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Peers de Nieuwburgh M, Dave A, Khan SA, Ngo M, Hayes KB, Slipenchuk M, Lieberman E, Youssef MR, Crompton D, Choudhry AM, Guo N, Tian Z, Rychik J, Davey MG, Flake AW. Assessment of extremely premature lambs supported by the Extrauterine Environment for Neonatal Development (EXTEND). Pediatr Res 2024:10.1038/s41390-024-03287-0. [PMID: 38834782 DOI: 10.1038/s41390-024-03287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/28/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Our team has previously reported physiologic support by the EXTra-uterine Environment for Neonatal Development (EXTEND) of 105 to 117 days gestational age (GA) lambs for up to 28 days with normal organ maturation. However, the fetal lamb brain matures more rapidly, requiring the study of 90-105 day GA fetal lambs to assess more neurodevelopmentally equivalent lambs to the 23-25 week GA extreme premature infant. METHODS Extremely preterm lambs (90-95 days of GA) were delivered by C-section and supported by EXTEND. Estimated circuit flows were maintained at around 325 ml/kg/min. After support on EXTEND, MRI and histopathologic analysis were performed and compared to 105-112 days GA control lambs. RESULTS The extremely preterm group includes 10 animals with a mean GA of 91.6 days, a mean weight at cannulation of 0.98 kg and a mean length of stay on EXTEND of 13.5 days (10-21 days). Hemodynamics and oxygenation showed stable parameters. Animals showed growth and physiologic cardiac function. MRI volumetric and diffusion analysis was comparable to controls. Histologic brain analysis revealed no difference between study groups. CONCLUSION EXTEND appears to support brain and cardiac development in an earlier gestation, less mature, lamb model. IMPACT Prolonged (up to 21 days) physiological support of extremely preterm lambs of closer neurodevelopmental equivalence to the 24-28 gestational week human was achieved using the EXTEND system. EXTEND treatment supported brain growth and development in extremely preterm fetal lambs and was not associated with intraventricular hemorrhage or white matter injury. Daily echocardiography demonstrated physiologic heart function, absence of cardiac afterload, and normal developmental increase in cardiac chamber dimensions. This study demonstrates hemodynamic and metabolic support by the EXTEND system in the extremely preterm ovine model.
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Affiliation(s)
| | - Apeksha Dave
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sameer A Khan
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Ngo
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin B Hayes
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Evan Lieberman
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mohanad R Youssef
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Alia Mohsin Choudhry
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nan Guo
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zhiyun Tian
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Alan W Flake
- Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Kalayci H, Yilmaz Baran Ş, Doğan Durdağ G, Yetkinel S, Alemdaroğlu S, Özdoğan S, Yüksel Şimşek S, Bulgan Kiliçdağ E. Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13 +6 weeks of gestation. J Matern Fetal Neonatal Med 2018; 33:1134-1139. [PMID: 30157671 DOI: 10.1080/14767058.2018.1517152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV.Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), "a"-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables.Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18-45), 23.9 kg/m2 (range, 15.5-46.6), 59.5 mm (range, 45-79), 12.3 weeks (range, 11.2-13.6), and 1.58 mm (range, 0.73-2.62), respectively. The median gravidity and parity were 2 (1-8) and 0 (0-4), respectively. The "a"-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro-Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (±2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively.Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements.
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Affiliation(s)
- Hakan Kalayci
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Şafak Yilmaz Baran
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Gülşen Doğan Durdağ
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Serdinç Özdoğan
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
| | - Esra Bulgan Kiliçdağ
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey
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Karakoç G, Yavuz A, Eriş Yalçın S, Akkurt MÖ, Danışman N. The significance of reverse flow in ductus venosus between sixteen and twenty weeks' gestation. Turk J Obstet Gynecol 2017; 14:23-27. [PMID: 28913131 PMCID: PMC5558314 DOI: 10.4274/tjod.61482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/27/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between reversed a-wave in ductus venosus at 16-20 weeks' gestation and trisomy 21 and adverse perinatal outcomes. MATERIALS AND METHODS Our study included 174 pregnant women who were under follow-up at a tertiary center between May and September 2010. Ductus venosus Doppler (DVD) measurements were obtained throughout the 6-month period from women who underwent amniocentesis procedures due to increased risk for trisomy 21 in terms of first or second trimester screening test results. These women were followed up for enrollment of subsequent data about perinatal outcomes. RESULTS In 13 of 174 cases, Doppler studies indicated a reversed a-wave in the ductus venosus. Of these fetuses, 3 were diagnosed as having trisomy 21 after amniocentesis, which related to 60% (3 of 5 fetuses) of all fetuses with trisomy 21. The pregnant women with reversed a-wave in DVD also had an increased rate of preeclampsia (15%) and gestational diabetes mellitus (GDM) (23%) in late pregnancy. CONCLUSION Reversed a-wave in ductus venosus between 16-20 weeks' gestation is associated with increased risk of trisomy 21, preeclampsia, and GDM. If further prospective studies confirm its utility, DVD interrogation for trisomy 21 may be extended until 20 weeks' gestation.
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Affiliation(s)
- Gökhan Karakoç
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Perinatology, Ankara, Turkey
| | - And Yavuz
- Süleyman Demirel University Faculty of Medicine, Department of Perinatology, Isparta, Turkey
| | - Serenat Eriş Yalçın
- Süleyman Demirel University Faculty of Medicine, Department of Perinatology, Isparta, Turkey
| | - Mehmet Özgür Akkurt
- Süleyman Demirel University Faculty of Medicine, Department of Perinatology, Isparta, Turkey
| | - Nuri Danışman
- Zekai Tahir Burak Women's Health Training and Research Hospital, Clinic of Perinatology, Ankara, Turkey
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Burger NB, Haak MC, Kok E, de Groot CJM, Shou W, Scambler PJ, Lee Y, Cho E, Christoffels VM, Bekker MN. Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus. Early Hum Dev 2016; 101:39-48. [PMID: 27405055 DOI: 10.1016/j.earlhumdev.2016.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In human fetuses with cardiac defects and increased nuchal translucency, abnormal ductus venosus flow velocity waveforms are observed. It is unknown whether abnormal ductus venosus flow velocity waveforms in fetuses with increased nuchal translucency are a reflection of altered cardiac function or are caused by local morphological alterations in the ductus venosus. AIM The aim of this study was to investigate if the observed increased nuchal translucency, cardiac defects and abnormal lymphatic development in the examined mouse models are associated with local changes in ductus venosus morphology. STUDY DESIGN Mouse embryos with anomalous lymphatic development and nuchal edema (Ccbe1(-/-) embryos), mouse embryos with cardiac defects and nuchal edema (Fkbp12(-/-), Tbx1(-/-), Chd7(fl/fl);Mesp1Cre, Jarid2(-/-NE+) embryos) and mouse embryos with cardiac defects without nuchal edema (Tbx2(-/-), Fgf10(-/-), Jarid2(-/-NE-) embryos) were examined. Embryos were analyzed from embryonic day (E) 11.5 to 15.5 using markers for endothelium, smooth muscle actin, nerve tissue and elastic fibers. RESULTS All mutant and wild-type mouse embryos showed similar, positive endothelial and smooth muscle cell expression in the ductus venosus at E11.5-15.5. Nerve marker and elastic fiber expression were not identified in the ductus venosus in all investigated mutant and wild-type embryos. Local morphology and expression of the used markers were similar in the ductus venosus in all examined mutant and wild-type embryos. CONCLUSIONS Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus. Ductus venosus flow velocity waveforms most probably reflect intracardiac pressure.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, the Netherlands.
| | - Evelien Kok
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam, the Netherlands.
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Weinian Shou
- Riley Heart Research Center, Herman B Wells Center for Pediatric Research, Division of Pediatric Cardiology, Indiana University School of Medicine, 705 Riley Hospital Dr. Indianapolis, Indiana, USA.
| | - Peter J Scambler
- Department of Molecular Medicine, University College London, Institute of Child Health, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Youngsook Lee
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, 1111 Highland Ave. Madison, Wisconsin, USA.
| | - Eunjin Cho
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, 1111 Highland Ave. Madison, Wisconsin, USA.
| | - Vincent M Christoffels
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam, the Netherlands.
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Burger NB, Matias A, Kok E, de Groot CJM, Christoffels VM, Bekker MN, Haak MC. Absence of an anatomical origin for altered ductus venosus flow velocity waveforms in first-trimester human fetuses with increased nuchal translucency. Prenat Diagn 2016; 36:537-44. [PMID: 27060369 DOI: 10.1002/pd.4820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To perform a morphological evaluation of the ductus venosus, heart and jugular lymphatic sac (JLS) in first-trimester human fetuses with normal and abnormal ductus venosus flow velocity waveforms (DV-FVWs) and normal and increased nuchal translucency (NT). METHOD Postmortem examination was performed on fetuses with increased NT or structural malformations with previous NT and DV-FVW measurements. Ductus venosus morphology was examined using markers for endothelium, smooth muscle actin (SMA), nerves and elastic fibers. Fetal hearts were studied by microscopy. The nuchal region was analyzed using markers for lymphatic vessels, endothelium, SMA and nerves. RESULTS Two trisomy 21 and two trisomy 18 fetuses with increased NT and abnormal DV-FVWs were analyzed. As a control, one euploid anencephalic fetus with normal NT, cardiac anatomy and DV-FVWs was examined. Similar endothelial and SMA expression was observed in the ductus venosus in all fetuses. Nerve and elastic fiber expression were not detected. Three trisomic fetuses showed cardiac defects, one trisomic fetus demonstrated normal cardiac anatomy. The JLS was abnormally enlarged or contained red blood cells in all trisomic fetuses. The control fetus showed a normal JLS. CONCLUSION Abnormal DV-FVWs are not justified by alterations in ductus venosus morphology. DV-FVWs most probably reflect intracardiac pressure. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandra Matias
- Department of Obstetrics and Gynecology, University Hospital Sao João, Porto, Portugal
| | - Evelien Kok
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Yu R, Li SL, Luo GY, Wen HX, Ouyang SY, Chen CY, Yuan Y. First-Trimester Echocardiographic Features and Perinatal Outcomes in Fetuses With Congenital Absence of the Aortic Valve. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:739-745. [PMID: 26939599 DOI: 10.7863/ultra.15.03042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the echocardiographic features and perinatal outcomes of congenital absence of the aortic valve diagnosed by first-trimester echocardiography. METHODS This retrospective study assessed the feasibility of first-trimester echocardiography in detecting absence of the aortic valve. All cases of absence of the aortic valve diagnosed by first-trimester fetal echocardiography from January 2010 to December 2014 were identified at a single referral center using an established perinatal database. Demographic information, echocardiograms, perinatal outcomes, and autopsy reports were reviewed. Echocardiographic features were described. RESULTS A total of 50,822 fetuses underwent first-trimester echocardiography during the study period. Ten cases of congenital absence of the aortic valve were diagnosed, for an overall incidence rate of 0.019%. The earliest gestational age at diagnosis was 11 weeks 6 days. The mean crown-lump length was 61.9 mm; mean gestational age was 12 weeks; and mean maternal body mass index ± SD was 21.2 ± 3.9 kg/m(2). Nine fetuses had increased nuchal translucency ranging from 2.4 to 12.4 mm (mean ± SD, 6.4 ± 3.6 mm). Color Doppler flow imaging revealed biphasic bidirectional flow in the ascending aorta and aortic arch and reversed flow in the ductus venosus during atrial systole in all cases. Reversed diastolic flow was present in the umbilical arteries and thoracic aorta. All cases had complex cardiac malformations as well as extracardiac abnormalities. CONCLUSIONS Our study confirms that absence of the aortic valve is a rare cardiac defect that can be diagnosed by first-trimester fetal echocardiography. A "to-and-fro" flow pattern or biphasic bidirectional flow in the great arteries is a key echocardiographic feature in fetuses with absence of the aortic valve.
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Affiliation(s)
- Rong Yu
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
| | - Sheng-li Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
| | - Guo-yang Luo
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut USA
| | - Hua-xuan Wen
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
| | - Shu-yuan Ouyang
- Department of Central Laboratory, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
| | - Cong-ying Chen
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
| | - Ying Yuan
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated With Southern Medical University, Shenzhen, China
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Karadzov-Orlic N, Egic A, Filimonovic D, Damnjanovic-Pazin B, Milovanovic Z, Lukic R, Mandic V, Joksic I, Vukomanovic V, Kosutic J, Djuricic S, Mikovic Z. Screening performances of abnormal first-trimester ductus venosus blood flow and increased nuchal translucency thickness in detection of major heart defects. Prenat Diagn 2015; 35:1308-15. [PMID: 26408089 DOI: 10.1002/pd.4693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/13/2015] [Accepted: 09/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the screening performances of abnormal ductus venosus (DV) blood flow for the detection of heart defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11-13 + 6 weeks' gestational in a population of singleton pregnancies. METHODS During an 8-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks were scanned for NT and DV blood flow assessment. Two groups of cases with abnormal NT were evaluated: NT ≥ 95th and NT ≥ 99th centile. DV waveforms were considered to be abnormal if the a-wave was reversed or absent (R/A). RESULTS Addition of DV R/A a-wave to either NT ≥ 95th or NT ≥ 99th percentile increased specificity (p < 0.001 and p < 0.001, respectively), but not screening performances in detection of major heart defects (p = 0.73 and p = 0.91, respectively). Combination of DV R/A a-wave with NT ≥ 95th or NT ≥ 99th centile correlated with right heart defects (p = 0.024 and p = 0.013, respectively). CONCLUSIONS In chromosomally normal fetuses, addition of abnormal DV a-wave to increased NT does not improve screening performances of NT in detection of major hearts defects in first trimester. However, there is correlation of such parameter with right heart defects and AV septal defects.
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Affiliation(s)
- Natasa Karadzov-Orlic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Amira Egic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejan Filimonovic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Barbara Damnjanovic-Pazin
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zagorka Milovanovic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Relja Lukic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Mandic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Joksic
- Genetic Laboratory, Obsterics/Gynecolgy Clinic 'Narodni font', University of Belgrade, Belgrade, Serbia
| | - Vladimir Vukomanovic
- Division of Pediatric Cardiology, Institute for Mother and Child Healthcare 'Dr Vukan Čupić', School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Kosutic
- Genetic Laboratory, Obsterics/Gynecolgy Clinic 'Narodni font', University of Belgrade, Belgrade, Serbia
| | - Slavisa Djuricic
- Department of Pathology, Institute for Mother and Child Healthcare 'Dr Vukan Čupić', University of Belgrade, Belgrade, Serbia
| | - Zeljko Mikovic
- High-risk Pregnancy Unit, Obsterics/Gynecolgy Clinic 'Narodni font', School of Medicine, University of Belgrade, Belgrade, Serbia
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8
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Peixoto AB, Caldas TMRDC, Martins WP, Ferreira PC, Nardozza LMM, Costa FDS, Araujo Júnior E. Reference range for the pulsatility index ductus venosus Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population. J Matern Fetal Neonatal Med 2015; 29:2738-41. [PMID: 26438979 DOI: 10.3109/14767058.2015.1103730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To establish reference range for the pulsatility index (PI) ductus venosus (DV) Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population. METHODS A retrospective cross-sectional study was performed with 430 singleton pregnancies. The PI DV Doppler measurement was performed as routine during the first trimester screening. DV was identified by color Doppler and the pulsed Doppler gate was placed in the distal portion of the umbilical sinus. When at least three typical DV waveforms were obtained, PI DV was measured manually in one waveform. Polynomial regression was used to obtain the best fit using PI DV Doppler measurement and crown-rump length (CRL) with adjustments by the determination coefficient (R(2)). 5th, 50th and 95th percentiles for the PI DV Doppler measurements at each gestational were determined. RESULTS The mean of PI DV Doppler measurement was 1.1 ± 0.2 (range 0.8-3.7). The linear regression was the best fit: PI DV measurement = 1.288-0.0034*CRL (R(2 )= 0.03). CONCLUSIONS Reference range for the PI DV Doppler measurement between 11 and 13 + 6 weeks of gestation in a Brazilian population was established.
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Affiliation(s)
- Alberto Borges Peixoto
- a 1Mario Palmério University Hospital - University of Uberaba (UNIUBE) , Uberaba-MG , Brazil .,b 2Radiologic Clinic of Uberaba (CRU) , Uberaba-MG , Brazil
| | - Taciana Mara Rodrigues da Cunha Caldas
- a 1Mario Palmério University Hospital - University of Uberaba (UNIUBE) , Uberaba-MG , Brazil .,b 2Radiologic Clinic of Uberaba (CRU) , Uberaba-MG , Brazil
| | - Wellington P Martins
- c 3Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (DGO-FMRP-USP) , Ribeirão Preto-SP , Brazil
| | - Polyana Costa Ferreira
- a 1Mario Palmério University Hospital - University of Uberaba (UNIUBE) , Uberaba-MG , Brazil
| | | | - Fabricio Da Silva Costa
- e 5Department of Perinatal Medicine, Royal Women's Hospital, and Department of Obstetrics and Gynaecology, University of Melbourne , Melbourne , Victoria , Australia
| | - Edward Araujo Júnior
- d 4Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP) , São Paulo-SP , Brazil , and
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9
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İlhan G, İyibozkurt AC, Kalelioğlu Hİ, İbrahimoğlu L, Zebitay AG, Eken MK, Karasu AFG. Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles. Arch Gynecol Obstet 2015; 293:345-50. [PMID: 26109506 DOI: 10.1007/s00404-015-3796-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker. METHODS DV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used. RESULTS DV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values. CONCLUSIONS DV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.
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Affiliation(s)
- Gülşah İlhan
- Suleymaniye Research and Education Hospital, Istanbul, Turkey.
| | | | | | - Lemi İbrahimoğlu
- İstanbul University İstanbul Medical Faculty, Istanbul, Turkey. lemi.ibrahimoglu.@gmail.com
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 719] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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Burger NB, Haak MC, De Bakker BS, Al Shaibani Z, De Groot CJM, Christoffels VM, Bekker MN. Systematic analysis of the development of the ductus venosus in wild type mouse and human embryos. Early Hum Dev 2013; 89:1067-73. [PMID: 23978399 DOI: 10.1016/j.earlhumdev.2013.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Doppler flow velocities of the ductus venosus are increasingly used to assess fetal increased nuchal translucency, growth-restriction and monochorionic twins, and might contribute to screening for cardiac defects. It is disputed whether a sphincter at the ductus venosus inlet actively regulates blood flow. AIMS This study aims to define the morphogenesis of the developing mouse and human ductus venosus and to address the existence of a sphincter. STUDY DESIGN The presence of endothelium, smooth muscle, elastic fibers and nerves in the ductus venosus of E10.5-15.5 mouse embryos and in three corresponding human embryos (CS16, CS19 and CS23) was examined using immunohistochemistry. Three-dimensional reconstructions of the ductus venosus of E11.5-15.5 mouse and CS14-23 human embryos were generated and examined. RESULTS The ductus venosus lumen was narrowed from ventral-caudal to dorsal-cranial in E13.5-15.5 mouse and CS16-23 human embryos. Mouse embryos showed positive endothelial Pecam1 expression from E11.5-15.5 and smooth muscle actin staining in the ventral-caudal part of the ductus venosus from E12.5-15.5. At all developmental stages, elastic fiber and nerve marker expression was not detected in the ductus venosus (Fig. 2). In human embryos endothelial Pecam1 and smooth muscle actin expression was found in the ductus venosus from CS16 and CS19 onwards. Elastic fiber and nerve marker expression was not detected in all stages (Fig. 4). Morphogenesis and staining results of the ductus venosus were similar in both species. CONCLUSIONS The ductus venosus lacks a sphincter at its inlet as no accumulation of smooth muscle cells, elastic fibers or nerve innervation was found in mouse embryos from E11.5-15.5 and in human embryos from CS14-23.
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Affiliation(s)
- Nicole B Burger
- Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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First-trimester detection of fetal anomalies in pregestational diabetes using nuchal translucency, ductus venosus Doppler, and maternal glycosylated hemoglobin. Am J Obstet Gynecol 2013; 208:385.e1-8. [PMID: 23353022 DOI: 10.1016/j.ajog.2013.01.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/02/2013] [Accepted: 01/19/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The frequency of fetal anomalies in women with pregestational diabetes correlates with their glycemic control. This study aimed to assess the predictive performance of first-trimester fetal nuchal translucency (NT), ductus venosus (DV) Doppler, and hemoglobin A1c (HbA1c) to predict fetal anomalies in women with pregestational diabetes. STUDY DESIGN This was a prospective observational study of patients undergoing first-trimester NT with DV Doppler. Screening performance was tested for first-trimester parameters to detect fetal anomalies. RESULTS Of 293 patients, 17 had fetal anomalies (11 cardiac, 7 major, 3 multisystem). All anomalous fetuses were suspected prenatally. One had NT >95th centile, 2 had reversed DV a-wave, and 13 had HbA1c >7.0%. The HbA1c was the primary determinant of anomalies (r(2), 0.15; P < .001) and >8.35% was the optimal cutoff for prediction of anomalies with an area under the curve of 0.72 (95% confidence interval, 0.57-0.88). Therefore, first-trimester prediction of anomalies was best in women with increased NT or HbA1c >8.3% (sensitivity 70.6%, specificity 77.4%, positive predictive value 16.2%, negative predictive value 97.7%, P < .001). CONCLUSION In women with pregestational diabetes and poor glycemic control, an increased NT increases risks for major fetal anomalies. Second-trimester follow-up is required to achieve accurate prenatal diagnosis.
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Prats P, Ferrer Q, Comas C, Rodríguez I. Is the addition of the ductus venosus useful when screening for aneuploidy and congenital heart disease in fetuses with normal nuchal translucency? Fetal Diagn Ther 2012; 32:138-43. [PMID: 22585666 DOI: 10.1159/000335489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 11/11/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to examine the possible role of Doppler ultrasound assessment of ductus venosus (DV) blood flow at 11⁺⁰-13⁺⁶ weeks' gestation in fetuses with normal nuchal translucency (NT) in screening for autosomal trisomies (AT) and for congenital heart diseases (CHD) in chromosomally normal fetuses. METHODS First-trimester combined screening for trisomy 21 (T21) was carried out prospectively for 7 years in singleton pregnancies. NT and the pulsatility index for DV (DVPI) were calculated. The DV was analyzed according to its association with AT and CHD. The detection rate (DR), false-positive rate (FPR), positive predictive value (PPV), and odds ratio (OR) for abnormal DV were calculated. RESULTS Abnormal DV as an early marker of euploid CHD gives a DR of 12.5%, an FPR of 4.3%, a PPV of 1.4%, and a negative predictive value (NPV) of 99.5%, with an OR of 3.1 (95% CI 1.3-7.4). Moreover, abnormal DV as an early marker of AT shows a DR of 35.7%, an FPR of 4.3%, a PPV of 1.2%, an NPV of 99.9%, and an OR of 12.3 (95% CI 4.1-36), and the values are 33.3, 4.3, 0.97, and 99.9% and 11 (95% CI 3.2-36.9), respectively, for T21. CONCLUSIONS Our data supports the association between increased DVPI and CHD or AT. The sensitivity of this marker is not strong enough to be used a screening test.
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Affiliation(s)
- Pilar Prats
- Fetal Medicine Service, Department of Obstetrics and Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain.
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Mogra R, Alabbad N, Hyett J. Increased nuchal translucency and congenital heart disease. Early Hum Dev 2012; 88:261-7. [PMID: 22482746 DOI: 10.1016/j.earlhumdev.2012.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Sonographic assessment of fetal nuchal translucency (NT) thickness is the cornerstone of screening for chromosomal abnormality at 11-13(+6) weeks gestation. This marker was first recognized in pregnancies being karyotyped for advanced maternal age, but its underlying pathophysiology remains to be fully determined. Although increased NT is clearly associated with changes in both lymphatic and cardiac development, neither is an obvious causative agent. The association with cardiac defects has now being subjected to a significant amount of research, with a large body of evidence showing that this marker is also a screening tool for major cardiac defects - although it performs more modestly than for chromosomal abnormality. The field continues to change rapidly. Recent evidence that uses a combination of increased NT, tricuspid regurgitation and abnormal flow in the 'a' wave of the ductus venosus can provide an effective screening strategy to predict many major cardiac defects at this early stage of pregnancy.
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Affiliation(s)
- Ritu Mogra
- Discipline of Obstetrics and Gynaecology, Central Clinical School, Faculty of Medicine, University of Sydney, Australia
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Papatheodorou SI, Evangelou E, Makrydimas G, Ioannidis JPA. First-trimester ductus venosus screening for cardiac defects: a meta-analysis. BJOG 2011; 118:1438-45. [DOI: 10.1111/j.1471-0528.2011.03029.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clur SAB, Oude Rengerink K, Mol BW, Ottenkamp J, Bilardo CM. Is fetal cardiac function gender dependent? Prenat Diagn 2011; 31:536-42. [PMID: 21413043 DOI: 10.1002/pd.2738] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/08/2011] [Accepted: 02/07/2011] [Indexed: 11/08/2022]
Abstract
INTRODUCTION An increased nuchal translucency (NT) is more common in males. A delayed diastolic cardiac function maturation has been proposed to explain this and the reported gender-related differences in ductus venosus (DV) flow. OBJECTIVE To investigate gender-related differences in fetal cardiac function. METHODS One hundred and ninety karyotypically/phenotypically normal fetuses with structurally normal hearts and known NT measurement, (104 > 95th percentile), were prospectively included between 1 October 2003 and 1 April 2009. They had been referred for fetal echocardiography. Three hundred and nine echocardiograms were performed between 11 and 35 weeks' gestation. The atrioventricular valve E- and A-wave peak velocity, E/A-velocity ratio and E/TVI ratio, myocardial performance index, semilunar valves acceleration time (AT) and peak velocity, stroke volume and cardiac output as well as DV pulsatility index for veins at 11-14 weeks' gestation, were measured. A multilevel analysis was performed using the NT (multiples of the median) as a continuous variable. RESULTS The male : female ratio was 1.56:1. The tricuspid valve E/TVI was significantly higher and pulmonary valve AT significantly lower in females compared to males. No other significant differences in cardiac function were found. CONCLUSIONS Our findings suggest better right ventricular (RV) relaxation and increased RV afterload in female fetuses, independent of NT thickness, between 11 and 35 weeks' gestation.
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Affiliation(s)
- S A B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
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Abstract
ABSTRACT
Ductus venosus is a tiny vessel with a central role in fetal circulation. Combining B-mode with color and pulsed Doppler is feasible to identify this vessel and evaluate the blood flow waveform at 11 to 13 weeks. The higher prevalence of abnormal A-wave in fetuses with abnormal karyotype and/or cardiac defects turned DV evaluation into a useful marker for chromosomal abnormalities and cardiopathies. Even when combined with nuchal translucency (NT) or biochemical markers, DV blood flow evaluation contributes to an increase in sensitivity and reduces false-positive rate. Abnormal ductal flow is also related to a worse fetal and perinatal outcome. In monochorionic twin pregnancies, in addition to NT measurement at 11 to 14 weeks, the Doppler assessment of DV blood flow increases relevantly the performance of screening for those at higher risk of developing twin-to-twin transfusion syndrome. This story of 14 years surely contributed to change the way first trimester screening is being implemented.
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Chelemen T, Syngelaki A, Maiz N, Allan L, Nicolaides KH. Contribution of Ductus Venosus Doppler in First-Trimester Screening for Major Cardiac Defects. Fetal Diagn Ther 2011; 29:127-34. [DOI: 10.1159/000322138] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
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Timmerman E, Clur SA, Pajkrt E, Bilardo CM. First-trimester measurement of the ductus venosus pulsatility index and the prediction of congenital heart defects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:668-675. [PMID: 20617506 DOI: 10.1002/uog.7742] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study was carried out to evaluate the additional predictive value of ductus venosus pulsatility index for veins (DV-PIV) in the identification of congenital heart defects (CHDs) in fetuses with an enlarged nuchal translucency (NT) and a normal karyotype. METHODS All chromosomally normal fetuses referred to our Fetal Medicine Unit between September 1996 and December 2008 with known NT, DV-PIV and ductus venosus (DV) a-wave measurements were included. Intrafetus variation in DV-PIV was overcome by averaging three recordings. Follow-up included special focus on CHD. The odds of CHD at any NT and DV-PIV value were evaluated using logistic regression analysis. RESULTS Of 792 fetuses included, the NT was enlarged (equal to or above the 95(th) percentile (P95)) in 318 (40.2%). The DV-PIV was abnormal (≥ P95) in 41.8% of the fetuses with an enlarged NT and the a-wave was abnormal (negative or reversed) in 29.9%. CHD was diagnosed in 35 fetuses, 33 of which had an enlarged NT. Amongst the fetuses with an enlarged NT, the sensitivities for CHD of abnormal DV-PIV and DV a-wave were 73% and 55%, with specificities of 62% and 73%, respectively. Logistic regression analysis showed that in this risk group the DV-PIV multiple of the median (MoM) (as a continuous variable) was significantly associated with the risk of CHD (odds ratio = 2.4), independent of the degree of NT enlargement, whereas the DV a-wave did not significantly add to the prediction of CHD. CONCLUSION Two-thirds of fetuses with an enlarged NT, a normal karyotype and CHD have an increased DV-PIV. DV-PIV can be used as continuous variable in combination with NT to increase specificity in the identification of CHD and to refine the individual risk assessment.
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Affiliation(s)
- E Timmerman
- Department of Obstetrics & Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
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20
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de Mooij YM, Haak MC, Bartelings MM, Twisk JW, Gittenberger-de Groot A, van Vugt JMG, Bekker MN. Abnormal ductus venosus flow in first-trimester fetuses with increased nuchal translucency: relationship with the type of cardiac defect? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1051-1058. [PMID: 20587428 DOI: 10.7863/jum.2010.29.7.1051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate ductus venosus flow velocities and a possible relationship with the type of cardiac defect in fetuses with increased nuchal translucency (NT). METHODS Seventy-two fetuses with normal NT and 137 fetuses with increased NT (>95th percentile) were evaluated. The ductus venosus pulsatility index for veins (PIV), late diastolic velocity (velocity during atrial contraction [a-V]), and intracardiac velocities were evaluated. In cases of pregnancy termination, a postmortem examination was performed. Cardiac defects were grouped into septal defects, left and right inflow obstruction, left and right outflow obstruction, and other defects. Data were evaluated by multilevel analysis. RESULTS A cardiac defect was found in 45 fetuses with increased NT. Fetuses with increased NT showed a higher ductus venosus PIV and a lower a-V compared to fetuses with normal NT (P < .05). Within the group of fetuses with increased NT, a higher PIV and a lower a-V were found in cases with a cardiac defect compared to cases with a normal heart (P < .001). No differences in PIV and a-V were found between the types of cardiac defects. Intracardiac velocities showed no differences between fetuses with normal and increased NT, irrespective of the presence of a cardiac defect. CONCLUSIONS Ductus venosus flow velocities in fetuses with increased NT are not related to a certain type of cardiac defect. This indicates that the altered ductus venosus flow velocities found in fetuses with increased NT cannot be explained by cardiac failure due to a specific altered cardiac anatomy.
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Affiliation(s)
- Yolanda M de Mooij
- Department of Obstetrics and Gynecology, VU University Medical Center, Suite PK6 -170, Postbus 7057, 1007-MB Amsterdam, the Netherlands.
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de Mooij YM, Bartelings MM, Twisk JWR, Lamberts RR, Gittenberger-de Groot AC, van Vugt JMG, Bekker MN. Altered jugular vein and ductus venosus flow velocities in fetuses with increased nuchal translucency and distended jugular lymphatic sacs. Am J Obstet Gynecol 2010; 202:566.e1-8. [PMID: 20227670 DOI: 10.1016/j.ajog.2010.01.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 10/11/2009] [Accepted: 01/20/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to assess blood flow in relation to jugular lymphatic distension in fetuses with increased and normal nuchal translucency (NT). STUDY DESIGN In all, 72 fetuses with normal NT and 71 fetuses with NT >95th percentile were evaluated. NT size, jugular lymphatic sacs (JLS), jugular vein and ductus venosus pulsatility index for veins (PIV), and intracardiac velocities were measured. RESULTS JLS were visualized in 22/72 fetuses with normal and in 55/71 fetuses with increased NT. Jugular vein and ductus venosus PIV was higher in fetuses with increased NT compared to normal NT (P < .01). Visibility of JLS was associated with a higher ductus venous PIV (P < .05), but not with a higher jugular vein PIV. Larger NT and larger JLS volumes were associated with higher jugular vein and ductus venosus PIV (P < .05). CONCLUSION This study shows a relation among increased NT, jugular lymphatic distension, and altered blood flow in jugular vein and ductus venosus.
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Affiliation(s)
- Yolanda M de Mooij
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Martínez JM, Comas M, Borrell A, Bennasar M, Gómez O, Puerto B, Gratacós E. Abnormal first-trimester ductus venosus blood flow: a marker of cardiac defects in fetuses with normal karyotype and nuchal translucency. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:267-272. [PMID: 20052662 DOI: 10.1002/uog.7544] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the independent contribution of ductus venosus (DV) blood flow assessment at 11-14 weeks' gestation to the prediction of congenital heart defects (CHD) in chromosomally normal fetuses, irrespective of the value of the nuchal translucency thickness (NT). METHODS During a 4-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks' gestation were scanned for NT and DV blood flow in a tertiary center. Abnormal DV blood flow was defined as either absent or reversed flow during atrial contraction (AR-DV). Fetal echocardiography was performed in all cases with either NT > 99(th) percentile or AR-DV. Follow-up was assessed by postnatal examination or autopsy in cases of termination of pregnancy or perinatal death. RESULTS A total of 6120 pregnancies were scanned at a median gestational age of 12 weeks, and 45 cases of CHD were detected. AR-DV was found in 206 fetuses, of which 145 (70.4%) had a normal karyotype. Among fetuses with AR-DV and normal karyotype, 11 cases of CHD were diagnosed, giving a sensitivity of 24.4%, a positive predictive value of 7.6% and an odds ratio of 9.8. Increased NT (> 99(th) centile) was present in 55 of the 145 (37.9%) cases with AR-DV and normal karyotype, and in 6/11 (54.5%) of those with CHD. Thus, the group of 90 fetuses with abnormal DV blood flow and normal NT contained five cases of CHD, for a sensitivity of 11.1%, a positive predictive value of 5.5% and an odds ratio of 8.5. Right-heart anomalies were predominant in those cases with isolated AR-DV (4/5), but no specific CHD pattern was found in those with increased NT. The detection rate of CHD by the combined use of increased NT and/or AR-DV in the first trimester improved from 28.9% (13/45) to 40.0% (18/45). CONCLUSIONS In experienced hands, abnormal DV blood flow in the first trimester is an independent predictor of CHD and should constitute an indication for early echocardiography. In this study, the use of DV blood flow assessment increased early detection of CHD by 11% with respect to the use of NT measurement alone.
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Affiliation(s)
- J M Martínez
- Fetal-Maternal Medicine Service, ICGON, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Clur SA, Ottenkamp J, Bilardo CM. The nuchal translucency and the fetal heart: a literature review. Prenat Diagn 2009; 29:739-48. [PMID: 19399754 DOI: 10.1002/pd.2281] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this overview the current knowledge of the relationship between an increased nuchal translucency (NT) measurement and fetal heart structure and function in chromosomally normal fetuses is reviewed. Relevant pathophysiological theories behind the increased NT are discussed. Fetuses with an increased NT have an increased risk for congenital heart disease (CHD) with no particular bias for one form of CHD over another. This risk increases with increasing NT measurement. Although the NT measurement is only a modestly effective screening tool for all CHD when used alone, it may indeed be effective in identifying specific CHD "likely to benefit" from prenatal diagnosis. The combination of an increased NT, tricuspid regurgitation and an abnormal ductus venosus (DV) Doppler flow profile, is a strong marker for CHD. A fetal echocardiogram should be performed at 20 weeks' gestation in fetuses with an NT > or = 95th percentile but < 99th percentile. When the NT measurement is > or = 99th percentile, or when tricuspid regurgitation and/or an abnormal DV flow pattern is found along with the increased NT, an earlier echocardiogram is indicated, followed by a repeat scan at around 20 weeks' gestation. The resultant increased demand for early fetal echocardiography and sonographers with this special expertise needs to be planned and provided for.
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Affiliation(s)
- S A Clur
- Department of Pediatric Cardiology of the Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.
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Screening for Adverse Pregnancy Outcome by Ductus Venosus Doppler at 11–13+6 Weeks of Gestation. Obstet Gynecol 2008; 112:598-605. [DOI: 10.1097/aog.0b013e3181834608] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maiz N, Plasencia W, Dagklis T, Faros E, Nicolaides K. Ductus venosus Doppler in fetuses with cardiac defects and increased nuchal translucency thickness. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:256-260. [PMID: 18307193 DOI: 10.1002/uog.5262] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To examine the possible role of Doppler ultrasound assessment of ductus venosus blood flow in screening for major cardiac defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11 + 0 to 13 + 6 weeks' gestation. METHODS Ductus venosus blood flow velocity waveforms were obtained immediately before chorionic villus sampling for fetal karyotyping in fetuses with NT thickness of 3.5 mm or more at 11 + 0 to 13 + 6 weeks of gestation. In the chromosomally normal group fetal echocardiography was performed by a specialist pediatric cardiologist at 11 + 0 to 13 + 6 weeks and/or 18-22 weeks' gestation. RESULTS Major cardiac defects were diagnosed in 16 (8.4%) of the 191 chromosomally normal fetuses. Reversed or absent flow in the ductus venosus during atrial contraction was observed in 11 of the 16 (68.8%) fetuses with cardiac defects and in 40 of the 175 (22.9%) with no cardiac defects. Multivariate analysis demonstrated that the prevalence of an abnormal A-wave in the ductus venosus in fetuses without major cardiac defects increased with fetal NT thickness (odds ratio (OR), 1.463; 95% CI, 1.183-1.809; P < 0.0001) but in those with cardiac defects it did not change significantly with NT thickness (OR, 2.054; 95% CI, 0.573-7.360; P = 0.269). The likelihood ratio for a major cardiac defect when the ductus venosus flow was abnormal decreased with fetal NT thickness from 4.58 at NT 3.5 mm to 2.47 for NT 5.5 mm, and the likelihood ratio when the ductus venosus flow was normal increased from 0.37 at NT 3.5 mm to 0.43 for NT 5.5 mm. CONCLUSION In chromosomally normal fetuses with increased NT the finding of an absent or reversed A-wave in the ductus venosus is associated with a three-fold increase in the likelihood of a major cardiac defect, whereas the finding of normal ductal flow is associated with a halving in risk for such defects.
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Affiliation(s)
- N Maiz
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Zidere V, Allan LD, Huggon IC. Implications of bidirectional flow in the great arteries at the 11-14-week scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:807-812. [PMID: 17963197 DOI: 10.1002/uog.5162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine the implications of a bidirectional Doppler flow pattern detected in one or both of the fetal great arteries in the first trimester. METHODS Database records were reviewed for cases of bidirectional flow found on fetal echocardiography performed at less than 15 weeks of gestation between January 1999 and October 2006 inclusive. Bidirectional flow consisted of antegrade flow in systole and retrograde flow in diastole. Data including indication for fetal echocardiography, gestational age at diagnosis, the anatomical features, karyotype, nuchal translucency measurement and outcome were collected. RESULTS From almost 2500 scans, bidirectional flow was detected in a total of 15 fetuses. The abnormal flow pattern was confined to the aorta in four, to the pulmonary artery in four, and was present in both great arteries in a further seven fetuses. Eight of the 15 fetuses had regurgitation at one or both atrioventricular valves. Additional cardiac abnormalities were detected by ultrasound in eight cases. Of the 13 cases for which the karyotype was known, 12 were abnormal and five of these had trisomy 18. None of the fetuses survived. There were two intrauterine deaths and 13 terminations of pregnancy. CONCLUSION Bidirectional flow in one or both great arteries is an unusual finding at the first-trimester scan and must be distinguished from the retrograde flow occurring only in systole in duct-dependent heart defects. It carries a poor prognosis, which is a consequence of both the high chance of underlying chromosomal abnormality and the hemodynamic compromise associated with severe arterial valve regurgitation.
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Affiliation(s)
- V Zidere
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
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Wald RM, Tham EB, McCrindle BW, Goff DA, McAuliffe FM, Golding F, Jaeggi ET, Hornberger LK, Tworetzky W, Nield LE. Outcome after prenatal diagnosis of tricuspid atresia: a multicenter experience. Am Heart J 2007; 153:772-8. [PMID: 17452152 DOI: 10.1016/j.ahj.2007.02.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The outcome of prenatally diagnosed tricuspid atresia (TA) is undefined. We sought to characterize clinical and echocardiographic features of fetal TA and to determine factors associated with mortality. METHODS AND RESULTS All fetuses with TA (n = 88) seen at 3 tertiary care institutions from 1990 to 2005 were reviewed. There were 58 liveborn infants (median gestational age 38 weeks, range 24-40 weeks), 4 in utero demises, 25 terminations of pregnancy, and 1 mother lost to follow-up. Obstruction was present at the pulmonary valve in 27 (45%), aortic valve in 6 (10%), and aortic arch in 15 (25%). Three neonates received compassionate care, 1 died with multiple extracardiac anomalies, 2 were lost to follow-up, and 52 liveborns were actively managed with Blalock-Taussig shunt (23), Norwood palliation (14), pulmonary artery band (10), bidirectional cavopulmonary connection (3), atrial septostomy (1), and right outflow stent (1). Of those actively managed, there were 7 (14%) of 52 who died. Kaplan-Meier estimates of survival were 91% at 1 month, 87% at 6 months, and 83% at 1 year with no subsequent deaths for 13 years. By multivariate analysis, 2 independent factors were associated with an increase in time-related mortality in the actively managed group: presence of chromosomal anomaly or syndrome (P = .005) and use of extracorporeal membrane oxygenation (P = .002). CONCLUSIONS This is the largest study describing TA in fetus. Compared with published observations of TA diagnosed postnatally, antenatal diagnosis of TA appears to have similar short-term survival in pregnancies surviving to birth.
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Affiliation(s)
- Rachel M Wald
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Bianco K, Small M, Julien S, Kershaw T, Michon M, Copel J. Second-trimester ductus venosus measurement and adverse perinatal outcome in fetuses with congenital heart disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:979-82; quiz 983. [PMID: 16870891 DOI: 10.7863/jum.2006.25.8.979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether Doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). METHODS We conducted a retrospective cohort study of all pregnant women undergoing fetal echocardiography for CHD in a single perinatal center during a 2-year period. We compared outcomes for fetuses having a diagnosis of CHD in the second trimester and abnormal DV Doppler velocimetric findings with those having CHD and normal DV Doppler findings. Karyotype, gestational age at delivery, fetal loss rate, and rate of termination were assessed. The referral value for an abnormal DV pulsatility index was above the 95th percentile for gestational age. Statistical analysis included the t test, Fisher exact test, and chi(2) test. RESULTS The incidence of CHD in our population was 7%. There were 98 patients with CHD; of those, 31 had DV measurement. A total of 9 patients had an abnormal DV. Three of this group (33%) had intrauterine fetal death or perinatal death. In patients with CHD and normal DV measurements, 83% had living children versus 33% in the group with an abnormal DV (P < .05). There was no statistically significant difference in the rate of aneuploidy between the normal DV (15%) and abnormal DV (20%) groups (P = .65). The mean gestational age at delivery was similar between the normal (37.63 weeks) and abnormal (38.33 weeks) DV groups (P = .71). There was no difference in the rate of pregnancy termination. CONCLUSIONS Abnormal second-trimester DV measurements are predictive of adverse perinatal outcome in patients with CHD, independent of karyotype or gestational age at delivery. This information may have a role in the counseling of parents with CHD.
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Affiliation(s)
- Katherine Bianco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight publications from the last year that have advanced the use of ultrasound in obstetrics. RECENT FINDINGS Anatomic examination of the fetus in the first trimester has been emphasized because it allows for early diagnosis of many conditions. The prevalence of absent nasal bone, a marker for trisomy 21, in euploid fetuses depends on ethnicity. Nasal bone hypoplasia is another marker for Down syndrome. Studies on genetic screening in the first trimester have involved various serum analytes, adjustments in timing and calculations, use in multiple gestations, and the association of extreme measurements with adverse outcomes. A first-trimester integrated screening approach, which incorporates nuchal translucency, nasal bone, crown-rump length, pregnancy-associated plasma protein-A, and free beta-human chorionic gonadotropin, has the potential to maximize detection rates of Down syndrome and trisomy 18 and minimizes the screen-positive rate. The value of combining first and second-trimester results in sequential, contingent, or integrated screening protocols has been assessed. Isolated mild ventriculomegaly (10-12 mm) may prove to be a normal variant, and the role of 'soft' ultrasound markers in genetic counseling continues to be debated. Anomaly or high-risk status detection in the second trimester has been enhanced by the use of Doppler, 3D/4D ultrasound, and magnetic resonance imaging. SUMMARY Imaging techniques have been critical in the development of screening methods for Down syndrome or trisomy 18 and for euploid fetuses at high risk for adverse outcomes.
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Affiliation(s)
- Karen Filkins
- Department of Obstetrics and Gynecology, University of California, Irvine, California, USA.
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Bekker MN, Arkesteijn JB, van den Akker NMS, Hoffman S, Webb S, van Vugt JMG, Gittenberger-de Groot AC. Increased NCAM expression and vascular development in trisomy 16 mouse embryos: relationship with nuchal translucency. Pediatr Res 2005; 58:1222-7. [PMID: 16306197 DOI: 10.1203/01.pdr.0000187795.82497.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Increased nuchal translucency in the human fetus is associated with chromosomal abnormalities, enlarged jugular lymphatic sacs, cardiac defects and changed flow through the ductus venosus. The developmental background of this nuchal edema in relation to the associated anomalies remains elusive. We studied the morphologic correlation between neurogenesis and vasculogenesis in neck, heart, and ductus venosus region of wild type and trisomy 16 mice embryos (E10- E18), using an antibody against Neural Cell Adhesion Molecule (NCAM). Trisomy 16 mice are a model for the above described human phenotype. From E12 trisomy 16 mice showed an altered arrangement of cranial nerves IX, X and XI, which are positioned between the carotid artery, jugular vein and enlarged lymphatic sac. The vagal nerve was significantly smaller, compared with wild type embryos. NCAM was over expressed in both neuronal and cardiovascular structures in trisomy 16 mice, being particularly prominent in the 4th and 6th pharyngeal arch arteries, and the ductus venosus. In the 4th and 6th pharyngeal arch arteries, NCAM over expression was located to the part of the vessel wall that is closely related to the vagal and recurrent nerve. In case of 4th pharyngeal arch artery abnormalities NCAM expression, on the other hand, was reduced. In conclusion, the interaction between neurogenesis and vasculogenesis is disturbed in the trisomy 16 mouse model, and might be a common denominator in the spectrum of anomalies associated with increased nuchal translucency.
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Affiliation(s)
- Mireille N Bekker
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands, and Department of Basic Medical Sciences, Anatomy and Developmental Biology, St. George Hospital Medical School, London, UK
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Bekker MN, Haak MC, Rekoert-Hollander M, Twisk J, Van Vugt JMG. Increased nuchal translucency and distended jugular lymphatic sacs on first-trimester ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:239-245. [PMID: 15736181 DOI: 10.1002/uog.1831] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To investigate the presence and volume of jugular lymphatic sacs (JLS) in first-trimester fetuses with normal nuchal translucency thickness (NT) and in those with increased NT. METHODS This was a prospective study of 26 fetuses with NT > 95(th) percentile, which were compared with 137 fetuses with normal NT. Following crown-rump length (CRL) and NT measurement the neck region of the fetus was studied by transvaginal ultrasound. The JLS presented as spheroidal translusencies in the anterolateral region of the neck. RESULTS The prevalence of JLS differed significantly between fetuses with enlarged NT and the control group (P < 0.0001). In the group of 26 fetuses with increased NT, 22 had clearly visible JLS. Chorionic villus sampling revealed aneuploidy in 10 and euploidy in 16 fetuses. In the control group two fetuses, with NT values of 2.8 mm and 2.9 mm, had JLS; pregnancy outcome was normal in both cases. Logistic regression analysis in the total study group showed that an increase in NT was associated with a greater probability of JLS being present (for NT = 3-3.5 mm, probability = 0.67; for NT > 3.5 mm, probability = 0.93). In fetuses with JLS, an increase in CRL was associated with a significant increase in right JLS volume (r = 0.51; P-value = 0.01) and a non-significant increase in left sac volume (r = 0.40; P-value = 0.09). Increase in NT was not associated with a significant increase in JLS volume. CONCLUSION There is a significant association between increased NT and the presence of JLS on first-trimester ultrasound. In our opinion, the pathophysiological explanation for increased NT lies in a disturbance in lymphangiogenesis.
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Affiliation(s)
- M N Bekker
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Timor-Tritsch IE, Bashiri A, Monteagudo A, Arslan AA. Qualified and trained sonographers in the US can perform early fetal anatomy scans between 11 and 14 weeks. Am J Obstet Gynecol 2004; 191:1247-52. [PMID: 15507948 DOI: 10.1016/j.ajog.2004.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to determine the extent to which normal fetal anatomy can be detected between 11- and 14-week scan by sonographers in the US. STUDY DESIGN In a prospective cross-sectional study, 223 unselected women underwent a detailed assessment of fetal anatomy at 11 to 13 and 6/7 weeks by sonographers with transabdominal and/or transvaginal transducers. Thirty-seven structures were examined. Two groups were identified: group I: 121 patients between 11 and 12 weeks, and group II: 102 patients between 13 and 14 weeks. RESULTS Structures other than the posterior fossa, heart, genitalia, and the sacral spine were seen between 64% to 99% for group I, and 72% to 98% for group II. The following structures were detected with statistically significantly higher rates in group II compared with group I: cerebellum, posterior fossa, face, 4-chamber view left ventricular outflow tract, aortic arch, ductal arch, kidneys, and genitalia. Comparing the patients of group I and group II, the transvaginal scans yielded a higher detection rate of structures than do the transabdominal scans. CONCLUSION Anatomic surveys between 11 and 14 weeks can be performed by sonographers with good detection rates of most structures. Using the vaginal probe compared with the abdominal probe improved the detection rate at 13 to 14 weeks as well as 11 to 12 weeks. If early fetal structure evaluation is to become customary in the US, the present practice of experienced and trained sonographers to scan such patients can be maintained.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University Medical Center, 550 First Avenue, NBV-9N26, New York, NY 10016, USA.
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Bahado-Singh RO, Cheng CSC. First trimester prenatal diagnosis. Curr Opin Obstet Gynecol 2004; 16:177-81. [PMID: 15017349 DOI: 10.1097/00001703-200404000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The recent developments in first trimester sonography promise to greatly enhance our diagnostic capabilities for detection of aneuploidies. Collateral benefits of nuchal translucency measurements include the prediction of non-chromosomal adverse outcomes. These advances will fundamentally change clinical practices. All obstetricians must therefore have a working knowledge of the expanding literature in this field. RECENT FINDINGS The review covers developments in nuchal translucency based first trimester detection of chromosomal anomalies and discusses the recent literature on the use of fetal nasal bone measurements to further improve diagnostic accuracy. Emerging data on the relationship between nuchal fluid measurement and the risk of cardiac anomaly will also be presented. SUMMARY It is likely that the emphasis in obstetric clinical care will shift substantially towards the first trimester. With the enhanced diagnostic capabilities, greater research emphasis will inevitably need to be placed on the first trimester treatment of fetal disorders.
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Affiliation(s)
- Ray O Bahado-Singh
- University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0526, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:611-7. [PMID: 12905995 DOI: 10.1002/pd.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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