title: First-trimester detection of major cardiac defects with the use of ductus venosus blood flow.
abstract: OBJECTIVE
  To assess the best method of combining fetal nuchal translucency (NT) and ductus venosus (DV) blood flow measurements in the detection of major cardiac defects in chromosomally normal fetuses during the first-trimester scan.
  
  
  METHODS
  During an 8-year period NT and DV blood flow were routinely assessed at 11-14 weeks' gestation. Only chromosomally normal singleton pregnancies were included in the study. When a cardiac defect was suspected, or when increased fetal NT and/or absent or reversed (AR) A-wave in the DV was observed, early fetal echocardiography was offered. Data on routine second- and third-trimester scans, neonatal follow-up or postmortem examination were obtained from hospital records. The detection and false-positive rates for all major cardiac defects were calculated for several screening strategies, including: NT or DV pulsatility index for veins (DV-PIV) above a fixed normal centile; AR A-wave; risk based on NT and DV-PIV or A-wave velocity above a fixed normal centile; and combinations of these strategies.
  
  
  RESULTS
  The study population included 37 chromosomally normal fetuses with a major cardiac defect and 12 799 unaffected pregnancies. Fetal NT above the 95(th) or the 99(th) centile and AR A-wave was observed in 40, 27 and 39% of the fetuses with major cardiac defects, respectively. A 47% detection rate with a 2.7% false-positive rate was obtained when AR A-wave or NT above the 99(th) centile was used as the selection criterion.
  
  
  CONCLUSIONS
  Half of major fetal cardiac defects could be detected in the first trimester if NT and DV Doppler are used to select 2.7% of the general pregnant population for extended fetal echocardiography.
authors.affiliation: Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic Barcelona, Catalonia, Spain. aborrell@clinic.cat
authors.forename: A
authors.initials: A
authors.lastname: Borrell
authors.forename: M
authors.initials: M
authors.lastname: Grande
authors.forename: M
authors.initials: M
authors.lastname: Bennasar
authors.forename: V
authors.initials: V
authors.lastname: Borobio
authors.forename: J M
authors.initials: JM
authors.lastname: Jimenez
authors.forename: I
authors.initials: I
authors.lastname: Stergiotou
authors.forename: J M
authors.initials: JM
authors.lastname: Martinez
authors.forename: H
authors.initials: H
authors.lastname: Cuckle
mesh_terms: D001783:Blood Flow Velocity; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000196:embryology / Q000235:genetics / Q000503:physiopathology; D006801:Humans; D048208:Nuchal Translucency Measurement / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal; D014680:Veins / Q000000981:diagnostic imaging