Toyama J M, Brizot M L, Liao A W, Lopes L M, Nomura R M Y, Saldanha F A T, Zugaib M
Fetal Medicine Unit, Department of Obstetrics, Hospital das Clínicas, São Paulo University Medical School, Brazil.
Ultrasound Obstet Gynecol. 2004 Apr;23(4):341-5. doi: 10.1002/uog.1025.
To evaluate the association between abnormal ductus venosus (DV) at 11-14 weeks' gestation and chromosomal abnormalities, structural defects and fetal outcome.
DV flow-velocity waveform (DV-FVW) and nuchal translucency thickness (NT) were prospectively evaluated in 1217 singleton pregnancies.
The DV-FVW was abnormal in 84 fetuses, NT was above the 95th centile in 160 fetuses and both markers were observed in 41 fetuses. Chromosomal defects were diagnosed in 22 fetuses. The sensitivity, specificity and positive and negative predictive values for an abnormal karyotype were 86.4%, 86.9%, 11.9% and 99.7%, respectively, for an increased NT. These values were 68.2%, 96.9%, 31.3% and 99.3%, respectively, for DV-FVW abnormalities and 68.2%, 97.6%, 36.6% and 99.3%, respectively, when both markers were found simultaneously. Regarding structural defects, these values were 43.8%, 92.9%, 8.3% and 99.1% for an abnormal NT, 25.0%, 92.6%, 4.8% and 98.8% for DV-FVW abnormalities and 25.0%, 97.9%, 15.4% and 98.9% for both together. Considering those cases of unexplained fetal demise, the values were 44.4%, 85.9%, 5.0% and 98.9% for NT abnormalities, 22.2%, 92.6%, 4.8% and 98.6% for an abnormal DV-FVW and 22.2%, 98%, 15.4% and 98.7% for both. In cases with increased NT, the percentage of live births with normal karyotype and no major fetal structural defects decreased from 93.8% in normal DV-FVW fetuses to 77.3% in abnormal ones.
DV assessment at 11-14 weeks' gestation is useful in screening for fetal chromosomal abnormalities and may help to reduce the false-positive rate when combined with NT measurement. Abnormal DV-FVW is also associated with an increase in adverse perinatal outcome in fetuses with enlarged NT. However, the value of DV-FVW assessment in cases with normal NT is unclear.
评估孕11 - 14周时静脉导管（DV）异常与染色体异常、结构缺陷及胎儿结局之间的关联。
对1217例单胎妊娠进行前瞻性评估，测量静脉导管血流速度波形（DV - FVW）和颈部透明带厚度（NT）。
84例胎儿DV - FVW异常，160例胎儿NT高于第95百分位数，41例胎儿两种指标均异常。22例胎儿被诊断出染色体缺陷。NT升高时，异常核型的敏感性、特异性、阳性预测值和阴性预测值分别为86.4%、86.9%、11.9%和99.7%。DV - FVW异常时，这些值分别为68.2%、96.9%、31.3%和99.3%；两种指标同时异常时，分别为68.2%、97.6%、36.6%和99.3%。关于结构缺陷，NT异常时，这些值分别为43.8%、92.9%、8.3%和99.1%；DV - FVW异常时，分别为25.0%、92.6%、4.8%和98.8%；两种指标同时异常时，分别为25.0%、97.9%、15.4%和98.9%。对于不明原因胎儿死亡的病例，NT异常时，这些值分别为44.4%、85.9%、5.0%和98.9%；DV - FVW异常时，分别为22.2%、92.6%、4.8%和98.6%；两种指标同时异常时，分别为22.2%、98%、15.4%和98.7%。在NT升高的病例中，核型正常且无主要胎儿结构缺陷的活产儿比例从DV - FVW正常胎儿的93.8%降至异常胎儿的77.3%。
孕11 - 14周时评估DV有助于筛查胎儿染色体异常，与NT测量联合使用可能有助于降低假阳性率。DV - FVW异常也与NT增大胎儿的围产期不良结局增加有关。然而，NT正常病例中DV - FVW评估的价值尚不清楚。
