Screening for adverse pregnancy outcome by Ductus venosus Doppler at 11–13+6 weeks – Ductus venosus at 11–13+6 weeks

Objective: To examine the contribution of abnormal flow in the ductus venosus(DV)at 11–13 +6 weeks in the prediction of major fetal abnormalities and fetal death. Methods : In this screening study for trisomy 21 in singleton pregnancies maternal characteristics, serum free ßhCG and PAPP-A,fetal nuchal translucency(NT)as well the a-wave in the DV were assessed. Patients were subdivided into 1.a normal outcome group of live births with no chromosomal abnormalities/fetal defects,2.miscarriage24 weeks,3.abnormal karyotype,4.fetal major defect. The significance of the contribution to adverse outcome of reversed a-wave in the DV,maternal characteristics,fetal delta NT,maternal serum log PAPP-A MoM and log free ß was analyzed. Results: Reversed a-wave was observed in 458(4.4%)of the 10,490 fetuses and the prevalence was significantly higher in the groups with miscarriage or fetal death(10.8%),abnormal karyotype(62.1%),fetal cardiac defect(25%)but not non-cardiac defect(4.3%)than in the normal outcome group(3.7%). Logistic regression analysis demonstrated a significant contribution to adverse outcome(3.5%)provided by reversed a-wave,NT,PAPP-A,Black ethnicity and maternal BMI. An adverse outcome was observed in 2.7% of the fetuses with NT at or < the 95 th centile(in 2.6% of those with normal a-wave and in 7% of those with reversed a-wave)and in 19.3% of the fetuses with NT > the 95 th centile(in 8.9% of those with normal a-wave and in 70.9% of those with reversed a-wave). Conclusion: Reversed a-wave in the DV 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