Reversed end-diastolic umbilical flow in a first-trimester fetus with congenital heart disease

Abstract

Reversed end‐diastolic umbilical artery velocities and a reduced chorionic sac were first seen at 10 weeks in a pregnancy subsequently showing a normal male karyotype on chorionic villi. Four weeks later Doppler studies demonstrated normal umbilical artery waveforms. At 20 weeks, ultrasound examination of the fetus revealed a mild pericardic effusion, hypoplastic right heart with hypertrophic myocardium and a single umbilical artery, suggesting pulmonary atresia. After neonatal death, pathological studies confirmed pulmonary atresia. This case suggests that reversed end‐diastolic umbilical flow in the first trimester may identify a subgroup of fetuses with a lethal abnormality (heart defect, severe intra‐uterine retardation, aneuploidy or others). Copyright © 1998 John Wiley & Sons, Ltd.

Diagnosis of Congenital Cardiac Defects Between 11 and 14 Weeks' Gestation in High‐Risk Patients

“…The 4-chamber view was observed in 90% of fetuses at 12 weeks' gestation, but the other views were not imaged as easily at this stage. The diagnostic capacity of fetal echocardiography when using transvaginal sonography between 11 and 14 weeks also has been described by D'Amelio et al 7 In a large 11 described reversed end-diastolic velocity in the umbilical artery at 10 weeks' gestation as the first sign of hypoplasia in the right atrium and ventricle.…”

Reversed end‐diastolic flow in the umbilical artery at 10–14 weeks of gestation is associated with absent pulmonary valve syndrome

“…REDF in the umbilical artery between the 10 th and 14 th weeks of gestation is very rare; a total of 23 cases have been reported so far2–9. The associated conditions included 14 cases of chromosomal anomalies (six trisomy 18; three trisomy 13; five other aneuploidies), two cases with isolated cardiac defects (one pulmonary atresia; one atrioventricular septal defect), one VACTERL association and one early twin‐to‐twin transfusion syndrome, and there were five anatomically normal fetuses, of which two developed early onset growth restriction.…”

“…Between the 11 th and 14 th weeks, positive diastolic flow emerges and remains detectable from then onwards1. Reversed end‐diastolic flow (REDF) in the umbilical artery in the first trimester is very rare and previous reports have found a strong association with chromosomal anomalies, fetal heart defects, early onset growth restriction and an unfavorable prognosis in affected fetuses2–9. Here, we report on five further cases of REDF in the umbilical artery detected in first‐trimester pregnancies, and describe their associated anomalies.…”

Dopplervelocimetria no Rastreamento de Aneuploidias no Primeiro Trimestre da Gestação

“…Concernente à artéria umbilical, o mecanismo etiopatogênico responsável pelo aumento do IP da artéria umbilical nas cromossomopatias é desconhecido. Postulam-se algumas teorias: alterações da angiogênese placentária 9 , alterações da matriz extracelular placentária (edema do estroma) 4 e distúrbio hemodinâmico decorrente de má-formação da estrutura cardíaca 30 , comum nas anormalidades cromossômicas.…”

“…De acordo com revisão de artigos da língua inglesa indexados no MEDLINE, até maio de 2000, existem apenas 6 casos descritos na literatura: 4 deles portavam anomalias cromossômicas [9][10][11] e 1, cardiopatia 30 . Recentemente, em junho de 2000, descrevemos o sexto e sétimo caso 13 : tratava-se de 1 triploidia e de 1 trissomia do cromossômicas 9.…”