---
title: "Doppler Ultrasound in Pregnancy, Tirana | Klinika Gjata"
description: "Doppler in Tirana: umbilical, middle cerebral and uterine arteries, fetal growth and pre-eclampsia risk. Results explained at the visit. Book at Klinika Gjata."
lang: en
url: https://klinikagjata.com/en/services/ultrasound-exams/doppler-ultrasound/
alternates:
  sq: https://klinikagjata.com/sherbimet/ekografi-ekzaminime/echo-doppler/
  en: https://klinikagjata.com/en/services/ultrasound-exams/doppler-ultrasound/
  it: https://klinikagjata.com/it/servizi/ecografia-esami/eco-doppler/
  fr: https://klinikagjata.com/fr/services/echographie-examens/echo-doppler/
---

# Doppler ultrasound in pregnancy and gynecology: a complete guide

> A Doppler ultrasound is a scan that measures blood flow: in the placenta, the umbilical cord, the baby’s brain and heart, and in the uterus and ovaries. In pregnancy it shows whether the baby is getting enough oxygen and nutrients and helps assess the risk of pre-eclampsia and growth restriction; in gynecology it helps assess masses and fertility. At Klinika Gjata in Tirana, the Doppler is performed and interpreted during the visit by Assoc. Prof. Dr. Elinda Gjata on a GE Voluson system.

- **What it is:** An ultrasound that measures blood flow in vessels
- **Duration:** Usually 15–30 minutes, as part of the scan
- **Preparation:** In pregnancy usually none; ask about your bladder
- **Pain:** Painless; you only feel the probe and the gel
- **When:** When clinically indicated, mostly after 20 weeks
- **Results:** Explained by the doctor at the same visit
- **Safety:** Safe with the ALARA principle and a clinical reason

## What is a Doppler ultrasound and what does it show?

A Doppler ultrasound is a scan that, as well as producing an image, measures how blood moves inside vessels. The machine sends sound waves and “listens” to how their frequency changes when they bounce off moving blood cells. That change is called the Doppler effect, and from it the machine calculates the direction and speed of flow.

Three modes are used, often in the same examination:

- Colour Doppler: blood flow is shown in red and blue over the black-and-white image, depending on its direction. It helps find the right vessel quickly.
- Pulsed (spectral) Doppler: the doctor places a small “gate” over one specific vessel and the machine draws a waveform of velocity with every heartbeat. Indices such as PI and RI are measured from this waveform.
- Power Doppler: very sensitive to slow, small flows; used to see how vascular a tissue is, for example a cyst, a fibroid or the endometrium.

What does it show? In pregnancy it shows whether the placenta is working well and whether the baby is adapting to the amount of oxygen it receives. In gynecology it shows the blood supply of the uterus, the ovaries and any mass that is found. The ISUOG practice guidelines (International Society of Ultrasound in Obstetrics and Gynecology, 2021) describe these three modes as the standard tools for assessing the fetoplacental circulation.

## How is a Doppler different from a normal pregnancy scan?

The short answer: a standard scan shows structure and size, while a Doppler shows function, meaning how the blood circulates.

- A standard (2D) scan measures the baby and checks the organs, the placenta and the amniotic fluid.
- A Doppler adds information about blood flow in the cord, in the baby’s brain, in the uterus and in the ovaries.
- A 3D/4D scan produces volume and moving images; it does not measure circulation and does not replace a Doppler.

For you, the experience is the same: the same probe, the same gel, the same couch. A Doppler is often not a separate appointment but a few extra minutes within a growth or follow-up scan. A baby can be a normal size with an abnormal Doppler, or small with a completely normal Doppler, which is why both are read together.

## When is a Doppler scan done in pregnancy, and who needs one?

There is no fixed week for every woman: a Doppler is done when there is a clinical reason. In low-risk pregnancies, the Cochrane review of routine Doppler found no clear benefit, whereas in higher-risk pregnancies umbilical artery Doppler reduced perinatal deaths by about 29% (Cochrane, Alfirevic and colleagues 2017: 16 trials, about 10,000 babies).

Your doctor may recommend a Doppler if:

- the baby seems smaller than expected or growth is slowing;
- you have high blood pressure, or pre-eclampsia now or in a previous pregnancy;
- you have diabetes, kidney disease or an autoimmune condition;
- you are expecting twins, especially if they share one placenta;
- there is reduced amniotic fluid;
- the baby is moving less;
- you have had a pregnancy loss or preterm birth before;
- there is Rh isoimmunisation or an infection that could cause fetal anaemia;
- you smoke, or your age or screening results suggest increased risk.

The usual timeline, depending on the indication:

1. Weeks 11–13+6: uterine artery Doppler can be part of pre-eclampsia risk assessment; fetal Doppler only with an indication.
2. Weeks 20–24: uterine artery Doppler for women with risk factors (RCOG Green-top Guideline 31).
3. From weeks 26–28 onwards: umbilical artery Doppler and growth scans in high-risk pregnancies (RCOG).
4. Third trimester: regular follow-up if the baby is small, at intervals your doctor sets.

## Which vessels are checked, and what do PI and RI mean?

PI (pulsatility index) and RI (resistance index) are numbers that show how easily blood passes through a vessel. Put simply: a low PI usually means blood is flowing freely; a high PI means there is more resistance. Values are compared with charts for each week of pregnancy and are often expressed as centiles.

The main vessels:

- Umbilical artery (in the cord): reflects the resistance of the placenta. Normally blood keeps flowing towards the placenta even between heartbeats. If this diastolic flow falls, disappears or reverses, the placenta is struggling.
- Middle cerebral artery (MCA, in the baby’s brain): when oxygen is short, the baby sends more blood to the brain and the PI here falls. The peak systolic velocity of this artery is also used to suspect fetal anaemia: a value above 1.5 MoM suggests moderate or severe anaemia (Mari and colleagues, NEJM 2000).
- Cerebroplacental ratio (CPR): the ratio between the MCA and the umbilical artery. A CPR below the 5th centile is one of the international criteria for fetal growth restriction (Delphi consensus, Gordijn 2016).
- Ductus venosus: a small vein near the baby’s heart; assessed in more severe cases to help decide on the timing of birth.
- Uterine arteries (the mother’s): show how well the placenta is supplied from the mother’s side.

No single number decides anything. The doctor reads the measurements together with the baby’s size, the amniotic fluid, the baby’s movements and the mother’s condition.

## Uterine artery Doppler and pre-eclampsia risk

Pre-eclampsia is high blood pressure with organ involvement that appears after 20 weeks of pregnancy and affects about 2–8% of pregnancies. Uterine artery Doppler is one of the best tools for identifying women at increased risk before any signs appear.

How it works: early in pregnancy the uterine arteries widen so the placenta can receive more blood. If this widening does not happen properly, the PI stays high and a “notch” (a small dip in the waveform) may appear. This is not a diagnosis but a risk signal.

What the evidence says:

- The Fetal Medicine Foundation (FMF) combined screening at 11–13 weeks combines the mother’s history, mean arterial pressure, uterine artery PI and placental proteins (PAPP-A, PlGF). In a study of about 60,000 pregnancies it detected 76.6% of preterm pre-eclampsia at a 10% false-positive rate.
- The ASPRE trial (Rolnik and colleagues, NEJM 2017): in high-risk women, low-dose aspirin reduced preterm pre-eclampsia by 62%.
- Aspirin works when started before 16 weeks, which is why early assessment matters.

Do not start aspirin on your own: the dose and duration are decided by your doctor. Signs that need urgent review without waiting for a Doppler: severe headache, blurred vision, pain under the ribs on the right, sudden swelling of the face or hands.

## Doppler for fetal growth restriction, wellbeing and twins

Fetal growth restriction (FGR or IUGR) means the baby is not reaching its growth potential, often because the placenta is not supplying enough. Doppler helps tell apart a baby who is small but healthy (constitutionally small) from a baby who is struggling.

International criteria (2016 Delphi consensus, used by ISUOG):

- estimated fetal weight or abdominal circumference below the 3rd centile, or
- below the 10th centile together with an abnormal Doppler (umbilical artery PI above the 95th centile or CPR below the 5th centile).

What happens after an abnormal Doppler:

1. Closer follow-up: growth every 2 weeks and Doppler as often as the finding requires.
2. Checks of amniotic fluid and movements; cardiotocography (CTG) may be added.
3. If findings worsen, the team plans the safest timing and mode of birth.

Twins: when two babies share one placenta (monochorionic twins), the ISUOG guidelines recommend a scan every 2 weeks from 16 weeks to pick up twin-to-twin transfusion syndrome (TTTS) early. From 20 weeks, the middle cerebral artery velocity helps detect twin anaemia-polycythaemia sequence (TAPS). Twins with two placentas usually need less frequent checks.

If a problem with the baby’s heart is suspected during the scan, a more detailed heart assessment or referral to a specialist centre may be advised.

## What is Doppler used for in gynecology and fertility?

Outside pregnancy, Doppler is usually added to a transvaginal or abdominal scan to look at the blood supply of organs and masses.

- Ovarian cysts and masses: the amount and pattern of blood flow help distinguish a simple functional cyst from a mass that needs more attention. The IOTA group uses a “colour score” from 1 (no flow) to 4 (very strong flow) as part of its assessment models.
- Fibroids and polyps: Doppler shows the feeding vessel of a polyp or the circulation around a fibroid, and helps plan treatment.
- Endometrium: post-menopausal bleeding or irregular cycles are assessed by measuring the endometrium and using Doppler.
- Ovarian torsion: Doppler helps, but according to ACOG (Committee Opinion 783) normal flow does not rule out torsion; sudden severe pain is an emergency.
- Fertility: Doppler of the uterine arteries, endometrium and ovarian stroma is used as additional information during a couple’s assessment and follicle tracking. It is not a test that predicts pregnancy success on its own, but it completes the picture.
- Early pregnancy with pain or bleeding: it helps assess location and viability, always with care over exposure.

The best time in the cycle depends on the question: gynecological scans are often done in the first days after a period, but your doctor will advise for your case.

## How is a Doppler scan done, step by step?

This is how a pregnancy Doppler usually goes at Klinika Gjata:

1. Short conversation: the doctor reviews your weeks of pregnancy, tests, previous scans and the reason for the Doppler.
2. Position: you lie on your back, tilted slightly to one side if that is more comfortable; your bump is uncovered and gel is applied.
3. Baseline scan: the baby is measured and the placenta, amniotic fluid and position are checked.
4. Colour Doppler: the cord, the middle cerebral artery and, if needed, the uterine arteries are located.
5. Pulsed Doppler: waveforms are recorded and PI, RI and velocities measured while the baby is calm and not making breathing movements (otherwise the readings change).
6. Repeat if needed: a measurement is repeated until it is reliable.
7. Explanation: the doctor tells you straight away what she saw, what the numbers mean and when the next check should be.
8. Report: you receive the findings in writing for your pregnancy file.

In gynecology the steps are similar, but a transvaginal probe is usually used, covered with a protective sheath and gel.

## How do I prepare, does it hurt, and is Doppler safe for the baby?

A Doppler is painless and involves no needles, radiation or contrast. Preparation is simple:

- In later pregnancy you usually do not need a full bladder.
- For a transvaginal scan the bladder should usually be empty; for an abdominal scan in early pregnancy or in gynecology you may be asked to drink water. Ask when you book.
- Wear comfortable clothes with a top that lifts easily.
- Bring previous scans and test results, and a list of your medicines.
- Eat normally; a very active or very quiet baby does not prevent the scan, but sometimes a short wait is needed.

Safety: ultrasound has been used in pregnancy for decades and there is no evidence of harm to the baby when it is used properly. Pulsed Doppler delivers more energy than ordinary imaging, so clear rules apply:

- The ALARA principle (“as low as reasonably achievable”): as little energy and time as needed to answer the question.
- ISUOG and WFUMB: Doppler is not used routinely in the embryonic period (up to 10+6 weeks); at 11–13+6 weeks it is used only for a clinical indication.
- The thermal index (TI) is usually kept at 1.0 or below and exposure time as short as possible, usually 5–10 minutes.
- Doppler of the mother’s uterine arteries has little relevance to embryo safety, because the embryo is not in the path of the beam.

## How are Doppler results read, and what happens next?

Your Doppler result is given at the same visit, because the doctor who performs it is the one who interprets it. This is what you may hear:

- Normal Doppler: the placenta is supplying the baby well; you continue with routine checks or your existing plan.
- Slightly raised umbilical artery PI or low CPR: closer follow-up is advised, usually a growth check and Doppler after 1–2 weeks.
- Absent or reversed diastolic flow: a serious finding that needs very close monitoring, often in hospital, and planning of the birth.
- High PI or notch in the uterine arteries: higher risk of pre-eclampsia or growth restriction; blood pressure is checked more often and growth scans are planned.
- High velocity in the middle cerebral artery: suspected fetal anaemia; this usually needs prompt referral to a fetal medicine centre.

What you can do: keep your appointments, measure your blood pressure if asked, monitor your baby’s movements and call straight away if movements decrease or you have a severe headache, bleeding or abdominal pain.

## Why have your Doppler scan at Klinika Gjata in Tirana?

At Klinika Gjata the Doppler is done by the same doctor who follows your pregnancy, not by a technician who sends a report later.

- Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc.: obstetrician-gynecologist with more than 25 years of experience and Associate Professor at the University of Medicine, Tirana.
- Specialist training: the Ian Donald School of ultrasound, and training in fetal cardiac ultrasound and Doppler (Tirana, 2006).
- A GE Voluson system, dedicated to obstetrics and gynecology.
- Scan and interpretation at the same visit: you know the result and the plan before you leave.
- Continuity: the same doctor knows you from the first visit to the birth, which makes it easier to compare measurements over time.
- A clinic in Tirana since 2009, on Rruga Hasan Sufa.

To book, call +355 4 234 0059.

## What does the cost of a Doppler scan depend on?

The cost of a Doppler is not the same for everyone, because the examination varies with the reason for it. The main factors are:

- Whether the Doppler is part of a growth scan or a separate examination.
- How many vessels need checking: only the umbilical artery, or also the middle cerebral artery, ductus venosus and uterine arteries.
- A single baby or twins (each baby is assessed separately).
- Obstetric or gynecological Doppler (abdominal or transvaginal).
- Whether the full consultation and a written report are included.
- How often it needs repeating during follow-up.

For the exact price for your case, call the clinic on +355 4 234 0059.

## Frequently asked questions

### Is a Doppler scan harmful to the baby?

No, when it is used for a clinical reason and within safety rules. ISUOG advises that Doppler should not be used routinely in the first weeks (up to 10+6) and that exposure time is kept short, usually 5–10 minutes. In the second and third trimesters Doppler is used widely around the world.

### At what week of pregnancy is a Doppler done?

There is no fixed week for everyone. Uterine artery Doppler can be done at 11–13 or 20–24 weeks, while umbilical artery Doppler is usually done from 26–28 weeks onwards in higher-risk pregnancies or when the baby seems small. Your doctor sets the timing for your case.

### Does every pregnant woman need a Doppler?

Not necessarily. In low-risk pregnancies, Cochrane reviews have not shown a benefit from routine Doppler. It is recommended when there is high blood pressure, diabetes, growth restriction, twins or a difficult obstetric history.

### Does a Doppler scan hurt?

No. You only feel the cool gel and the light pressure of the probe on your bump. Sometimes the doctor presses a little more to get a good reading, but it should not hurt.

### Do I need a full bladder for a Doppler?

In later pregnancy usually not. For a transvaginal scan the bladder should be empty, while for an abdominal scan in early pregnancy or in gynecology a little water is sometimes requested. Ask when you book.

### How long does a Doppler scan take?

Usually 15–30 minutes together with the scan. The Doppler measurements take a few minutes; the time increases if the baby moves a lot, if there are twins or if more vessels are needed.

### What does an umbilical artery Doppler show?

It shows how easily blood passes from the baby to the placenta. Low resistance (a normal PI) means a placenta that is working well. A high PI or absent diastolic flow points to a struggling placenta and needs closer follow-up.

### What does absent end-diastolic flow in the cord mean?

It means that between heartbeats blood no longer flows towards the placenta, because resistance is very high. It is a serious finding that needs very frequent checks, usually in hospital, and planning of the timing of birth by the team.

### What is a middle cerebral artery Doppler for?

It shows how blood circulates in the baby’s brain. A low PI can mean the baby is redirecting oxygen to the brain, while a high velocity (above 1.5 MoM) suggests fetal anaemia, for example with Rh isoimmunisation.

### What are PI and RI on a Doppler report?

They are indices that measure resistance to blood flow. There is no single “normal number”: values are compared with charts for each week of pregnancy and expressed as centiles. Your doctor explains whether your values are within range.

### What is a “notch” in the uterine arteries?

It is a small dip in the uterine artery Doppler waveform. After the first trimester, especially when it is on both sides and with a high PI, it is linked to a higher risk of pre-eclampsia and growth restriction. It is not a diagnosis, but a reason for closer follow-up.

### Should I take aspirin if my Doppler shows a pre-eclampsia risk?

That decision is made by your doctor. The ASPRE trial showed that low-dose aspirin in high-risk women reduced preterm pre-eclampsia by 62%, but it works when started before 16 weeks. Do not start it on your own.

### How is a Doppler done in twins?

Each baby is measured separately. In twins who share one placenta, ISUOG recommends a scan every 2 weeks from 16 weeks and, from 20 weeks, middle cerebral artery measurements, to detect TTTS and TAPS early.

### Is a Doppler the same as a 3D or 4D scan?

No. 3D and 4D produce volume and moving images of the baby, while a Doppler measures blood flow. Both can be done on the same machine, but they answer different questions.

### Why is a Doppler done for an ovarian cyst?

Because the amount and pattern of blood flow help distinguish a simple cyst from a mass that needs more attention. Doppler is one part of the assessment, together with the appearance of the cyst, your symptoms and, where needed, blood tests.

### Can a Doppler help with trouble getting pregnant?

It can add information about the blood supply of the uterus, endometrium and ovaries during a fertility assessment or follicle tracking. It is not a test that decides on its own, but it completes the couple’s overall picture.

### Can I use a fetal Doppler at home?

It is not advised. The US FDA warns against home fetal heartbeat monitors because they can give false reassurance. If your baby’s movements decrease, call your doctor straight away rather than checking yourself.

### Do I need a referral for a Doppler at Klinika Gjata?

You can book directly on +355 4 234 0059. Bring previous scans and test results; the doctor decides during the visit which Doppler measurements are needed for your case.

### How is the baby’s heart checked during the scan?

The baby’s heart is checked at every pregnancy scan, but the most detailed assessment is usually done during the morphology scan, at 18–22 weeks. The doctor examines the four chambers of the heart, the valves, the main vessels leaving it and the heart rhythm, often with the help of colour Doppler.

A more in-depth fetal heart examination may be advised when there are risk factors, such as:

- congenital heart disease in the family
- diabetes in the mother
- increased nuchal translucency
- twins sharing a placenta
- certain medications taken during pregnancy

Dr. Gjata is trained in fetal cardiac ultrasound. If any of these apply to you, tell us at your visit so we can plan the right check.

---

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- **Phone:** +355 4 234 0059
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