title: Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome.
abstract: OBJECTIVE
  To evaluate the association between abnormal ductus venosus (DV) at 11-14 weeks' gestation and chromosomal abnormalities, structural defects and fetal outcome.
  
  
  METHODS
  DV flow-velocity waveform (DV-FVW) and nuchal translucency thickness (NT) were prospectively evaluated in 1217 singleton pregnancies.
  
  
  RESULTS
  The DV-FVW was abnormal in 84 fetuses, NT was above the 95th centile in 160 fetuses and both markers were observed in 41 fetuses. Chromosomal defects were diagnosed in 22 fetuses. The sensitivity, specificity and positive and negative predictive values for an abnormal karyotype were 86.4%, 86.9%, 11.9% and 99.7%, respectively, for an increased NT. These values were 68.2%, 96.9%, 31.3% and 99.3%, respectively, for DV-FVW abnormalities and 68.2%, 97.6%, 36.6% and 99.3%, respectively, when both markers were found simultaneously. Regarding structural defects, these values were 43.8%, 92.9%, 8.3% and 99.1% for an abnormal NT, 25.0%, 92.6%, 4.8% and 98.8% for DV-FVW abnormalities and 25.0%, 97.9%, 15.4% and 98.9% for both together. Considering those cases of unexplained fetal demise, the values were 44.4%, 85.9%, 5.0% and 98.9% for NT abnormalities, 22.2%, 92.6%, 4.8% and 98.6% for an abnormal DV-FVW and 22.2%, 98%, 15.4% and 98.7% for both. In cases with increased NT, the percentage of live births with normal karyotype and no major fetal structural defects decreased from 93.8% in normal DV-FVW fetuses to 77.3% in abnormal ones.
  
  
  CONCLUSIONS
  DV assessment at 11-14 weeks' gestation is useful in screening for fetal chromosomal abnormalities and may help to reduce the false-positive rate when combined with NT measurement. Abnormal DV-FVW is also associated with an increase in adverse perinatal outcome in fetuses with enlarged NT. However, the value of DV-FVW assessment in cases with normal NT is unclear.
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics, Hospital das Clínicas, São Paulo University Medical School, Brazil.
authors.forename: J M
authors.initials: JM
authors.lastname: Toyama
authors.forename: M L
authors.initials: ML
authors.lastname: Brizot
authors.forename: A W
authors.initials: AW
authors.lastname: Liao
authors.forename: L M
authors.initials: LM
authors.lastname: Lopes
authors.forename: R M Y
authors.initials: RM
authors.lastname: Nomura
authors.forename: F A T
authors.initials: FA
authors.lastname: Saldanha
authors.forename: M
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D002869:Chromosome Aberrations / Q000196:embryology*; D005260:Female; D005333:Fetus / Q000002:abnormalities / Q000098:blood supply* / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007621:Karyotyping; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*