title: Screening for adverse pregnancy outcome by ductus venosus Doppler at 11-13+6 weeks of gestation.
abstract: 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 beta-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 beta-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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Nerea
authors.initials: N
authors.lastname: Maiz
authors.forename: Catalina
authors.initials: C
authors.lastname: Valencia
authors.forename: Edoho E
authors.initials: EE
authors.lastname: Emmanuel
authors.forename: Ismini
authors.initials: I
authors.lastname: Staboulidou
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides