Early antenatal diagnosis of cardiac failure using Doppler ultrasound of umbilical artery

Abstract

Background: During the last 2 years, few prenatal ultrasonographic studies have documented a strong association between abnormal fetal venous return and chromosomal abnormalities. Articles in the English language medical literature were identified through MEDLINE. There is only one report of reverse flow pattern in the umbilical vein in severe intrauterine growth restriction at 29 weeks' gestation. The present case is the earliest documentation of this alteration in fetal venous return.A 30‐year‐old primigravida was referred to our ultrasonography clinic at 12 weeks of gestation. The fetal crown‐rump length (57 mm) was not compatible with menstrual dates. The ultrasound examination showed an increased nuchal translucency (9.1 mm), bilateral pyelectasis, hiperechoic bowel, echogenic intracardic focus and ventricular septal cardiac defect. The fetal heart rate was 147 beats/min. The Doppler examination revealed high retrograde flow in the inferior vena cava, reverse flow in the ductus venosus during atrial contraction and reverse flow in the umbilical vein. Cytogenetic analysis by chorionic villus sampling diagnosed trisomy 9. Ten days later, fetal demise was observed. A non‐mosaic trisomy of chromosome 9 was confirmed on fetal cells' analysis. At autopsy, the characteristics findings were of complete trisomy 9 and the multiple abnormalities detected by ultrasonography were confirmed.Conclusion: Doppler blood evaluation of the venous return to the heart might provide relevant information on cardiac function. The reverse blood flow in umbilical vein may indicate an impending fetal death. We speculate that the association of abnormal nuchal translucency thickness with alterations of the fetus venous return might be a complementary tool to assess the risk for fetal aneuploidy in the first trimester of pregnancy. In addition, these Doppler velocimetry alterations can be an alarm sign for investigating cardiac abnormalities.