Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 3 , ISSUE 2 ( April-June, 2009 ) > List of Articles

RESEARCH ARTICLE

Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit

Mónica Echevarria, Carmen Comas, M Angeles Rodríguez, Joan Nicolau, Bernat Serra, Concha Bach, Josep Sabrià

Keywords : Doppler ultrasound,Ductus venosus,first-trimester screening,trisomy 21

Citation Information : Echevarria M, Comas C, Rodríguez MA, Nicolau J, Serra B, Bach C, Sabrià J. Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit. Donald School J Ultrasound Obstet Gynecol 2009; 3 (2):10-17.

DOI: 10.5005/jp-journals-10009-1010

License: CC BY-NC 4.0

Published Online: 00-06-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective

To estimate the improvement in screening efficiency when ductus venosus (DV) Doppler studies are added to existing Down syndrome (DS) screening protocols.

Methods

First-trimester combined screening for trisomy 21 was prospectively carried out, from October 2003 to March 2008, in 8842 consecutive singleton pregnancies attended in our tertiary reference center. The nuchal translucency (NT) and the pulsatility index for veins for DV were calculated. The maternal serum biochemistry was measured using the Kryptor analyzer, at the same time of the scan (one step strategy) or before it (two step strategy). The detection rate (DR) and false-positive rates for standard screening strategy (maternal age, NT and biochemistry) and the same strategy but including DV assessment were calculated.

Results

Successful DV assessment was possible in the 95.3% of cases, representing a total of 8426 cases. Down syndrome was identified in 34 pregnancies (prevalence of DS 1:250). For a fixed screen positive rate of 5%, the addition of the DV assessment improves the DR from 85 to 94% and, for a fixed DR of 85%, it reduces the number of unnecessary invasive tests from 3.7 to 3.2%.

Conclusion

Early evaluation of DV can be introduced to standard DS screening strategies in experienced centers as a first level test to reduce invasive test rate derived from the existing protocols.


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  1. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004;191:45-67.
  2. Multicenter study of first-trimester screening for trisomy 21 in 75821 pregnancies: Results and estimation of the potential impact of individual risk-orientated two-stage first-trimester screening. Ultrasound Obstet Gynecol 2005;25:221-26.
  3. Screening for fetal abnormalities with ultrasound. Curr Opin Obstet Gynecol 2008;20:139-45.
  4. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 2008;31:618-24.
  5. Screening for chromosomal abnormalities at 10-14 weeks: The role of ductus venosus blood flow. Ultrasound Obstet Gynecol 1998;12:380-84.
  6. The role of ductus venosus blood flow assessment in screening for chromosomal abnormalities at 10-16 weeks of gestation. Ultrasound Obstet Gynecol 2001;17:295-300.
  7. Firsttrimester ductus venosus velocimetry in relation to nuchal translucency thickness and fetal karyotype. Fetal Diagn Ther 2002;17:52-57.
  8. Application of ductus venosus Doppler velocimetry for the detection of fetal aneuploidy in the first trimester of pregnancy. Fetal Diagn Ther 2002;17:308-14.
  9. Ductus venosus assessment at the time of nuchal translucency measurement in the detection of fetal aneuploidy. Prenat Diagn 2003;23:921-26.
  10. The ductus venosus in early pregnancy and congenital anomalies. Prenat Diagn 2004;24:688-92.
  11. Firsttrimester ductus venosus, nasal bones, and Down syndrome in a high-risk population. Obstet Gynecol 2005;105:1348-54.
  12. First-trimester screening for Down syndrome with ductus venosus Doppler studies in addition to nuchal translucency and serum markers. Prenat Diagn 2005;25:901-05.
  13. Abnormal ductus venosus blood flow in trisomy 21 fetuses during early pregnancy. Am J Obstet Gynecol 1998;179:1612-17.
  14. Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: Relationship with nuchal translucency measurement and fetal outcome. Ultrasound Obstet Gynecol 2001;17:288-94.
  15. Screening for aneuploidy in the first trimester by assessment of blood flow in the ductus venosus. BJOG 2002;109:1015-19.
  16. Correct estimation of parameters for ultrasound nuchal translucency screening. Prenat Diagn 1998;18:519-20.
  17. Ductus venosus revisited: A Doppler blood flow evaluation in the first trimester of pregnancy. Ultrasound Med Biol 1997;23:171-76.
  18. Cribado prenatal de aneuploidías. Metodología y recomendaciones para la aplicación de las distintas estrategias. Prog Diag Trat Prenatal 2004;16:83-96.
  19. The mathematical basis of multivariate risk screening: With special reference to screening for Down syndrome associated pregnancy. Ann Clin Biochem 1990;27:452-58.
  20. Learning curve for Doppler assessment of ductus venosus flow at 11 + 0 to 13 + 6 weeks' gestation. Ultrasound Obstet Gynecol 2008;31:503-06.
  21. Nuchal translucency measurement: Training of potential examiners. Ultrasound Obstet Gynecol 1996;8:192-95.
  22. Learning curve for sonographic examination of the fetal nasal bone at 11-14 weeks. Ultrasound Obstet Gynecol 2003;22:135-37.
  23. Reliability analysis on ductus venosus assessment at 11-14 weeks' gestation in a high-risk population. Prenat Diagn 2007;27:442-46.
  24. Implementation of nuchal translucency image-scoring method during ongoing audit. Ultrasound Obstet Gynecol 1999;14:388-92.
  25. Quality assessment in prospective nuchal translucency screening for Down syndrome. Ultrasound Obstet Gynecol 2001;18:641-44.
  26. First-trimester trisomy screening: Nuchal translucency measurement training and quality assurance to correct and unify technique. Ultrasound Obstet Gynecol 2002;19:353-59.
  27. Fetal nuchal translucency test for Down's syndrome. Lancet 1997;350:1631-32.
  28. Firsttrimester screening for trisomy 21 combining biochemistry and ultrasound at individually optimal gestational ages. An interventional study. Prenat Diagn 2004;24:541-45.
  29. Temporal changes in maternal serum biochemical markers of trisomy 21 across the first and second trimester of pregnancy. Ann Clin Biochem 2002;39:567-76.
  30. Appropriate biochemical parameters in first-trimester screening for Down syndrome. Prenat Diagn 1999;19:505-12.
  31. Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 11-14 weeks. Ultrasound Obstet Gynecol 1999;14:307-10.
  32. Abnormal first-trimester ductus venosus blood flow: A risk factor for adverse outcome in fetuses with normal nuchal translucency. Ultrasound Obstet Gynecol 2007;30:192-96.
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