HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Maiz, N. Articles by Nicolaides, K. H. PubMed PubMed Citation Articles by Maiz, N. Articles by Nicolaides, K. H. Related Collections Ultrasound/doppler

Screening for Adverse Pregnancy Outcome by Ductus Venosus Doppler at 11–13⁺⁶ Weeks of Gestation

From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom.

OBJECTIVE: To estimate the independent contribution of abnormal flow in the ductus venosus at 11 to 13⁺⁶ weeks of gestation in the prediction of major fetal abnormalities and fetal death.

METHODS: This was a prospective assessment of singleton pregnancies by maternal history, serum free β-hCG, pregnancy-associated plasma protein A (PAPP-A), fetal nuchal translucency thickness, and ductus venosus Doppler. The patients were subdivided into five groups: normal outcome (n=10,120), miscarriage or fetal death (n=185), abnormal karyotype (n=95), and major cardiac (n=20) or noncardiac defect (n=70). Regression analysis was performed to determine the significance of the contribution to adverse outcome of reversed a-wave in the ductus venosus, maternal characteristics, fetal delta nuchal translucency, maternal serum log PAPP-A multiples of the median, and log free β-hCG multiples of the median.

RESULTS: The prevalence of reversed a-wave was significantly higher in the groups with miscarriage or fetal death (10.8%), abnormal karyotype (62.1%), and fetal cardiac defect (25.0%) than in the normal outcome group (3.7%), but not noncardiac defect (4.3%). An adverse outcome was observed in 2.7% of the fetuses with nuchal translucency at or below the 95th centile (in 2.6% of those with normal a-wave and in 7.0% of those with reversed a-wave) and in 19.3% of the fetuses with nuchal translucency above the 95th centile (in 8.9% of those with normal a-wave and in 70.9% of those with reversed a-wave).

CONCLUSION: Reversed a-wave is associated with increased risk for chromosomal abnormalities, cardiac defects, and fetal death. However, in about 80% of cases with reversed a-wave, the pregnancy outcome is normal.

LEVEL OF EVIDENCE: II