Ductus Venosus Pulsatility Index Research Articles

Uptake and outcomes of implementing non-invasive prenatal testing (Prenatal Reflex DNA testing) into first-trimester contingent screening protocols for trisomy 21, 18, 13: A study protocol

Chromosomal anomalies (CAs), such as trisomies 21 (T21), 18 (T18), and 13 (T13), are significant contributors to birth defects and genetic conditions worldwide. Cell-free fetal DNA testing (cff-DNA) is the preferred method for detecting these trisomies from maternal blood samples. However, its adoption is hindered by high costs and complexities. To enhance efficiency and reduce financial strain, we propose a practical protocol. This approach involves a contingent test based on biochemical and ultrasound markers commonly used in clinical practice. We aim to leverage cost-effective contingent prenatal DNA screening for trisomies 21, 18, and 13. This is integrated into standard aneuploidy screening during the first trimester at prenatal centers. Screening participants are categorized into four pathways (1T Quad, 1T Combined, 1T Expanded Combined, and 1T Expanded Combined + Ductus Venosus Pulsatility Index) based on biochemical markers (PAPP-A, Free β-hCG, PlGF, AFP) and ultrasound indicators (NT, DV-PI) as per FMF guidelines. Pregnant subjects (Low/High/Moderate Risk) with a high chance of affected pregnancy (1:1000 ≤ Risk < 1:10) undergo the DNA reflex screening test using stored plasma samples.

Role of Ductus Venosus Doppler Sonography for the Prediction of Perinatal Outcome in Term Pregnancies Complicated by Gestational Diabetes Mellitus.

Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM. This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn. A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases. In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.

Construction of prediction model for fetal growth restriction during first trimester in an Asian population.

To construct a prediction model for fetal growth restriction (FGR) during the first trimester of pregnancy and evaluate its screening performance. This was a prospective cohort study of singleton pregnancies that underwent routine ultrasound screening at 11 to 13 + 6 weeks at the Affiliated Suzhou Hospital of Nanjing Medical University between January 2019 and April 2022. Basic clinical information, ultrasound indicators and serum biomarkers of pregnant women were collected. Fetal weight assessment was based on the fetal growth curve for the Southern Chinese population. FGR was diagnosed according to Delphi consensus criteria. Least absolute shrinkage and selection operator (lasso) regression was used to select variables for inclusion in the model. Discrimination, calibration and clinical effectiveness of the model were evaluated in training and validation cohorts. A total of 1188 pregnant women were included, of whom 108 had FGR. Lasso regression identified seven predictive features, including history of maternal hypertension, maternal smoking or passive smoking, gravidity, uterine artery pulsatility index, ductus venosus pulsatility index and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The nomogram prediction model constructed from these seven variables accurately predicted FGR, and the area under the receiver-operating-characteristics curve in the validation cohort was 0.82 (95% CI, 0.74-0.90). The calibration curve and Hosmer-Lemeshow test demonstrated good calibration, and the clinical decision curve and clinical impact curve supported its practical value in a clinical setting. The multi-index prediction model for FGR has good predictive value during the first trimester. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound signs of fetal chromosomal abnormalities at 11–14 weeks of pregnancy and its value in the era of modern genetic testing

A steady increase in average maternity age at the time of first childbirth lead to a higher risk of fetal chromosomal abnormalities. The Order No. 1130n of the Ministry of Health of the Russian Federation establish the screening protocol at 11–14 weeks of gestation with assessing the followed criteria of fetal chromosomal pathology: the nuchal translucency thickness, nasal bone measurement, ductus venosus pulsatility index, tricuspid regurgitation, and heart rate. The value of non-invasive prenatal testing (NIPT) in the early prenatal diagnosis of the most common chromosomal abnormalities, as the trisomies 21, 18, 13, and monosomy X is also increasing. Additionally, numerous other fetal karyotype abnormalities can also be suspected at 11–14 weeks of gestation by revealing a number of other ultrasound signs. The article presents the literature review on additional ultrasound signs of various, both more and less common, chromosomal abnormalities. Pathological signs, abnormalities of fetal anatomy and extrafetal structures in the first trimester, which could be used as additional ultrasound signs of chromosomal pathology of various organs and systems (central nervous system and head, heart and blood vessels, urinary system, abdominal organs, fetal skeleton, as well as the placenta, umbilical cord, amniotic membranes) are described in the article. Despite the use of NIPT, including its extended panels, there remains a need to use ultrasound to detect the signs of rarer, but no less significant chromosomal pathologies, such as triploidies, mosaic trisomies, rare autosomal trisomies, duplications, and deletions.

The Relation of Ductus Venosus Pulsatility Index and Nuchal Translucency Thickness in a First-Trimester Sonographic Examination: A Matched Case-Control Study

Objective: Accumulating evidence suggests that abnormal ductus venosus (DV) flow is associated with fetal anomalies. This study aimed to investigate the relationship between quantitative DV Doppler parameters and nuchal translucency (NT). Materials and Methods: A total of 76 singleton pregnancies with an NT ≥3 mm were enrolled in the experimental group, and 156 singleton pregnancies with an NT &lt;3 mm were recruited in the control group. Ductus venosus Doppler parameters were collected for both groups. The relationship of the DV Doppler parameters between the two groups and the correlation within the experimental group were analyzed. A receiver-operating characteristic curve was used to determine the best diagnostic cut-off point of DV pulsatility index (DVPI) to indicate a measured NT ≥3 mm. Results: There was a significantly higher values for DVPI, DV resistance index (DVRI), and systolic velocity/maximum velocity during atrial wave ratio in fetuses with an NT ≥3 mm compared with those in the control group ( P &lt; .00). Fetuses with increased NT, DVPI, and DVRI showed significant positive correlations with NT ( P &lt; .00; r = 0.44 and P &lt; .00; r = 0.37, respectively). The best diagnostic cut-off point of DVPI for indicating a measured NT ≥3 mm was 1.15, indicating acceptable performance for the area under the curve of 0.83 (95% confidence interval: 0.770–0.892). Conclusion: In this study, in fetuses with an NT ≥3, the DVPI was higher than that in those with an NT &lt;3. In addition, a positive correlation between DVPI and an NT ≥3 was observed.

Congenital Heart Diseases: Risk Factors and Ultrasound Diagnostic Potential at the First Screening

Introduction: Due to the high incidence of congenital heart diseases (CHD) it is important to identify risk factors for abnormal organogenesis. There is a crucial medical need to understand cardiogenesis and possible markers of abnormalities in fetuses.Objective: To determine risk factors for CHD in pregnant women and their partners and assess CHD markers on the first ultrasound screening.Materials and methods: We analyzed 221 medical records of pregnant women with prenatally diagnosed fetal CHD and divided the patients into 2 groups: group I (n = 177) with CHD compatible with postnatal development and group II (n = 44) with CHD incompatible with postanatal development. We evaluated physical findings and somatic and reproductive history in both groups. We retrospectively analyzed 2272 ultrasound scans and first screening markers: nuchal translucency (NT) thickness and ductus venosus pulsatility index (DVPI).Results: We identified possible risk factors for fetal CHD: body mass index, P = .000; age of menarche, P = .037; chronic tonsillitis, Р = .046; cervical erosion, Р = .045; vulvovaginal candidiasis, Р = .005; vaginitis, Р = .027; cervicitis, Р = .027; chronic hepatitis B and C viruses, Р = .005; respiratory tract infection with fever during the current pregnancy, Р = .012. We built 500 networks with the highest performance for a predictive model and found that the model’s predictors did not fully represent the risk factors for CHD. CHD with increased NT thickness (≥2.5 mm) was detected in 2.24% of cases. NT thickness and DVPI were 3.37 ± 0.92 mm and 1.098 ± 0.158, respectively. According to our correlation analysis, increased DVPI and NT thickness were associated with CHD (R = 0.510).Conclusions: It is not possible to identify risk factors for CHD in fetuses by medical history, reproductive history and physical status of pregnant women, and unhealthy habits of their sexual partners. Increased NT thickness and DVPI moderately correlate with CHD incidence.

The value of combined detailed first-trimester ultrasound-biochemical analysis for screening fetal aneuploidy in the era of non-invasive prenatal testing.

This study aimed to investigate the performance, cost-effectiveness and additional findings of combined detailed ultrasound and biochemical screening for risks of major fetal trisomies in the first-trimester. This is a retrospective analysis study, we estimated the risk of trisomies 21, 18 and 13 based on maternal age, fetal nuchal translucency thickness, nasal bone, ductus venosus pulsatility index velocity, tricuspid regurgitation, fetal heart rate, free beta-human chorionic gonadotropin, and pregnancy-associated plasma protein A in singleton pregnant women, and performed non-invasive prenatal testing for women with risks of trisomy 21 between 1:500 and 1:300. Invasive diagnostic testing was performed for women with positive or failed non-invasive prenatal testing result and in the high-risk group of this screening method. The direct costs were compared between this strategy and the non-invasive prenatal testing which alone used as first-line screening for all pregnant women. Among 25,155 singleton pregnant women who underwent screening, 24,361 were available for analysis, of these, 194 cases underwent non-invasive prenatal testing. Among the 24,361 women, 39, 19, and 7 had trisomies 21, 18 and 13, respectively. The use of this strategy could potentially detect approximately 94.87% of trisomy 21 cases, 100% of trisomy 18 cases, and 100% of trisomy 13 cases, with false-positive rates of 2.49%, 0.41%, and 0.49%, respectively. The overall detection rate and overall false-positive rates were 96.92% and 2.52%, respectively. The detection rate was 100% in the advanced age group and 94.12% in the general age group. Additionally, structural abnormalities were detected in 137 fetuses, and 44 fetuses had other chromosomal abnormalities. The total cost of this strategy was $3,730,843.30, and the cost per person tested was $153.15. The total cost of using non-invasive prenatal testing as the first-line strategy would be $6,813,387.04 and the cost per person tested was $279.68. Our strategy is an efficient and cost-effective approach for detecting major trisomies and identifying more fetuses with a potential abnormality. Therefore, this strategy is a valuable screening method and highly feasible in the clinical setting.

EP01.28: Association between ductus venosus pulsatility index and adverse maternal and perinatal outcomes in a cohort of Colombian pregnant women

EP01.28: Association between ductus venosus pulsatility index and adverse maternal and perinatal outcomes in a cohort of Colombian pregnant women

Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high-risk pregnancies before and after 34 weeks.

The objective of the study was to compare the accuracy of the ductus venosus pulsatility index (DV PI) with that of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome at two gestational ages: <34 and ≥34 weeks' gestation. This was a retrospective study of 169 high-risk pregnancies (72 < 34 and 97 ≥ 34 weeks) that underwent an ultrasound examination of CPR, DV Doppler and estimated fetal weight at 22-40 weeks. The CPR and DV PI were converted into multiples of the median, and the estimated fetal weight into centiles according to local references. Adverse perinatal outcome was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean delivery, 5' Apgar score <7, neonatal pH <7.10 and admission to neonatal intensive care unit. Values were plotted according to the interval to labor to evaluate progression of abnormal Doppler values, and their accuracy was evaluated at both gestational periods, alone and combined with clinical data, by means of univariable and multivariable models, using the Akaike information criteria (AIC) and the area under the curve (AUC). Prior to 34 weeks' gestation, DV PI was the latest parameter to become abnormal. However, it was a poor predictor of adverse perinatal outcome (AUC 0.56, 95% CI: 0.40-0.71, AIC 76.2, p > 0.05), and did not improve the predictive accuracy of CPR for adverse perinatal outcome (AUC 0.88, 95% CI: 0.79-0.97, AIC 52.9, p < 0.0001). After 34 weeks' gestation, the chronology of the DV PI and CPR anomalies overlapped, but again DV PI was a poor predictor for adverse perinatal outcome (AUC 0.62, 95% CI: 0.49-0.74, AIC 120.6, p > 0.05), that did not improve the CPR ability to predict adverse perinatal outcome (AUC 0.80, 95% CI: 0.67-0.92, AIC 106.8, p < 0.0001). The predictive accuracy of CPR prior to 34 weeks persisted when the gestational age at delivery was included in the model (AUC 0.91, 95% CI: 0.81-1.00, AIC 46.3, p < 0.0001, vs AUC 0.86, 95% CI: 0.72-1, AIC 56.1, p < 0.0001), and therefore was not determined by prematurity. CPR predicts adverse perinatal outcome better than DV PI, regardless of gestational age. Larger prospective studies are needed to delineate the role of ultrasound tools of fetal wellbeing assessment in predicting and preventing adverse perinatal outcome.

Cardiac structural and functional remodeling in the fetuses associated with maternal hypothyroidism during pregnancy

Objectives We sought to investigate the effect of maternal hypothyroidism during pregnancy on fetal cardiac structural and functional remodeling using fetal echocardiography. Methods A total of 59 pregnant women with history of hypothyroidism were prospectively enrolled as the study group, and 74 normal fetuses as the control group. Fetal echocardiography was performed on each subject. Demographic, clinical, and fetal echocardiographic variables were measured, including left ventricular (LV) and right ventricular (RV) free wall and ventricular septal thickness, fractional shortening (FS), stroke volume (SV), cardiac output (CO), combined cardiac output (CCO), cardiac index (CI), combined cardiac index (CCI), aortic and pulmonary artery velocity, ductus venosus (DV) and pulmonary vein (PV) spectral Doppler, and Tei index. Results The incidence of echogenic intracardiac foci (EIF) was higher in the study group than that in the control group (18.6% vs. 6.8%, p = .036). The thickness of LV free wall and interventricular septum was reduced, the pulmonary velocities and CCI, RV FS, CO, and CI were lower, the S, D, S/A, and pulsatility index (PI) of DV were higher, and LV Tei index was higher in the study group compared with the control group. There was no significant difference in other variables between the two groups. Conclusions There is cardiac remodeling, and systolic, diastolic functional alterations in fetuses with maternal hypothyroidism. Further investigation is warranted to develop strategies to optimize the outcome of these fetuses.

Fetal Doppler in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome and selective in utero growth restriction

BackgroundMonochorionic (MC) twin pregnancies may be complicated by placental pathologies that impact fetal cardiac function, such as twin-twin transfusion syndrome (TTTS) and selective intrauterine growth-restriction (sIUGR). In the TTTS, the unbalanced blood flow through placental anastomoses lead a recipient volume overload, hypertension and hypertrophic cardiomyopathy and the donor twin experiences hypovolemia and hypertension due to increased placental resistance and poor renal perfusion. When MC pregnancies were complicated by sIUGR, the increase of placental resistances lead to complex fetal compensatory mechanisms with redistribution of cardiac output to vital organs. Increased placental vascular resistances, hypoxia and hemodynamic compensation mechanisms lead to higher pre and/or afterload for both ventricles, right cardiac failure and eventually left cardiac failure observed just before fetal death. ObjectivesThe purpose of this study was to describe the anomalies of umbilical, ductal and aortic isthmic Doppler as well as left and right myocardial performance index (MPI) across various clinical phenotypes of MC twin pregnancies, uncomplicated or complicated by TTTS or sIUGR, in order to help differentiating these conditions and to improve the understanding of TTTS and sIUGR pathophysiology. Study designAortic isthmic systolic index (ISI), umbilical artery pulsatility index (UAPI), ductus venosus pulsatility index (DVPI), and MPI were studied in uncomplicated MC twins (control group) and cases of sIUGR or TTTS. ResultsThe measurements were obtained in 113 pregnancies (24 uncomplicated, 22 sIUGR, 51 TTTS). In comparison with controls, the sIUGR smaller twin sets had lower ISI and higher UAPI, and the larger twin had higher ISI. The TTTS donor and recipient had lower ISI, higher UAPI and DVPI. Compared to the co-twin, the ISI values were lower in the sIUGR smaller twin and the TTTS donor had lower ISI and MPI. Comparing TTTS and sIUGR, the recipient had higher DVPI and MPI than the sIUGR larger twin. ConclusionsThe Doppler anomalies observed in the smaller twin reflected increased placental blood flow resistance, presumably due to abnormal feto-fetal transfusion in TTTS and to unequal placental sharing in sIUGR. Early hemodynamic changes suggestive of cardiac overload in the recipient twin may help to differentiate TTTS and sIUGR.

The comparison of systemic inflammatory response markers and Doppler ultrasound parameters between pregnancies with intrahepatic cholestasis and control cases

Objective: This study aims to detect a relationship between inflammatory markers, ductus venosus (DV) pulsatility index (PI), middle cerebral artery (MCA) PI, and umbilical artery (UA) systole to diastole ratio (S/D) and PI between pregnancies with intrahepatic cholestasis and control cases. Methods: This prospective study included 82 cases having intrahepatic cholestasis of pregnancy (ICP) and 80 gestational age-matched healthy control cases. The Doppler measurements (DV PI, MCA PI, and UA S/D and PI), inflammatory markers (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], mean platelet volume [MPV], and red blood cell distribution width [RDW]), and fetal and maternal outcomes were compared. Results: Patients with ICP had increased PLR value (p=0.019) and decreased lymphocyte count (p=0.004) compared to control cases. Also, there was a positive correlation between PLR value and the presence of ICP (χ2=5.774, p=0.016). There were no significant differences between ICP and control groups concerning NLR, RDW, MPV, and UA PI values. We found higher UA S/D, and DV PI values and lower MCA PI values in pregnancies with ICP compared to controls (p&lt;0.001, p=0.026, and p=0.003, respectively). Conclusion: In ICP cases, the PLR value was significantly increased than the controls, but the NLR, RDW, MPV, and UA PI values were found to be similar to control cases. The UA S/D, and DV PI values were increased, and MCA PI was significantly decreased in the ICP group compared to healthy pregnancies. However, we could not demonstrate the benefit of Doppler measurements in predicting neonatal outcomes in ICP cases.

Reference values for ductus venosus Doppler velocity indices between 11 and 13+6 weeks of gestation: A single-center prospective study in Iran.

This study aimed to investigate reference Doppler velocimetry indices (DVIs) of the fetal ductus venosus (DV) during 11-13 + 6 gestational weeks. In a prospective observation over referrals to a single tertiary care center in a 2-year interval, normal singleton pregnancies with fetal crown-rump lengths (CRLs) of 43-80 mm were examined by a single experienced sonographer for their DV pulsatility index (DVPI), DV resistance index (DVRI), and S-wave maximum velocity/A-wave minimum velocity (S/A ratio). Multinomial and quantile regression functions were used to analyze the effect of gestational age (estimated by CRL) on reference values (5th and 95th percentiles of the distribution in each gestational day/week). P < 0.05 was considered significant. Over a sample of 415 participants with a mean/median gestational age of 12 + 1 weeks, no significant correlations were found between the CRL and DVIs using multinomial regression functions (linear model best fitted for all [DVPI: B coefficient = 0.001, P = 0.235] [DVRI: B coefficient = 0.001, P = 0.287] [DV S/A: B coefficient = 0.010, P = 283]). Quantile regression analyses of DVIs' reference values were nonsignificant across the CRL range except for the DVRI ([5th regression line: coefficient = -0.004, P = 0.018] [95th regression line: coefficient = -0.001, P = 0.030]). Reference values for DVPI, DVRI, and DV S/A ratios were established as 0.80-1.39, 0.62-0.88, and 2.57-6.70, respectively. Future meta-analyses and multicenter studies are required to incorporate DV DVIs into an updated universal version of the practice.

Doppler Spectral Wave Patterns of Ductus Venosus: Do They Change with Foetal Position in the First Trimester?

Introduction: The ductus venosus is a branch of the umbilical vein that carries oxygenated blood to the foetus’s right atrium. Assessing the ductus venosus during the first trimester is used as one of the soft markers to detect aneuploidy. Since, operators often have to wait for extended periods for the foetus to assume the desired position. Prolonged scanning increases costs and reduces efficiency by extending scan times. Therefore, it is crucial to determine whether the foetal position affects the ductus waveform. In India, where the number of qualified operators is limited compared to the high demand for scans, efficiency is particularly important. Aim: To observe the spectral flow patterns on colour Doppler of the ductus venosus in supine, prone, and oblique positions of the foetus. Materials and Methods: The authors conducted a prospective observational study at Kempegowda Institute of Medical Sciences and Delta Diagnostics, Bengaluru, Karnataka, India, between August 2021 and December 2021. The study included 100 pregnant women who underwent routine first-trimester antenatal scans between 11 weeks and 13 weeks and six days. Colour Doppler flow mapping was used to visualise the umbilical vein, ductus venosus, and foetal heart. Spectral flow patterns of the ductus venosus were obtained in the supine, prone, and oblique positions of the foetus. The parameters studied were peak systolic velocity, end-diastolic velocity, and ductus venosus pulsatility index. Friedman’s Test followed by Wilcoxon Signed Rank Post hoc test was used to compare the mean values of systolic and diastolic velocity and pulsatility index between different foetal positions. Results: A total of 100 singleton pregnancies were included, mean gestational age was 12 weeks and four days. There was no difference in the subjective evaluation of the waveforms obtained in different positions. All foetuses exhibited type 1 spectral waveform. There were no false positives in the subjective evaluation for ‘a’ wave reversal. However, there was a significant difference in the systolic and diastolic velocities of the ductus venosus with different foetal positions, with a p-value of less than 0.001. The mean systolic velocities in supine, prone, and oblique positions were 60.09 cm/s, 51.59 cm/s, and 31.38 cm/s, respectively. The mean diastolic velocities in supine, prone, and oblique positions were 25.23 cm/s, 22.05 cm/s, and 19.05 cm/s, respectively. There was no significant difference in the pulsatility index among the supine, prone, and oblique positions. Conclusion: Radiologists do not need to wait for the foetus to be in the horizontal position to assess the ductus venosus waveforms. The waveforms can be evaluated in other foetal positions without affecting the assessment of aneuploidy risk.

Роль ультразвуковых маркеров I триместра в прогнозировании синдрома фето-фетальной трансфузии при монохориальном многоплодии

Aim: to evaluate the relevance of ultrasound markers in the first trimester of pregnancy for predicting twin-to-twin transfusion syndrome (TTTS) in monochorionic twins. Patients and Methods: this prospective study was conducted from January 2016 to September 2022 and involved 178 women with monochorionic diamniotic twins in the first trimester (11+0–14+0 weeks) who underwent ultrasound once every 2 weeks. Group 1 included women who were later diagnosed with TTTS (n=68). Group 2 included women without TTTS (n=110). Results: in women who later developed TTTS, a significant increase in the discordance of the nuchal translucency (NT) thickness (p=0.036), increase in the pulsatile index (PI) of blood flow in the ductus venosus in one fetus higher than normative (p=0.036), a significant difference in the difference in the crown-rump length (CRL) (p=0.046), large arterial anastomosis in the placenta with predominant signal on one side of the isoline, and chorion previa (CP) (p=0.012) were reported. The difference in isovolumic relaxation time (IVRT) in the first trimester was more than 9 (6–11) ms in the TTTS group and 5 (4–9) ms in the non-TTTS group. However, this difference was insignificant (p=0.06). A prognostic model of TTTS was built based on ultrasound signs (NT thickness, CRL, IVRT, ductus venosus PI) using logistic regression. Conclusion: our study revealed risk factors for TTTS at the end of the first trimester in monochorionic twins. However, these risk factors require further evaluation in a large prospective case series of monochorionic twins. A method for predicting severe complications of monochorionic twins during early pregnancy provides an additional option for stratifying patients. KEYWORDS: multiple pregnancy, monochorionic twins, twin-to-twin transfusion syndrome, first trimester ultrasound markers, nuchal translucency thickness, crown rump length, ductus venosus pulsatility index, placental anastomosis, isovolumic relaxation time. FOR CITATION: Markova T.V., Kosovtsova N.V., Shumakov S.Yu., Chumarnaya T.V., Ermak E.M., Pospelova Ya.Yu. Role of ultrasound markers in the first trimester for predicting twin-to-twin transfusion syndrome in monochorionic twins. Russian Journal of Woman and Child Health. 2023;6(3):226–232 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-2.

Ductus venosus Doppler assessment: do the results differ between the sagittal and the transverse approach?

Objective To compare the ductus venosus (DV) pulsatility index for veins (PIV) obtained in a mid-sagittal plane with that obtained in an oblique transverse plane of the fetal abdomen. Methods Prospective observational study in singleton uncomplicated pregnancies undergoing an ultrasound examination between 24 and 34 weeks of gestation. Pregnancies complicated by fetal anomalies, fetal growth restriction, or oligohydramnios were excluded. Two consecutive recordings of DV Doppler waveform were obtained in each woman: one in a mid-sagittal plane, and the other in an oblique transverse plane of the fetal abdomen. The peak velocity during ventricular systole (S-wave) and diastole (D-wave), the velocity during atrial contraction (a-wave), and the time-averaged maximum velocity (TAmax) were measured, and the PIV was calculated. The paired t-test was used to compare results obtained with the two approaches. A change of the DV-PIV of 0.10 or more was considered clinically relevant. Results The DV waveform was successfully obtained in 53 women (mean gestational age 28.5 weeks). The mean DV-PIV was 0.57 (±0.16 SD) in the sagittal plane and 0.54 (±0.16 SD) in the transverse plane. The mean difference (0.03) was statistically significant (p = .04), but not clinically relevant. The sagittal S-, D-, and a-wave velocities and TAmax were significantly higher in the sagittal plane compared to the transverse plane, with an increase of 12, 8, 8, and 10%, respectively (p < .05). Conclusions The difference in the DV-PIV obtained in a mid-sagittal plane compared to a transverse plane of the fetal abdomen is small and not clinically significant. The higher DV flow velocities observed in the sagittal plane are likely the result of a better alignment with the vessel obtained using this plane. These findings have implications for clinical practice and for research.

Performance of Ductus Venosus Doppler (at 11–13 + 6 Weeks) in Predicting Adverse Fetal Outcomes in Indian Population

The objective of this study is to examine the performance of Ductus venosus (DV) Doppler done at the routine first trimester screening (11-13 + 6 weeks) in predicting the adverse fetal outcomes in Indian population. This observational study was conducted between 2013 and 2019, on 4340 singleton pregnancies. Ductus Doppler were considered abnormal if DV pulsatility index values were >95th centile for that gestation or with a reversed "a" wave. Anatomical survey was done to rule out other abnormalities. Women were followed up till delivery and outcomes were divided into 4 groups: 1) aneuploidies; 2) cardiac defects; 3) non-cardiac structural abnormalities; and 4) miscarriages before 24 weeks or fetal deaths after 24 weeks. Prevalence of abnormal DV Doppler is 5.12% (205/4004). There were significantly higher number of fetal losses (4.4 versus 0.3%), aneuploidies (10.2 versus 1.7%), fetal cardiac defects (5.9 versus 1.4%), and non-cardiac structural defects (5.4 versus 1.4%) among the pregnancies with abnormal DV Doppler in comparison to those with normal flow (P < .001). Logistic regression analysis has shown that significant contribution to fetal chromosomal abnormalities and cardiac defects was associated with abnormal DV. Other factors which were found to have a significant association with adverse fetal outcome were increased nuchal translucency and increased body mass index (BMI). DV Doppler in first trimester can be used as a screening tool for cardiac defects and fetal deaths. Women with abnormal DV Dopplers should be offered fetal echocardiography at 18-22 weeks and third trimester growth scans with Dopplers.

Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control.

This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

Prenatal cardiac biometry and flow assessment in fetuses with bicuspid aortic valve at 20 weeks' gestation: multicenter cohort study.

To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy. This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups. Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04). Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Evaluation of the effect of gestational diabetes mellitus on fetal cardiac functions with Myocardial Performance Index.

We aimed to evaluate the fetal cardiac functions with Myocardial Performance Index (MPI) in gestational diabetes mellitus (GDM). In this study, 35 patients who were diagnosed with GDM, and 35 pregnant without glucose intolerance and their babies were evaluated. Fetal echocardiographic, biometric measurements, umbilical artery pulsatility indices (UAPI) and ductus venosus pulsatility indices (DVPI) measurements were performed to evaluate fetal well-being between the groups. There was no statistically significant difference between the groups in terms of UAPI, DVPI, systolic functions, the mode of delivery and 5-minute APGAR scores (P=0.849, P=0.485, P=0.770, P=0.060, P=0.587). There was statistically significant difference between the isovolumetric relaxation time and isovolumetric contraction time of groups (P=0.006, P=0.03). The MPI results were statistically different between the groups (P=0.000). Postpartum need for hospitalization was more frequently observed in GDM than the control group (P=0.014). MPI, which is independent of the ventricular anatomy and fetal heart rate, showing both diastolic and systolic functions, was found significantly higher in GDM. We recommend performing MPI measurement routinely to fetal cardiac functions in GDM.