← Back to PAHMCJ Volume 3, Number 2 (July 2026)

Review Article

Author(s): Begum T

PAH Med Col J. Jul 2026; 3(2): 74-82

Abstract

Fetal growth restriction (FGR) is a common complication of pregnancy, affecting 5–10% of pregnancies, and is associated with a wide range of adverse perinatal outcomes^1,10. Differentiating a fetus that is constitutionally small from one that is pathologically growth-restricted remains a major diagnostic challenge, and Doppler ultrasonography of the maternal, placental and fetal circulations provides physiological information that complements conventional fetal biometry in this assessment.To provide a comprehensive narrative review of the physiological basis, technique, clinical application and limitations of Color and spectral Doppler ultrasonography in FGR, covering the uterine artery, umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR) and ductus venosus (DV), and to compare the recommendations of the major professional societies.This narrative review draws on the current major clinical practice guidelines on FGR and obstetric Doppler ultrasonography, the international Delphi consensus definition of FGR³, the randomized Trial of Randomized Umbilical and Fetal Flow in Europe trial⁸, systematic reviews and meta-analyses of Doppler parameters in suspected FGR, a staging protocol for FGR management¹¹, and recent multi-society clinical opinion papers on the evidence-based approach to suspected FGR and the role of the fetal biophysical profile.

Uterine artery Doppler reflects the maternal side of placentation and has a recognized role in risk stratification for placental dysfunction. UA Doppler has the most consistently established role in FGR surveillance across guidelines. The CPR shows better predictive accuracy for adverse perinatal outcome than either UA or MCA Doppler alone in independent meta-analyses. DV Doppler changes characterize progressive cardiovascular compromise in severe early-onset FGR and informed the monitoring approach evaluated in the TRUFFLE trial. Recommendations regarding the routine clinical use of MCA, DV and uterine artery Doppler differ among SMFM, ACOG and ISUOG, and multi-society clinical opinion has called for a more standardized, evidence-based, multimodal approach.Doppler ultrasonography provides physiological information that meaningfully complements fetal biometry in FGR. UA Doppler is the best-established parameter for surveillance, while the clinical application of uterine artery, MCA, CPR and DV Doppler should be individualized according to gestational age, FGR phenotype, disease stage and the guideline framework adopted

Keywords

Intrauterine growth restriction; fetal growth restriction; Color Doppler; Doppler velocimetry; umbilical artery; ductus venosus;

📄 Download Full Review Article PDF

How to cite: Begum T. Role of Color Doppler in Intrauterine Growth Restriction: A Comprehensive Review. PAH Med Col J. Jul 2026; 3(2): 74-82.

DOI: https://doi.org/10.70945/pahmc.v03i02.06