title: First-trimester measurement of the ductus venosus pulsatility index and the prediction of congenital heart defects.
abstract: OBJECTIVE
  This study was carried out to evaluate the additional predictive value of ductus venosus pulsatility index for veins (DV-PIV) in the identification of congenital heart defects (CHDs) in fetuses with an enlarged nuchal translucency (NT) and a normal karyotype.
  
  
  METHODS
  All chromosomally normal fetuses referred to our Fetal Medicine Unit between September 1996 and December 2008 with known NT, DV-PIV and ductus venosus (DV) a-wave measurements were included. Intrafetus variation in DV-PIV was overcome by averaging three recordings. Follow-up included special focus on CHD. The odds of CHD at any NT and DV-PIV value were evaluated using logistic regression analysis.
  
  
  RESULTS
  Of 792 fetuses included, the NT was enlarged (equal to or above the 95(th) percentile (P95)) in 318 (40.2%). The DV-PIV was abnormal (≥ P95) in 41.8% of the fetuses with an enlarged NT and the a-wave was abnormal (negative or reversed) in 29.9%. CHD was diagnosed in 35 fetuses, 33 of which had an enlarged NT. Amongst the fetuses with an enlarged NT, the sensitivities for CHD of abnormal DV-PIV and DV a-wave were 73% and 55%, with specificities of 62% and 73%, respectively. Logistic regression analysis showed that in this risk group the DV-PIV multiple of the median (MoM) (as a continuous variable) was significantly associated with the risk of CHD (odds ratio = 2.4), independent of the degree of NT enlargement, whereas the DV a-wave did not significantly add to the prediction of CHD.
  
  
  CONCLUSIONS
  Two-thirds of fetuses with an enlarged NT, a normal karyotype and CHD have an increased DV-PIV. DV-PIV can be used as continuous variable in combination with NT to increase specificity in the identification of CHD and to refine the individual risk assessment.
authors.affiliation: Department of Obstetrics & Gynecology, Academic Medical Centre, Amsterdam, The Netherlands. e.timmerman@amc.uva.nl
authors.forename: E
authors.initials: E
authors.lastname: Timmerman
authors.forename: S A
authors.initials: SA
authors.lastname: Clur
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.forename: C M
authors.initials: CM
authors.lastname: Bilardo
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000235:genetics / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D048208:Nuchal Translucency Measurement / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins / Q000098:blood supply / Q000000981:diagnostic imaging*