Umbilical Artery Doppler in Fetal Growth Restriction

Umbilical artery (UA) Doppler velocimetry is a noninvasive tool used to assess placental vascular resistance and improve risk stratification in pregnancies complicated by suspected fetal growth restriction (FGR). Placental insufficiency remains a leading cause of stillbirth and neonatal morbidity, making early identification critical for optimizing perinatal outcomes. This clinical review synthesizes current evidence regarding the role of UA Doppler in identifying placental insufficiency, outlines key waveform interpretations, and evaluates how Doppler findings guide clinical management and delivery planning. Evidence and major society guidelines support UA Doppler as a targeted surveillance tool in high-risk pregnancies complicated by suspected FGR. Progressive abnormalities, including elevated resistance, absent end-diastolic flow (AEDF), and reversed end-diastolic flow (REDF), correlate with worsening placental insufficiency and increasing fetal risk, informing surveillance intensity and timing of delivery. In contrast, routine use in low-risk populations is not supported because of the low prevalence of abnormal findings and limited predictive value. For physician assistants and other clinicians practicing in obstetric and acute care settings, accurate interpretation of UA Doppler findings is essential for timely escalation of care, evidence-based clinical decision-making, and improved patient-centered outcomes.