Abnormal first-trimester ductus venosus blood flow: a risk factor for adverse outcome in fetuses with normal nuchal translucency

ABSTRACT Ductus venosus is a tiny vessel with a central role in fetal circulation. Combining B-mode with color and pulsed Doppler is feasible to identify this vessel and evaluate the blood flow waveform at 11 to 13 weeks. The higher prevalence of abnormal A-wave in fetuses with abnormal karyotype and/or cardiac defects turned DV evaluation into a useful marker for chromosomal abnormalities and cardiopathies. Even when combined with nuchal translucency (NT) or biochemical markers, DV blood flow evaluation contributes to an increase in sensitivity and reduces false-positive rate. Abnormal ductal flow is also related to a worse fetal and perinatal outcome. In monochorionic twin pregnancies, in addition to NT measurement at 11 to 14 weeks, the Doppler assessment of DV blood flow increases relevantly the performance of screening for those at higher risk of developing twin-to-twin transfusion syndrome. This story of 14 years surely contributed to change the way first trimester screening is being implemented.

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Characteristics of blood flow in the ductus venosus of fetus with congenital development anomalies diagnosed during the first trimester

10.21516/2413-1458-2018-17-3-211-214 ◽

2018 ◽

Author(s):

O.L. Galkina

Keyword(s):

Blood Flow ◽

Congenital Anomalies ◽

Chromosomal Abnormalities ◽

First Trimester ◽

Nuchal Translucency ◽

Ductus Venosus ◽

Multiple Congenital Anomalies ◽

Fetal Anomalies ◽

Ultrasound Monitoring ◽

Edwards Syndrome

Objectives: to analyze the characteristics of blood flow in the ductus venosus of fetus with congenital anomalies diagnosed during the first trimester. Materials: 20 821 first trimester pregnant women have been examined during the last 3 years. 82 fetuses have been diagnosed with congenital anomalies. In 74 out of 82 cases assessment of blood flow took place. A comparative analysis of the following parameters has been carried out: characteristics of blood flow in the ductus venosus of fetus with multiple and isolated congenital anomalies, normal nuchal translucency and expanded nuchal translucency, isolated and concomitant development anomalies of the heart and major vessels, normal and anomalous karyotype. Results: anomalous blood flow in the ductus venosus was recorded in 40 % of the fetuses with congenital anomalies – the highest in the group of fetus with multiple congenital anomalies in combination with the expanded nuchal translucency and chromosomal abnormalities – 60 %, in the group of fetus with Edwards syndrome – 90 %. Conclusion: the recording of abnormal blood flow in the ductus venosus of a fetus should be an indication for an expanded anatomical assessment of the fetus and ultrasound monitoring, as sensitive markers of fetal anomalies and chromosomal abnormalities.

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Screening performances of abnormal first-trimester ductus venosus blood flow and increased nuchal translucency thickness in detection of major heart defects

Prenatal Diagnosis ◽

10.1002/pd.4693 ◽

2015 ◽

Vol 35 (13) ◽

pp. 1308-1315 ◽

Cited By ~ 3

Author(s):

Natasa Karadzov-Orlic ◽

Amira Egic ◽

Dejan Filimonovic ◽

Barbara Damnjanovic-Pazin ◽

Zagorka Milovanovic ◽

...

Keyword(s):

Blood Flow ◽

Heart Defects ◽

First Trimester ◽

Nuchal Translucency ◽

Ductus Venosus ◽

Increased Nuchal Translucency

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First trimester ultrasound screening for trisomy 21 based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0035-1558776 ◽

2015 ◽

Vol 36 (S 01) ◽

Author(s):

KO Kagan ◽

M Hoopmann ◽

P Wagner ◽

H Abele

Keyword(s):

Trisomy 21 ◽

Maternal Age ◽

Nasal Bone ◽

First Trimester ◽

Nuchal Translucency ◽

Ductus Venosus ◽

Ultrasound Screening ◽

First Trimester Ultrasound

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First-trimester presentation of ultrasound findings in trisomy 13 and validation of multiparameter ultrasound-based risk calculation models to detect trisomy 13 in the late first trimester

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0383 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Bartosz Rajs ◽

Agnieszka Nocuń ◽

Anna Matyszkiewicz ◽

Marcin Pasternok ◽

Michał Kołodziejski ◽

...

Keyword(s):

Heart Defects ◽

False Positive Rate ◽

Nasal Bone ◽

First Trimester ◽

Nuchal Translucency ◽

Trisomy 13 ◽

Ductus Venosus ◽

Patau Syndrome ◽

A Prospective Study ◽

Cns Anomalies

AbstractObjectivesTo identify the most common ultrasound patterns of markers and anomalies associated with Patau syndrome (PS), to explore the efficacy of multiparameter sonographic protocols in detecting trisomy 13 (T13) and to analyze the influence of maternal age (MA) on screening performance. Methods: The project was a prospective study based on singleton pregnancies referred for a first-trimester screening examination. The scan protocol included nuchal translucency (NT), fetal heart rate (FHR), secondary ultrasound markers [nasal bone (NB), tricuspid regurgitation (TR), ductus venosus reversed a-wave (revDV)] and major anomaly findings. Results: The study population comprised 6133 pregnancies: 6077 cases of euploidy and 56 cases of T13. Statistically significant differences were found in MA, FHR, NT, absence of NB, presence of revDV, TR and single umbilical artery. Fourteen cases of T13 (25%) demonstrated no markers of aneuploidy. The best general detection rate (DR) (DR of 78.6% with an false positive rate (FPR) of 1.2%) was obtained for a cutoff of 1/300 utilizing the “NT+T13” algorithm. The logistic regression model revealed that the central nervous system (CNS) anomalies had the greatest odds ratio (of 205.4) for T13. Conclusions: The effectiveness of the multiparameter sonographic protocol used for T13 screening showed promising results in patients older than 36 years and suboptimal results in patients between 26 and 36 years old. When screening for T13 left heart defects, CNS anomalies, abdominal anomalies, FHR above the 95th percentile, increased NT, revDV and lack of NB should receive specific attention.

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Doppler ultrasound in pregnancy – quality requirements of DEGUM and clinical application (part 2)

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1452-9898 ◽

2021 ◽

Author(s):

Renaldo Faber ◽

Kai-Sven Heling ◽

Horst Steiner ◽

Ulrich Gembruch

Keyword(s):

Blood Flow ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Umbilical Artery ◽

Prophylactic Treatment ◽

Doppler Sonography ◽

First Trimester ◽

Ductus Venosus ◽

Fetal Diagnosis

AbstractThis second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.

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