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Objective: To test the hypothesis the application of ductus venosus Doppler velocimetry may serve as a screening tool between 10 and 14 weeks’ gestation for the detection of fetuses with chromosomal abnormalities. Methods: 372 consecutive fetuses were studied. Based on prior study, a chromosomal abnormality was suspected when either the nuchal translucency was above the 95th centile, or there was reversed or absent flow in the ductus venosus during atrial contraction. Sensitivity, specificity, and the negative and positive predictive values were calculated. Results: There were 29 chromosomally abnormal fetuses. Of these 29 fetuses, ductus venosus blood flow during atrial contraction was either absent (n = 2) or reversed (n = 25) in 93.1%. In the chromosomally normal fetuses (n = 343), only 6 (1.7%) had abnormal Doppler profiles in the ductus venosus (specificity = 98.3%, positive and negative predictive values = 81.8% and 99.4%, respectively). Conclusion: The Doppler waveform of the ductus venosus was at least equal to NT thickness measurement for the detection of chromosomal abnormalities.

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This report describes a case of reverse flow in the umbilical vein and ductus venosus during atrial contraction of a fetus at 12 weeks of gestation with increased nuchal translucency (9.1 mm). In addition, Doppler velocimetry detected high retrograde flow in the inferior vena cava. Cytogenetic analysis of chorionic villi revealed trisomy 9. We suggest that these findings may be a first trimester sign of chromosomal and cardiac abnormalities in the fetus.

We propose the routine inspection of metabolic components related to severe PCOS. These parameters configure the cardiovascular risk and such conduct is of undoubted importance to public health.

IntroduçãoDentre os novos métodos de rastreamento para anomalias cromossômicas, destaca-se a medida da translucência nucal (TN) entre a 11 a e a 14 a semana de idade gestacional. Uma alta proporção de fetos portadores tanto de trissomias do cromossomo 21, 18 e 13, quanto da síndrome de Turner e triploidias tem sido detectada mediante exame ultra-sonográfico, quando a medida da TN encontra-se superior ao percentil 95 para o comprimento crânio-caudal (CCN) [1][2][3] . O estudo hemodinâmico da circulação arterial (umbílico-placentária) e venosa (duto venoso e veia umbilical) constitui-se na proposição mais recente que busca correlacionar a presença de alterações hemodinâmicas à presença de anomalias cromossômicas no feto. Nesse particular, a dopplervelocimetria venosa e a arterial revelam os circuitos que talvez denotem a peculiaridade da anatomia placentária e da função cardíaca fetal, ambos passíveis de alterações nas aneuploídias fetais 4,5 , uma vez que as placentas com alterações cromossômicas possuem defeitos na angiogêne-

ResumoOBJETIVO: Estabelecer a prevalência da acantose nigricante (AN) no contexto da síndrome dos ovários policísticos (SOP) e as respectivas associações com a obesidade, a resistência insulínica (RI), a insulinemia e a síndrome metabólica (SM). MÉTODOS: Em um estudo transversal e prospectivo, foram selecionadas cem pacientes acometidas pela SOP, diagnosticadas segundo o Consenso de Rotterdam (2003). O exame cutâneo incluiu, além da verificação da presença da AN, a presença do hirsutismo (escore ≥8) e da acne. Foram investigados os dados clínicos e bioquímicos, os fatores de risco cardiovascular que se fazem presentes na SM, como circunferência abdominal (CA), obesidade, hipertensão e os índices de HDL e triglicérides. O modelo de aferição da resistência insulínica foi realizado por meio do teste homeostatic model assessment of insulin resistance (HOMA-IR). RESULTADOS: A prevalência da AN (53%) mostrou correspondência significativa com o hirsutismo (p=0,02), o índice de massa corpórea (IMC) (p<0,01), a insulinemia basal (p<0,01), o HOMA-IR (p<0,01) e a SM (p<0,05). A SM alcançou a prevalência de 36% e associou-se significativamente apenas com a AN (p<0,01). Conquanto ausente o diabetes mellitus, sobressaem as conotações do HOMA-IR alterado (p=0,01) com a SM (p<5%) e a AN (p<0,01). CONCLUSÕES: A AN integra o quadro fenotípico grave da SOP como mais um signo previsível dos riscos da doença cardiovascular. Abstract PURPOSE:To establish the prevalence of acanthosis nigricans (AN) within the context of polycystic ovary syndrome (PCOS) and its associations with obesity, insulin resistance, insulinemia, and metabolic syndrome (MS). METHODS: A cross-sectional prospective study was conducted on 100 patients with PCOS diagnosed according to the Rotterdam Consensus (2003). The skin test included, in addition to the detection of the presence of AN, the presence of hirsutism (score ≥8) and acne. In addition to clinical and biochemical data, we investigated cardiovascular risk factors present in MS such as abdominal circumference, obesity, hypertension and HDL and triglyceride levels. Insulin resistance was determined by the HOMA-IR test. RESULTS: The prevalence of AN (53%) was significantly correlated with hirsutism (p=0.02), body mass index (p<0.01), basal insulinemia (p<0.01), (HOMA-IR) (p<0.01), and MS (p<0.01). The prevalence of MS reached 36% and was significantly associated only with AN (p<0.01). Although diabetes mellitus was absent, there was a significant association of altered HOMA-IR (p<0.01) with MS (p<5%) and AN (p<0.01). CONCLUSION: AN is part of the severe phenotypic profile of PCOS as an additional predictable sign of the risks of cardiovascular disease.