First‐trimester ductus venosus velocity ratio as a marker of major cardiac defects

Wagner, Philipp; Eberle, Katrin; Sonek, Jiri; Berg, Christoph; Gembruch, Ulrich; Hoopmann, Markus; Prodan, Natalia; Kagan, Karl Oliver

doi:10.1002/uog.20099

Cited by 13 publications

(8 citation statements)

References 23 publications

(31 reference statements)

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“…Of the twenty-two studies included, ten were carried out in an unselected population, ten in an euploid population and two in a high-risk population for CHD. Among the ten studies performed in an euploid population, eight studies analyzed only chromosomally normal fetuses [33][34][35][36][37][38][39][40][41][42]. Of the two studies carried out in a high-risk population, the study by Clur S.A.B et al included women referred for fetal echocardiography with known risk factors for CHD, such as: increased NT, an increased a-priori risk for CHD or suspicion of a CHD at ultrasound examination [43].…”

Section: Resultsmentioning

confidence: 99%

The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis

Savoia

Scala

Coppola

et al. 2022

Arch Gynecol Obstet

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Purpose Abnormal flow in the ductus venosus (DV) has been reported to be associated with adverse perinatal outcome, chromosomal abnormalities, and congenital heart defects (CHD). Aneuploid fetuses have increased risk of CHD, but there are discrepancies on the performance of this markers in euploid fetuses. The aim of this meta-analysis was to establish the predictive accuracy of DV for CHD. Methods MEDLINE, EMBASE, and CINAHL were searched from inception to February 2022. No language or geographical restrictions were applied. Inclusion criteria regarded observational and randomized studies concerning first-trimester DV flow as CHD marker. Random effect meta-analyses to calculate risk ratio (RR) with 95% confidence interval (CI), hierarchical summary receiver-operating characteristics (HSROC), and bivariate models to evaluate diagnostic accuracy were used. Primary outcome was the diagnostic performance of DV in detecting prenatal CHD by means of area under the curve (AUROC). Subgroup analysis for euploid, high-risk, and normal NT fetuses was performed. Quality assessment of included papers was performed using QUADAS-2. Results Twenty two studies, with a total of 204.829 fetuses undergoing first trimester scan with DV Doppler evaluation, fulfilled the inclusion criteria for this systematic review. Overall, abnormal DV flow at the time of first trimester screening was associated to an increased risk of CHD (RR 6.9, 95% CI 3.7–12.6; I2 = 95.2%) as well in unselected (RR: 6.4, 95% CI 2.5–16.4; I2 = 93.3%) and in euploid (RR: 6.45, 95% CI 3.3–12.6; I2 = 95.8%) fetuses. The overall diagnostic accuracy of abnormal DV in detecting CHD was good in euploid fetuses with an AUROC of 0.81 (95% CI 0.78–0.84), but it was poor in the high-risk group with an AUROC of 0.66 (95% CI 0.62–0.70) and in the unselected population with an AUROC of 0.44 (95% CI 0.40–0.49). Conclusions Abnormal DV in the first trimester increases the risk of CHD with a moderate sensitivity for euploid fetuses. In combination with other markers (NT, TV regurgitation) could be helpful to identify fetuses otherwise considered to be at low risk for CHD. In addition to the improvement of the fetal heart examination in the first trimester, this strategy can increase the detection of major CHD at earlier stage of pregnancy.

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Section: Resultsmentioning

confidence: 99%

The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis

Savoia

Scala

Coppola

et al. 2022

Arch Gynecol Obstet

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“…The latter can further be increased if the assessment of the ductus venosus flow is added to the scanning protocol. Some research groups observed detection rates of up to 60% in the first trimester 35,36 . In comparison, a recent Scandinavian study shows that the detection rate of a detailed anomaly scan in the second trimester, considered as the gold standard for the diagnosis of fetal defects, is also only about 50%.…”

Section: First Trimester Screening Strategiesmentioning

confidence: 92%

“…Some research groups observed detection rates of up to 60% in the first trimester. 35,36 In comparison, a recent Scandinavian study shows that the detection rate of a detailed anomaly scan in the second trimester, considered as the gold standard for the diagnosis of fetal defects, is also only about 50%. For cardiac defects the reported detection rate was as low as 13%.…”

Section: Why the First-trimester Scan Matters And How To Perform Itmentioning

confidence: 96%

First‐trimester screening strategies: A balance between costs, efficiency and diagnostic yield

2023

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What's already known about this topic?� An early scan at 11-13 + 6 weeks offers the ideal opportunity for a first detailed anatomical assessment of the fetus.� Non-invasive prenatal testing (NIPT) is superior to the combined test to screen for common trisomies, especially trisomy 21, in both singleton and twin pregnancies. What does this study add?� In first-trimester screening strategies based on NIPT and ultrasound, many factors must be considered when choosing how to combine the two methods. We propose four screening strategies with different pro-and contra arguments.� The article may help choose the strategy that best fits local needs and health economic considerations. | INTRODUCTIONThe introduction of non-invasive prenatal testing (NIPT) by cell-free DNA (cfDNA) has reshaped the way first-trimester screening (FTS) is performed. In several countries NIPT is offered as second line screening, after the combined test (CT) including nuchal translucency (NT) measurement and maternal serum biochemistry (free beta-HCG and PAPP-A). 1 However, there is an increasing tendency to completely replace the CT with NIPT. 2,3 It is undisputed that, in a direct comparison with the CT, NIPT is a superior screening method for common trisomies, especially trisomy 21, in both singleton and twin pregnancies. [4][5][6] The performance diminishes when microdeletions are also tested or a genome-wide approach is offered. 7 In fact, the screen-positive rate increases, the positive predictive value decreases and counseling couples to ensure informed consent becomes more challenging. [8][9][10] The additional value of these expanded menus needs to be balanced against this background. Replacing the CT with NIPT may result in a loss of the opportunity for a first detailed anatomical assessment of the fetus, which is highly valued by women. 11,12 It is known that about 30%-50% of fetal abnormalities can always be detected in the first trimester and that while some are strongly associated with chromosomal aberrations, others are isolated. 13,14 Notably, their prevalence exceeds that of genetic anomalies, especially in younger women who constitute the majority of the reproductive population. 15 Although there is still an ongoing debate, it seems reasonable that screening for structural anomalies should have its own place, next to NIPT, in the current FTS paradigm. 14,[16][17][18][19][20] The primary aim of this commentary is to present four different screening strategies combining NIPT and ultrasound in the first trimester (NIPT after CT, NIPT after a 12-13 weeks anatomical assessment, NIPT without a 12-13 weeks anatomical assessment and NIPT followed by a 12-13-week anatomical assessment) with their pro and contra arguments. We are aware that the ultimate decision on which strategy to offer will be nationally determined by costeffectiveness arguments, availability of local resources, and health policy priorities. We recognize that some pro-and contra-argumentsThis is an open access article under the terms of the Creative Commons Attribution-...

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“…There is a redistribution of fetal circulation in situations of FGR, so the Doppler ductus venous ow is changed, ranging from an increased pulsatility index to the absence or reversal of the A wave. The pulmonary veins' Doppler ow re ects pressure in the left atrium, and its Doppler waveform is identical to the ductus venosus [11]. As a result, the fetal pulmonary vein pulsatility index undergoes the same alterations as the ductus venosus in speci c fetal conditions.…”

Section: Introductionmentioning

confidence: 99%

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: A Vietnamese matched cohort study

Pham

Tran

Pham

et al. 2023

Preprint

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Background: In clinical obstetrics, many guidelines recommended the use of Doppler fetal ductus venosus blood flow to monitor and to manage fetal growth restriction (FGR). The ductus venosus and the pulmonary venous flow pattern of fetuses are similar. Umbilical artery pH (UA pH) is essential in identifying adverse pregnancy outcomes, particularly in fetal growth restriction cases. Nevertheless, the literature indicates that the relationship between pulmonary vein pulsatility index (PVPI) and UA pH in FGR cases has not been well investigated. This study aimed to identify the alteration in PVPI in FGR cases and evaluate the correlation between PVPI and UA pH in FGR newborns. Methods: This matched cohort study of singleton pregnancies from 28+0 to 40+0 weeks of gestation without congenital abnormalities included 135 cases of FGR (disease group) and 135 cases of normal growth (control group). The PVPI was measured at the proximal segment of the right or left pulmonary vein, approximately 5 mm from the left atrium wall. The umbilical artery pulsatility index (UAPI) was measured on the free umbilical cord. An elective cesarean section or labor induction are both options for ending the pregnancy, depending on the condition of the mother or fetus. Umbilical artery blood samples were collected within 5 minutes of delivery for UA pH measurement. SPSS version 20 and Medcalc version 20.1 were used for data analysis. Results: FGR cases had a significantly higher mean fetal PVPI than the control group (1.16 ± 0.26 vs. 0.84 ± 0.16; p < 0.01), and PVPI and UAPI were positively correlated (r = 0.63; p < 0.001). PVPI and UA pH were negatively correlated in FGR patients, with r = -0.68; p < 0.001. The PVPI value on the 95th percentile had a prognostic value of UA pH < 7.20 with a sensitivity of 88.2%, specificity of 66.3%, positive predictive value of 46.9%, and negative predictive value of 94.3%. Conclusions: There was a statistically significant difference in PVPI values in FGR cases compared to the normal growth group, a positive correlation between PVPI and UAPI, and a negative correlation between PVPI and UA pH. PVPI might have a prognostic meaning in predicting UA pH at birth.

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First‐trimester ductus venosus velocity ratio as a marker of major cardiac defects

Abstract: In the first trimester, a/S-ratio has the potential to detect approximately 60% of congenital cardiac defects for a false positive rate of 5%. This article is protected by copyright. All rights reserved.

Cited by 13 publications

References 23 publications

The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis

The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis

First‐trimester screening strategies: A balance between costs, efficiency and diagnostic yield

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: A Vietnamese matched cohort study

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