Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome

Toyama, Júlio; Brizot, Maria de Lourdes; Liao, Adolfo Wenjaw; Lopes, Lílian Maria; Nomura, Roseli Mieko Yamamoto; Saldanha, Fátima Aparecida Targino; Zugaib, Marcelo

doi:10.1002/uog.1025

Cited by 58 publications

(65 citation statements)

References 16 publications

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“…The S-wave, D-wave, and A-wave reflect forward flow in the normal fetus [2]. Previous reports have shown abnormal flow velocity, increased PIV, or waveform of DV and reversed A-wave in fetuses with congenital heart disease or chromosomal abnormalities, especially in trisomy 21 fetuses [3,4,5,6]. However, the studies revealed some contradictory results or did not evaluate DV Doppler indices, especially the PIV [7,8,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports have raised interest in DV Doppler studies at 10-14 weeks of gestation, demonstrating an association between abnormal flow patterns and fetal chromosomal abnormalities, congenital cardiac defects, and adverse outcomes such as intrauterine growth restriction, fetal anemia, and twin-twin transfusion syndrome [3,4,5,6]. However, to evaluate the effectiveness of these abnormal flow patterns in association with these abnormal outcomes, it is essential that normal reference ranges are first constructed, and these may be specific to particular populations.…”

Section: Introductionmentioning

confidence: 99%

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A Reference for Ductus Venosus Blood Flow at 11-13<sup>+6</sup> Weeks of Gestation

Pruksanusak¹,

Kor-anantakul²,

Suntharasaj³

et al. 2014

Gynecol Obstet Invest

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Objective: To establish reference ranges for ductus venosus (DV) blood flow assessment obtained transabdominally at 11-13⁺⁶ weeks of gestation. Methods: A cross-sectional study was conducted on singleton pregnancies with a crown-rump length (CRL) ranging from 45 to 84 mm, normal fetus, and subsequent newborn birth weight appropriate for gestational age. Measurements of DV Doppler variables were performed by experienced sonographers: peak velocity during ventricular systole (S-wave) and diastole (D-wave), nadir during atrial contraction (A-wave), time-averaged maximum velocity (TA_max), pulsatility index for veins (PIV), and peak velocity index for veins (PVIV). Results: A total of 304 fetuses were included. The mean CRL was 60.7 ± 7.2 mm (range: 45.9-75.5). The mean nuchal translucency measurement was 1.4 ± 0.4 mm. The S-wave, D-wave, A-wave, and TA_max values varied significantly with gestational age (p < 0.05) and regression models were constructed for each variable. The remaining variables, systolic/atrial wave ratio, preload index, PVIV, and PIV, did not vary significantly with gestational age within this CRL range. Conclusion: Reference ranges for DV Doppler assessment were established in normal fetuses. These ranges may be a useful tool for evaluation of anueploidy and fetal cardiac function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Reference for Ductus Venosus Blood Flow at 11-13<sup>+6</sup> Weeks of Gestation

Pruksanusak¹,

Kor-anantakul²,

Suntharasaj³

et al. 2014

Gynecol Obstet Invest

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“…Reviewing the literature, we found two kinds of studies regarding the role of DV: some of them assessed the DV in high-risk pregnancies (increased NT) [4,6,10,23,32,33] and others evaluated the predictive value of DV blood flow in the general population. Focusing on this second group, we found different interesting reports: Murtha et al [7] reported that an abnormal DV waveform would detect 93% of chromosomally abnormal fetuses and that 4 of 10 cases with normal NT and abnormal DV waveforms had chromosomal abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…In qualitative analysis, absence or reversal of the a-wave (DV-RAV) is regarded as abnormal. Using either approach, abnormal flow in the DV at 11 +0 –13 +6 gestational weeks has been associated with an increased risk of CHD and chromosomal abnormalities [4,5,6,7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Is the Addition of the Ductus Venosus Useful when Screening for Aneuploidy and Congenital Heart Disease in Fetuses with Normal Nuchal Translucency?

et al. 2012

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Objective: The aim of this study was to examine the possible role of Doppler ultrasound assessment of ductus venosus (DV) blood flow at 11⁺⁰–13⁺⁶ weeks’ gestation in fetuses with normal nuchal translucency (NT) in screening for autosomal trisomies (AT) and for congenital heart diseases (CHD) in chromosomally normal fetuses. Methods: First-trimester combined screening for trisomy 21 (T21) was carried out prospectively for 7 years in singleton pregnancies. NT and the pulsatility index for DV (DVPI) were calculated. The DV was analyzed according to its association with AT and CHD. The detection rate (DR), false-positive rate (FPR), positive predictive value (PPV), and odds ratio (OR) for abnormal DV were calculated. Results: Abnormal DV as an early marker of euploid CHD gives a DR of 12.5%, an FPR of 4.3%, a PPV of 1.4%, and a negative predictive value (NPV) of 99.5%, with an OR of 3.1 (95% CI 1.3–7.4). Moreover, abnormal DV as an early marker of AT shows a DR of 35.7%, an FPR of 4.3%, a PPV of 1.2%, an NPV of 99.9%, and an OR of 12.3 (95% CI 4.1–36), and the values are 33.3, 4.3, 0.97, and 99.9% and 11 (95% CI 3.2–36.9), respectively, for T21. Conclusions: Our data supports the association between increased DVPI and CHD or AT. The sensitivity of this marker is not strong enough to be used a screening test.

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“…However, it is possible to measure FLL even at 7 th -9 th week of pregnancy (8). Crown-rump length (CRL), nuchal translucency (NT), nasal bone (NB), tricuspid valve (TV) regurgitation, and ductus venosus (DV) blood flow can be assessed in the second trimester ultrasound (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Correlation between the Fetal Liver Length and Crown-Rump Length During the First Trimester Screening

Toprak¹,

Bozkurt²,

Karasu³

2015

JAREM

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Objective: The aim of the present study was to determine the correlation between fetal liver length (FLL) at the 11+0-13+6 week of pregnancy and crown-rump length (CRL).Methods: Pregnant women (n=63) referring to the Başkent University Konya Hospital Obstetrics and Gynecology Clinic between January and March 2014 for first trimester screening were included in the study. Patients were excluded for the following reasons: two for type II DM, one for metabolic disease, and three because they refused to share their information. FLL was measured in patients at the 11+0-13+6 week of gestation and in those who had normal ultrasonographic findings. Exclusion criteria were as follows: nuchal translucency of ≥3.5 mm, antenatal first trimester combined test results of ≥1/250, reverse flow of the ductus venosus and tricuspid valve, absence of nasal bone (NB), and fetal malformation in second trimester. Fiftyseven women who fulfilled inclusion criteria were included in the study. Statistical Package for the Social Sciences version 15.0 (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis. Descriptive statistics and Pearson's correlation test was used for correlation between FLL and CRL.Results: Mean age of patients was 28. 18±4.7 (19-39). Mean gravida and parity were 2.05±1.2 (1-6) and 1±0.8 (0-5), respectively. Mean gestational age was 12.4 weeks (min: 11.1 -max: 13.6), and mean FLL of the study group was 11.2±1.1 mm (8.2-13.7 mm). Mean NT was 1.1±0.3 (0.5-2.4) mm. In the present study, it was established that FLL was correlated with CRL (r (57): 0.840; p<0.001).Conclusion: This study showed that there was a significant, strong, positive correlation between FLL and CRL at the 11 th -13 th week of pregnancy. (JAREM 2015; 5: 60-3)

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Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome

Cited by 58 publications

References 16 publications

A Reference for Ductus Venosus Blood Flow at 11-13<sup>+6</sup> Weeks of Gestation

A Reference for Ductus Venosus Blood Flow at 11-13<sup>+6</sup> Weeks of Gestation

Is the Addition of the Ductus Venosus Useful when Screening for Aneuploidy and Congenital Heart Disease in Fetuses with Normal Nuchal Translucency?

Correlation between the Fetal Liver Length and Crown-Rump Length During the First Trimester Screening

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