Oh C, Harman C, Baschat A A
Center for Advanced Fetal Care, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Ultrasound Obstet Gynecol. 2007 Aug;30(2):192-6. doi: 10.1002/uog.4034.
First-trimester nuchal translucency thickness (NT) is a potent tool for assessment of fetal risks of aneuploidy and other adverse outcomes. When NT is increased, Doppler assessment of the ductus venosus (DV) enhances the prediction specificity for Down syndrome. This study assessed abnormal Doppler DV waveform as a predictor of adverse outcome when the NT is normal.
This was a case-control study of 2,505 consecutive patients undergoing NT screening in our certified first-trimester screening program. First-trimester Doppler assessment of DV was performed and atrial systolic velocity was rated as antegrade (normal) or absent/reversed (DV-RAV; abnormal). Each case with normal NT (< 95(th) percentile) and DV-RAV was matched with two controls with respect to maternal age within 1 year, NT within 0.2 mm, crown-rump length within 3 mm, and closest calculated aneuploidy risk. Outcomes for paired variables were compared using t-test and Chi-square test.
Forty-seven (1.9%) patients had normal NT and DV-RAV. After exclusion of three cases with obvious first-trimester anomalies and two with incomplete outcome data, 42 remained for analysis. Adverse outcome included cardiovascular defects (n = 6), fetal growth restriction (n = 3), renal anomaly (n = 2), aneuploidy (n = 3) and multiple defects (n = 3), in a total of 11/42 cases (26.2%). Cardiac abnormalities, renal abnormalities and perinatal death were all significantly more common in the study group (all P < 0.05).
Abnormal first-trimester DV Doppler findings appear to predict adverse outcome independently of a normal NT. These patients need detailed mid-trimester assessment of fetal anatomy with formal echocardiography, and subsequent follow-up.
孕早期颈部半透明厚度（NT）是评估胎儿非整倍体及其他不良结局风险的有力工具。当NT增加时，静脉导管（DV）的多普勒评估可提高唐氏综合征的预测特异性。本研究评估了NT正常时异常的DV多普勒波形作为不良结局预测指标的情况。
这是一项病例对照研究，纳入了在我们经认证的孕早期筛查项目中连续接受NT筛查的2505例患者。对DV进行孕早期多普勒评估，并将心房收缩期速度评定为正向（正常）或缺失/反向（DV-RAV；异常）。每例NT正常（<第95百分位数）且DV-RAV的病例与两名对照在母亲年龄相差1岁以内、NT相差0.2mm以内、头臀长度相差3mm以内以及最接近的计算非整倍体风险方面进行匹配。使用t检验和卡方检验比较配对变量的结局。
47例（1.9%）患者NT正常但DV-RAV。排除3例孕早期明显异常及2例结局数据不完整的病例后，剩余42例用于分析。不良结局包括心血管缺陷（n = 6）、胎儿生长受限（n = 3）、肾脏异常（n = 2）、非整倍体（n = 3）和多发缺陷（n = 3），共11/42例（26.2%）。心脏异常、肾脏异常和围产期死亡在研究组中均显著更常见（均P < 0.05）。
孕早期DV多普勒检查异常似乎可独立于正常NT预测不良结局。这些患者需要在孕中期通过正式超声心动图对胎儿解剖结构进行详细评估，并进行后续随访。
