Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 5 , ISSUE 2 ( April-June, 2011 ) > List of Articles

REVIEW ARTICLE

Ductus Venosus: A Love Story of 14 Years

Nuno Montenegro, Alexandra Matias

Keywords : Ductus venosus,Doppler blood flow,Chromosomal abnormalities,Cardiac defects,Pregnancy loss,Twin-to-twin transfusion syndrome

Citation Information : Montenegro N, Matias A. Ductus Venosus: A Love Story of 14 Years. Donald School J Ultrasound Obstet Gynecol 2011; 5 (2):141-149.

DOI: 10.5005/jp-journals-10009-1190

License: CC BY-NC 4.0

Published Online: 01-06-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


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.


PDF Share
  1. Catalunya and Balears Monochorionic Network. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet 2007;96(2):98-102.
  2. Familial recurrence of congenital heart disease in a prospective series of mothers referred for fetal echocardiography. Am J Cardiol 1986;58:334-37.
  3. Role of ductus venosus in distribution of umbilical flow in human fetuses during second half of pregnancy. Am J Physiol 2000;279:H1256-63.
  4. Abnormal ductus venosus blood flow in trisomy 21 fetuses during early pregnancy. Am J Obstet Gynecol 1998; 179:1612-17.
  5. 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.
  6. Ductus venosus assessment at the time of nuchal translucency measurement in the detection of fetal aneuploidy. Prenat Diagn 2003;23:921-26.
  7. Reliability analysis on ductus venosus assessment at 11-14 weeks’ gestation in a high-risk population. Prenat Diagn 2007;27:442-46.
  8. Early signs of cardiac failure: A clue for Parvovirus infection screening in first trimester. Feb 16 2011 [Epub ahead of print].
  9. Nuchal translucency thickness in monochorionic multiple pregnancies: Value in predicting pregnancy outcome. J Ultrasound Med 2008; 27(3):363-69.
  10. Perinatal mortality 2008.
  11. Embryonic development in the human of the sphincter of the ductus venosus. Anat Rec 1953;115:151-73.
  12. The publishing of papers on first-trimester Doppler. Ultrasound Obstet Gynecol 1999;14:159-60.
  13. Liver and ductus venosus blood flow in fetal lambs in utero. Circ Res 1978;42:426-33.
  14. Histochemical and pharmacological studies on amine mechanisms in the umbilical cord, umbilical vein and ductus venosus of the human fetus. Acta Physiol Scand 1968;72:15-24.
  15. Data from 2004. European Perinatal Health Report 2008. http://www.europeristat.com .
  16. The role of fetal nuchal translucency and ductus venosus Doppler at 11-14 weeks of gestation in the detection of major congenital heart defects. Ultrasound Obstet Gynecol 2003;21:239-43.
  17. Nuchal translucency and ductus venosus blood flow as early sonographic markers of thanatophoric dysplasia: A case report. Fetal Diagn Ther 2004;19(3):241-45.
  18. Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins. Am J Obstet Gynecol 2006;195:178-83.
  19. The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome. Obstet Gynecol 1993;81:569-74.
  20. Ductus venosus flow velocities in relation to the cardiac defects in first-trimester fetuses with enlarged nuchal translucency. Am J Obstet Gynecol 2003;188:727-33.
  21. Assessment of ductus venosus flow during the first and early second trimesters: What can we expect? Ultrasound Obstet Gynecol 2001a;17:285-87.
  22. Ductus venosus blood flow velocity waveforms in the human fetus. Ultrasound Med Biol 1992;18:33-37.
  23. Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2007;29:527-32.
  24. Longitudinal reference ranges for ductus venosus flow velocities and waveform indices. Ultrasound Obstet Gynecol 2006;28:890-98.
  25. Ultrasonographic velocimetry of the fetal ductus venosus. Lancet 1991;338:1412-14.
  26. Ductus venosus: A longitudinal Doppler velocimetric study of the human fetus. J Matern Fetal Invest 1992;2:5-11.
  27. Estimation of the pressure gradient across the fetal ductus venosus based on Doppler velocimetry. Ultrasound Med Biol 1994A;20:225-32.
  28. The fetal circulation. Prenat Diagn 2004;24:1049-59.
  29. Ductus venosus blood velocity and the umbilical circulation in the seriously growth-retarded fetus. Ultrasound Obstet Gynecol 1994b;4:109-14.
  30. Umbilical flow distribution to the liver and the ductus venosus: An in vitro investigation of the fluid dynamic mechanisms in the fetal sheep. Am J Obstet Gynecol 1997;177:86-90.
  31. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 1999;84:139-47.
  32. Blood flow and degree of shunting through the ductus venosus in the human fetus. Am J Obstet Gynecol 2000a;182:147-53.
  33. Effect of NO, phenylephrine and hypoxemia on the ductus venosus diameter in the fetal sheep. Am J Physiol 2000b;279:H1166-71.
  34. The role of ultrasound examination in the first trimester and at 16 weeks’ gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol 2008;199(5):493.e1-7.
  35. Human fetal and neonatal circulation. Eur J Cardiol 1977;5:265-81.
  36. Concordance for bilateral congenital diaphragmatic hernia in a monozygotic dichorionic twin pair: First clinical report. Fetal Diagn Ther 2010;27(2): 106-09.
  37. Learning curve for Doppler assessment of ductus venosus flow at 11 + 0 to 13 + 6 weeks’ gestation. Ultrasound Obstet Gynecol 2008a;31:503-06.
  38. Ductus venosus Doppler in fetuses with cardiac defects and increased nuchal translucency thickness. Ultrasound Obstet Gynecol 2008b;31:256-60.
  39. Screening for adverse pregnancy outcome by ductus venosus Doppler at 11-13 + 6 weeks of gestation. Obstet Gynecol 2008c;112:598-605.
  40. Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation. Ultrasound Obstet Gynecol 2009a;33:512-17.
  41. Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies. Obstet Gynecol 2009b;113:860-65.
  42. Ductus venosus in the first trimester: Contribution to screening of chromosomal, cardiac defects and monochorionic twin complications. Fetal Diagn Ther 2010;28:65-71.
  43. Abnormal first trimester ductus venosus: A marker of cardiac defects in fetuses with normal karyotype and nuchal translucency. Ultrasound Obstet Gynecol 2011 (in press).
  44. The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2003;22: 246-51.
  45. Abnormal first-trimester ductus venosus blood flow: A marker of cardiac defects in fetuses with normal karyotype and nuchal translucency. Ultrasound Obstet Gynecol 2010;35(3):267-72.
  46. Screening for chromosomal abnormalities at 10-14 weeks: The role of ductus venosus blood flow. Ultrasound Obstet Gynecol 1998;12:380-84.
  47. Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10-14 weeks. Ultrasound Obstet Gynecol 1999;14:307-10.
  48. Anticipating twin-twin transfusion syndrome in monochorionic twin pregnancy. Is there a role for nuchal translucency and ductus venosus blood flow evaluation at 11-14 weeks? Twin Res 2000;3:65-70.
  49. Screening for twin-twin transfusion syndrome at 11-14 weeks of pregnancy: The key role of ductus venosus blood flow assessment. Ultrasound Obstet Gynecol 2010;35: 142-48.
  50. Intraobserver and interobserver variability of transabdominal Doppler velocimetry measurements of the fetal ductus venosus between 10 and 14 weeks of gestation. Ultrasound Obstet Gynecol 2001;17:306-10.
  51. The human ductus venosus between 13 and 17 weeks of gestation: Histological and morphometric studies. Ultrasound Obstet Gynecol 2002;19:39-46.
  52. Increased fetal nuchal translucency: Possible involvement of early cardiac failure. Ultrasound Obstet Gynecol 1997;10: 265-68.
  53. 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.
  54. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004;191:45-67.
  55. 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.
  56. Reproducibility of ductus venosus Doppler flow measurements at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2001;17:301-05.
  57. Reference values for ductus venosus Doppler flow measurements at 10-14 weeks of gestation. Ultrasound Obstet Gynecol 2002;20:42-46.
  58. Firsttrimester ductus venosus, nasal bones and Down syndrome in a high-risk population. Obstet Gynecol 2005;105:1348-54.
  59. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol 1997a;104:1203-07.
  60. Increased nuchal translucency thickness at 10-14 weeks of gestation as a predictor of severe twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 1997b;10:86-89.
  61. Inter twin membrane folding in monochorionic pregnancies. Ultrasound Obstet Gynecol 1998;11:324-27.
  62. Early prediction of severe twin-to-twin transfusion syndrome. Hum Reprod 2000;15:2008-10.
  63. Twin-to-twin transfusion syndrome results from dynamic asymmetrical reduction in placental anastomoses: A hypothesis. Placenta 2001;22:383-91.
  64. Assessment of fetal anatomy at the 11-14 weeks ultrasound examination. Ultrasound Obstet Gynecol 2004;24:730-34.
  65. Screening for major structural abnormalities at the 11-to 14-week ultrasound scan. Am J Obstet Gynecol 2006;194:393-96.
  66. Prenatal detection of heart defects at the routine fetal examination at 18 weeks in a non-selected population. Ultrasound Obstet Gynecol 1995;5:372-80.
  67. Prenatal detection of heart defects in a non-selected population of 30,149 fetuses: Detection rates and outcome. Ultrasound Obstet Gynecol 2006;27:252-65.
  68. Ductus venosus Doppler velocimetry in the first trimester: A new finding. Ultrasound Obstet Gynecol 2008;31:261-65.
  69. Ductus venosus pulsatility index measurement reduces the false-positive rate in first-trimester screening. Ultrasound Obstet Gynecol 2010;36(6):661-67.
  70. First-trimester measurement of the ductus venosus pulsatility index and the prediction of congenital heart defects. Ultrasound Obstet Gynecol 2010;36(6):668-75.
  71. Ductus venosus blood flow assessment at 11 to 14 weeks of gestation and fetal outcome. Ultrasound Obstet Gynecol 2004;23:341-45.
  72. Fetal venous and arterial flow velocity waveforms between eight and twenty weeks of gestation. Pediatr Res 1996;40:158-62.
  73. Firsttrimester ductus venosus velocimetry in relation to nuchal translucency thickness and fetal karyotype. Fetal Diagn Ther 2002;17:52-57.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.