1038±1043<br />

28. Stottard MF, Pearson AC, Kern MJ et al (1989) Influence<br />

of alteration in preload of left ventricular diastolic<br />

filling as assessed by Doppler echocardiography in humans.<br />

Circulation 79:1226±1236<br />

29. Gardin JM (1989) Doppler measurements of aortic blood<br />

velocity and acceleration: load independent indexes of<br />

left ventricular performance? Am J Cardiol 64:935±936<br />

30. Bedotto JB, Eichorn EJ, Grayburn PA (1989) Effects of<br />

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