Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome

Objective To investigate, in a high-risk group of fetuses, the role of duct us venosus Doppler velocimetry as a prognostic factor, in addition to nucha l translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome. Methods Nuchal translucency was measured and ductus venosus pulsatility ind ex and late diastolic flow (a-wave) were recorded in 186 fetuses tit a medi an gestational age of 12.6 weeks (range, 10-17). Fetal karyotype, the prese nce of structural anomalies, pregnancy outcome, neonatal examination at bir th and postnatal follow trp were the outcome values. Results Nuchal translucency measurement was increased in 112 fetuses. The o utcome of pregnancy was normal in 130 fetuses. Fifty-six fetuses had an adv erse outcome (46 chromosomal anomalies, three intrauterine deaths, six stru ctural anomalies and one developmental disorder). The sensitivity of an abn ormal ductus venosus pulsatility index or of absent or reversed flow during the a-wave was 65% for chromosomal anomalies and 68% for an adverse outcom e. The specificity was 79%. There was a significant correlation between nuc hal translucency and ductus venosus pulsaltility index. In chromosomally no rmal fetuses with an enlarged nuchal translucency an abnormal ductus venosu s flow was associated with a nearly nine-fold increase in adverse outcome ( odds ratio 11.7). Conclusion Ductus venosus Doppler velocimetry can be used in addition to nu chal translucency measurement as a predictor of chromosomal anomalies. Howe ver, as the ductus venosus blood flow pattern is correlated with nuchal tra nslucency measurement it cannot be used as an independent variable to reduc e the indication fur fetal karyotyping. Ductus venosus Doppler velocimetry may have a role in the counseling of parents in the case Of an enlarged nuc hal translucency and normal karyotype by identifying those fetuses in need of an intensive follow up due to an increased risk of adverse outcome.