Analysis of Umbilical Artery Hemodynamics in Development of Intrauterine Growth Restriction Using Computational Fluid Dynamics with Doppler Ultrasound.

Abstract

Intrauterine growth restriction (IUGR), the failure of the fetus to achieve his/her growth potential, is a common and complex problem in pregnancy. Clinically, IUGR is usually monitored using Doppler ultrasound of the umbilical artery (UA). The Doppler waveform is generally divided into three typical patterns in IUGR development, from normal blood flow (Normal), to the loss of end diastolic blood flow (LDBF), and even to the reversal of end diastolic blood flow (RDBF). Unfortunately, Doppler ultrasound hardly provides complete UA hemodynamics in detail, while the present in silico computational fluid dynamics (CFD) can provide this with the necessary ultrasound information. In this paper, CFD is employed to simulate the periodic UA blood flow for three typical states of IUGR, which shows comprehensive information on blood flow velocity, pressure, and wall shear stress (WSS). A new finding is the "hysteresis effect" between the UA blood flow velocity and pressure drop in which the former always changes after the latter by 0.1-0.2 times a cardiac cycle due to the unsteady flow. The degree of hysteresis is a promising indicator characterizing the evolution of IUGR. CFD successfully shows the hemodynamic details in different development situations of IUGR, and undoubtedly, its results would also help clinicians to further understand the relationship between the UA blood flow status and fetal growth restriction.