title: Absence of an anatomical origin for altered ductus venosus flow velocity waveforms in first-trimester human fetuses with increased nuchal translucency.
abstract: OBJECTIVE
  To perform a morphological evaluation of the ductus venosus, heart and jugular lymphatic sac (JLS) in first-trimester human fetuses with normal and abnormal ductus venosus flow velocity waveforms (DV-FVWs) and normal and increased nuchal translucency (NT).
  
  
  METHODS
  Postmortem examination was performed on fetuses with increased NT or structural malformations with previous NT and DV-FVW measurements. Ductus venosus morphology was examined using markers for endothelium, smooth muscle actin (SMA), nerves and elastic fibers. Fetal hearts were studied by microscopy. The nuchal region was analyzed using markers for lymphatic vessels, endothelium, SMA and nerves.
  
  
  RESULTS
  Two trisomy 21 and two trisomy 18 fetuses with increased NT and abnormal DV-FVWs were analyzed. As a control, one euploid anencephalic fetus with normal NT, cardiac anatomy and DV-FVWs was examined. Similar endothelial and SMA expression was observed in the ductus venosus in all fetuses. Nerve and elastic fiber expression were not detected. Three trisomic fetuses showed cardiac defects, one trisomic fetus demonstrated normal cardiac anatomy. The JLS was abnormally enlarged or contained red blood cells in all trisomic fetuses. The control fetus showed a normal JLS.
  
  
  CONCLUSIONS
  Abnormal DV-FVWs are not justified by alterations in ductus venosus morphology. DV-FVWs most probably reflect intracardiac pressure. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Burger
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Sao João, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Matias
authors.affiliation: Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Kok
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Christoffels
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Mireille N
authors.initials: MN
authors.lastname: Bekker
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Monique C
authors.initials: MC
authors.lastname: Haak
mesh_terms: D000028:Abortion, Induced; D000199:Actins / Q000378:metabolism; D000757:Anencephaly / Q000000981:diagnostic imaging; D001344:Autopsy; D001783:Blood Flow Velocity; D019002:CD56 Antigen / Q000378:metabolism; D002887:Chromosomes, Human, Pair 18; D004314:Down Syndrome / Q000000981:diagnostic imaging*; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D048208:Nuchal Translucency Measurement; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011673:Pulsatile Flow; D014314:Trisomy / Q000175:diagnosis*; D000073842:Trisomy 18 Syndrome; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D014680:Veins / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology
chemical_list: D000199:Actins; D019002:CD56 Antigen; C522918:NCAM1 protein, human; D019408:Platelet Endothelial Cell Adhesion Molecule-1