Screening for chromosomal abnormalities at 10-14 weeks: the role of ductus venosus blood flow.

Abstract

To assess the possible role of Doppler ultrasound assessment of ductus venosus blood flow in screening for chromosomal abnormalities at 10-14 weeks of gestation. Ductus venosus flow velocity waveforms were obtained immediately before fetal karyotyping in 486 consecutive singleton pregnancies at 10-14 weeks of gestation. All cases were screened for chromosomal defects by a combination of maternal age and fetal nuchal translucency thickness. The peak systolic and diastolic velocities, the velocity during atrial contraction and the pulsatility index were measured. There were 63 chromosomal defects (38 cases of trisomy 21, 12 cases of trisomy 18, seven cases of trisomy 13, three cases of Turner's syndrome and three cases of triploidy). In 57 (90.5%) cases there was reverse or absent flow during atrial contraction. Abnormal ductus venosus flow was also observed in 13 (3.1%) of the 423 chromosomally normal fetuses. In the chromosomally abnormal group, compared to the normal group, the median heights of the S and D waves were significantly lower and the pulsatility index was significantly higher. However, multivariate regression analysis demonstrated that only the height of the A wave provided a significant independent contribution in distinguishing between the chromosomally normal and abnormal groups. These preliminary results suggest that assessment of ductus venous blood flow in pregnancies considered to be at high risk for chromosomal defects may result in a major reduction in the need for invasive testing, with only a small decrease in sensitivity.