Bilardo C M, Müller M A, Zikulnig L, Schipper M, Hecher K
Department of Obstetrics and Gynecology, Academic Medical Center, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2001 Apr;17(4):288-94. doi: 10.1046/j.1469-0705.2001.00387.x.
To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome.
Nuchal translucency was measured and ductus venosus pulsatility index and late diastolic flow (a-wave) were recorded in 186 fetuses at a median gestational age of 12.6 weeks (range, 10-17). Fetal karyotype, the presence of structural anomalies, pregnancy outcome, neonatal examination at birth and postnatal follow up were the outcome values.
Nuchal translucency measurement was increased in 112 fetuses. The outcome of pregnancy was normal in 130 fetuses. Fifty-six fetuses had an adverse outcome (46 chromosomal anomalies, three intrauterine deaths, six structural anomalies and one developmental disorder). The sensitivity of an abnormal ductus venosus pulsatility index or of absent or reversed flow during the a-wave was 65% for chromosomal anomalies and 68% for an adverse outcome. The specificity was 79%. There was a significant correlation between nuchal translucency and ductus venosus pulsatility index. In chromosomally normal fetuses with an enlarged nuchal translucency an abnormal ductus venosus flow was associated with a nearly nine-fold increase in adverse outcome (odds ratio 11.7).
Ductus venosus Doppler velocimetry can be used in addition to nuchal translucency measurement as a predictor of chromosomal anomalies. However, as the ductus venosus blood flow pattern is correlated with nuchal translucency measurement it cannot be used as an independent variable to reduce the indication for fetal karyotyping. Ductus venosus Doppler velocimetry may have a role in the counseling of parents in the case of an enlarged nuchal translucency and normal karyotype by identifying those fetuses in need of an intensive follow up due to an increased risk of adverse outcome.
在一组高危胎儿中，研究除颈部透明带测量外，静脉导管多普勒测速作为预测染色体异常以及在核型正常时预测胎儿结局的预后因素的作用。
对186例中位孕龄为12.6周（范围10 - 17周）的胎儿测量颈部透明带，并记录静脉导管搏动指数和舒张末期血流（a波）。胎儿核型、结构异常的存在情况、妊娠结局、出生时的新生儿检查及产后随访为观察指标。
112例胎儿颈部透明带测量值升高。130例胎儿妊娠结局正常。56例胎儿有不良结局（46例染色体异常、3例宫内死亡、6例结构异常和1例发育障碍）。静脉导管搏动指数异常或a波血流缺失或反向时，对染色体异常的敏感性为65%，对不良结局的敏感性为68%。特异性为79%。颈部透明带与静脉导管搏动指数之间存在显著相关性。在颈部透明带增大的染色体正常胎儿中，静脉导管血流异常与不良结局增加近9倍相关（优势比11.7）。
除颈部透明带测量外，静脉导管多普勒测速可作为染色体异常的预测指标。然而，由于静脉导管血流模式与颈部透明带测量相关，它不能作为独立变量来减少胎儿核型分析的指征。静脉导管多普勒测速在颈部透明带增大且核型正常的情况下，通过识别那些因不良结局风险增加而需要密切随访的胎儿，可能在为父母提供咨询方面发挥作用。
