Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter March 3, 2021

Assessment of fetal Doppler parameters in pregnant women with COVID-19 infection: a prospective case-control study

  • Sule Goncu Ayhan , Atakan Tanacan ORCID logo , Aysegul Atalay , Selcan Sinaci , Eda Ozden Tokalioglu , Dilek Sahin and Ozlem Moraloglu Tekin



To investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on fetal Doppler parameters.


This was a prospective case-control study conducted in Ankara City Hospital with confirmed SARS-CoV-2 infected pregnants between August 1, 2020 and October 1, 2020. There were 54 COVID-19 confirmed pregnant women and 97 age-matched pregnant women as a control group between 28 and 39 weeks. Infection was confirmed based on positive real-time polymerase-chain reaction results. Demographic features, uterine artery (right, left), umblical artery, middle cerebral artery, ductus venosus, cerebro-placental ratio, and cerebral-placental-uterine ratio Doppler parameters were investigated in both groups.


Two groups were similar in terms of demographic features and no difference was found for fetal Doppler parameters.


COVID-19 seems to have no adverse effect on fetoplacental circulation in mild and moderate patients during the acute phase of the infection.

Corresponding author: Sule Goncu Ayhan, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey, E-mail:


Special thanks to all the perinatology division staff who work with devotion for the treatment of high-risk pregnancy patients during the pandemic period.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board. The applied protocol was approved by the Turkish Ministry of Health and Medical Research Ethics Department of the hospital (Ankara City Hospital) (E1-20-1086).


1. Huang, C, Wang, Y, Li, X, Ren, L, Zhao, J, Hu, Y, et al.. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 2020;395:497–506. in Google Scholar

2. Wang, D, Hu, B, Hu, C, Zhu, F, Liu, X, Zhang, J, et al.. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061–9. in Google Scholar

3. Middeldorp, S, Coppens, M, van Haaps, TF, Foppen, M, Vlaar, AP, Müller, MC, et al.. Incidence of venous thromboembolism in hospitalized patients with COVID‐19. J Thromb Haemost 2020;18:1995–2002. in Google Scholar

4. Ranucci, M, Ballotta, A, Di Dedda, U, Bayshnikova, E, Dei Poli, M, Resta, M, et al.. The procoagulant pattern of patients with COVID‐19 acute respiratory distress syndrome. J Thromb Haemost 2020;18:1747–1751. in Google Scholar

5. Huntley, BJ, Huntley, ES, Di Mascio, D, Chen, T, Berghella, V, Chauhan, SP. Rates of maternal and perinatal mortality and vertical transmission in pregnancies complicated by severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) infection: a systematic review. Obstet Gynecol 2020;136:303–12. in Google Scholar

6. Dashraath, P, Wong, JLJ, Lim, MXK, Lim, LM, Li, S, Biswas, A, et al.. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;222:521–31. in Google Scholar

7. Di Mascio, D, Sen, C, Saccone, G, Galindo, A, Grünebaum, A, Yoshimatsu, J, et al.. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med 2020;48:950–8. in Google Scholar

8. Mappa, I, Distefano, FA, Rizzo, G. Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. J Perinat Med 2020;48:545–50. in Google Scholar

9. Schwartz, DA, Graham, AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020;12:194. in Google Scholar

10. Berkley, E, Chauhan, SP, Abuhamad, A, Committee SfM-FMP. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol 2012;206:300–8. in Google Scholar

11. Alfirevic, Z, Stampalija, T, Dowswell, T. Fetal and umbilical Doppler ultrasound in high‐risk pregnancies. Cochrane Database Syst Rev 2017;6. in Google Scholar

12. Shah, PS, Diambomba, Y, Acharya, G, Morris, SK, Bitnun, A. Classification system and case definition for SARS‐CoV‐2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020;99:565–8. in Google Scholar

13. Thompson, R, Trudinger, B, Cook, C. A comparison of Doppler ultrasound waveform indices in the umbilical artery—I. Indices derived from the maximum velocity waveform. Ultrasound Med Biol 1986;12:835–44. in Google Scholar

14. MacDonald, TM, Hui, L, Robinson, AJ, Dane, KM, Middleton, AL, Tong, S, et al.. Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2019;54:367–75. in Google Scholar

15. Shanes, ED, Mithal, LB, Otero, S, Azad, HA, Miller, ES, Goldstein, JA. Placental pathology in COVID-19. Am J Clin Pathol 2020;154:23–32. in Google Scholar

16. Algarroba, GN, Rekawek, P, Vahanian, SA, Khullar, P, Palaia, T, Peltier, MR, et al.. Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. Am J Obstet Gynecol 2020;223:275–278. in Google Scholar

17. Alfirevic, Z, Keeney, E, Dowswell, T, Welton, N, Medley, N, Dias, S, et al.. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. Obstet Anesth Digest. 2017;37:145–6. in Google Scholar

18. Jamal, A, Abbasalizadeh, F, Vafaei, H, Marsoosi, V, Eslamian, L. Multicenter screening for adverse pregnancy outcomes by uterine artery Doppler in the second and third trimester of pregnancy. Med Ultrasonogr 2013;15:95–100. in Google Scholar

19. Papageorghiou, AT, Leslie, K. Uterine artery Doppler in the prediction of adverse pregnancy outcome. Curr Opin Obstet Gynecol 2007;19:103–9. in Google Scholar

20. Tolu, LB, Ararso, R, Abdulkadir, A, Feyissa, GT, Worku, Y. Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia. PloS One 2020;15:e0234810. in Google Scholar

21. Oros, D, Ruiz‐Martinez, S, Staines‐Urias, E, Conde‐Agudelo, A, Villar, J, Fabre, E, et al.. Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review. Ultrasound Obstet Gynecol 2019;53:454–64. in Google Scholar

22. Vollgraff Heidweiller‐Schreurs, C, De Boer, M, Heymans, M, Schoonmade, L, Bossuyt, P, Mol, B, et al.. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis. Ultrasound Obstet Gynecol 2018;51:313–22. in Google Scholar

23. Hoffman, C, Galan, HL. Assessing the ‘at-risk’fetus: Doppler ultrasound. Curr Opin Obstet Gynecol. 2009;21:161–6. in Google Scholar

24. Ragab, D, Salah Eldin, H, Taeimah, M, Khattab, R, Salem, R. The COVID-19 cytokine storm; what we know so far. Front Immunol. 2020;11:1446. in Google Scholar

25. Iba, T, Levy, JH, Levi, M, Thachil, J. Coagulopathy in COVID‐19. J Thromb Haemost 2020;18:2103–9. in Google Scholar

26. Boukhris, M, Hillani, A, Moroni, F, Annabi, MS, Addad, F, Ribeiro, MH, et al.. Cardiovascular implications of the COVID-19 pandemic: a global perspective. Can J Cardiol 2020. in Google Scholar

27. Khalil, A, Morales-Rosello, J, Khan, N, Nath, M, Agarwal, P, Bhide, A, et al.. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? Am J Obstet Gynecol 2017;216:606e1–10. in Google Scholar

28. DeVore, GR. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol 2015;213:5–15. in Google Scholar

29. Faure‐Bardon, V, Isnard, P, Roux, N, Leruez‐Ville, M, Molina, T, Bessieres, B, et al.. Protein expression of angiotensin‐converting enzyme 2, a SARS‐CoV‐2‐specific receptor, in fetal and placental tissues throughout gestation: new insight for perinatal counseling. Ultrasound Obstet Gynecol 2021;57:242–7. in Google Scholar

30. Binder, J, Monaghan, C, Thilaganathan, B, Carta, S, Khalil, A. De‐novo abnormal uteroplacental circulation in third trimester: pregnancy outcome and pathological implications. Ultrasound Obstet Gynecol 2018;52:60–5. in Google Scholar

31. Karimi-Zarchi, M, Neamatzadeh, H, Dastgheib, SA, Abbasi, H, Mirjalili, SR, Behforouz, A, et al.. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol 2020;39:246–50. in Google Scholar

32. Chen, H, Guo, J, Wang, C, Luo, F, Yu, X, Zhang, W, et al.. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–15. in Google Scholar

Received: 2020-11-09
Accepted: 2021-02-08
Published Online: 2021-03-03
Published in Print: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 11.12.2023 from
Scroll to top button