Second trimester ductus venosus measurements as a predictor of adverse perinatal outcome in congenital heart disease

Abstract

PERINATAL OUTCOME IN CONGENITAL HEART DISEASE KATHERINE BIANCO, MARIA SMALL, NICOLE BROWNE, SVENA JULIEN, TRACE KERSHAW, MICA MICHON, JOSHUA COPEL, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California, Yale University, OB/ GYN, New Haven, Connecticut, Yale University, Department of Obstetrics and Gynecology, New Haven, Connecticut, Yale University, Obstetrics and Gynecology, NewHaven, Connecticut, YaleUniversity, School of PublicHealth, New Haven, Connecticut, Yale University, Obstetrics & Gynecology, New Haven, Connecticut OBJECTIVE: To determine whether doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). STUDY DESIGN: We conducted a retrospective cohort study of all women undergoing fetal echo for CHD, in a single perinatal center during a 2-year period. We compared outcomes for fetuses diagnosed with CHD in the midtrimester and abnormal DV Doppler velocimetry to those with CHD and normal DV Doppler. Karyotype, gestational age at delivery and rate of termination were assessed. The referral value for abnormal DV pulsatility index (PI) was >95th percentile for gestational age. Statistical analysis included t-test, Fischer’s exact test or Chi square tests. RESULTS: The incidence of CHD in our population was 8%. 98 patients had CHD, of those 31 had DV measurement. A total of 9 patients had abnormal DV. 33% (3/9) of this group had IUFD/perinatal death. In patients with CHD and normal DV measurements, 83% had living children vs. 33% in the group with abnormal DV; P ! .05. Aneuploidy was not more common in the abnormal DV group (15% aneuploidy in normal DV vs. 20% in abnormal DV; P ! .05). gestational age at delivery was similar, normal ductus mean gestational age 34.5 vs. abnormal ductus mean gestational age 31.66 P = .405. The rate of pregnancy termination was not different. Table. CONCLUSION: Abnormal second trimester ductus venosus 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 whith CHD.