What are common limitations when using Doppler to evaluate regurgitation in the fetus?

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Evaluating fetal regurgitation with Doppler hinges on seeing a jet that is well aligned with the ultrasound beam and large enough to be detected above background noise. The main limitations are a suboptimal angle of insonation, fetal movement that shifts the heart and jet out of the best imaging window, small jet size that may be below the sensitivity of color or spectral Doppler, and the difficulty of keeping the beam precisely aligned with the direction of flow in the tiny fetal heart. These factors together reduce the ability to detect or accurately characterize regurgitant flow. While imaging artifacts from machine settings can influence appearance, they do not replace the fundamental constraints of angle, motion, jet size, and alignment, and it’s important to avoid assuming regurgitation when the jet cannot be confidently visualized due to these limitations.