Screening for fetal abnormalities with ultrasound

Flood, Karen; Malone, Fergal D.

doi:10.1097/gco.0b013e3282f73253

Cited by 12 publications

(14 citation statements)

References 41 publications

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“…Doppler studies of the fetal circulation have demonstrated the importance of the DV in the continuous monitoring of fetuses with intrauterine growth restriction due to placental insufficiency, with some reports demonstrating an association of abnormal DV flow patterns and fetal chromosomal abnormalities, congenital cardiac defects, or adverse pregnancy outcome in highrisk pregnancies where increased values of the pulsatility index for veins (PIV) and absent or reversed flow during atrial contraction were related to abnormal pregnancy outcome [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Zytoon

El-Abakawy²,

Hassanein

2020

Egypt J Radiol Nucl Med

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Background: Doppler studies of the fetal circulation have demonstrated the importance of the ductus venosus in the continuous monitoring of fetuses, especially those of high-risk pregnancies that can lead to abnormal pregnancy outcome. We tried to put reference values for the normal ductus venosus (DV) flow in normal gestation to be used in further studies assessing the different pathologies. Results: The DV length ranged from 9.8 to 20.9 mm, and the diameter ranged from 0.6 to 2.3 mm. The DV pulsatility index, resistive index, and systolic velocity/maximum velocity during atrial wave ratio declined linearly with increasing of gestational age and were increased after that during the last weeks of pregnancy. Ductus venosus S wave and A wave velocities increased linearly from a mean of 38.30 at the first trimester to 61.68 at the third trimester and from a mean of 11.38 at the first trimester to 30.71 at the third trimester respectively. Conclusion: A reference range of the normal ductus venosus different Doppler parameters was constructed in a centile module.

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Section: Introductionmentioning

confidence: 99%

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Zytoon

El-Abakawy²,

Hassanein

2020

Egypt J Radiol Nucl Med

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“…[9][10][11][12] The overall sensitivity increases to 93% when first and second trimester ultrasound examinations are combined. 13 Detection of structural anomalies within the gestational period makes it possible to plan interventions during pregnancy or during the immediate and early postpartum period, thereby reducing perinatal and infant morbidity and mortality. 14,15 In addition, early detection facilitates multidisciplinary planning for maternal-fetal interventions that may be required during the gestational period and provides greater information for parents and relatives.…”

Section: Introductionmentioning

confidence: 99%

Fetal structural anomalies diagnosed during the first, second and third trimesters of pregnancy using ultrasonography: a retrospective cohort study

et al. 2019

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BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.

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“…3,5,10,14,31,32 This additional utility increases the clinical interest of the DV assessment. More research is needed to quantify the benefit of measuring DV flow in routine obstetric practice.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Recently, several studies have demonstrated an increased impedance to flow in the ductus venosus at the 11 to 13 +6 weeks' scan in DS fetuses. [5][6][7][8][9][10][11][12] Therefore, ductus venosus (DV) Doppler studies could be used to modify the estimated DS risk either selectively in women referred because high-risk for this condition as a secondary screening method, [5][6][7]11,[13][14][15] or incorporated routinely into existing screening protocols as a primary screening method.…”

Section: Introductionmentioning

confidence: 99%

Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit

Echevarría¹,

Comas²,

Rodríguez³

et al. 2009

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Objective: To estimate the improvement in screening efficiency when ductus venosus (DV) Doppler studies are added to existing Down syndrome (DS) screening protocols.Methods: First-trimester combined screening for trisomy 21 was prospectively carried out, from October 2003 to March 2008, in 8842 consecutive singleton pregnancies attended in our tertiary reference center. The nuchal translucency (NT) and the pulsatility index for veins for DV were calculated. The maternal serum biochemistry was measured using the Kryptor analyzer, at the same time of the scan (one step strategy) or before it (two step strategy). The detection rate (DR) and false-positive rates for standard screening strategy (maternal age, NT and biochemistry) and the same strategy but including DV assessment were calculated.Results: Successful DV assessment was possible in the 95.3% of cases, representing a total of 8426 cases. Down syndrome was identified in 34 pregnancies (prevalence of DS 1:250). For a fixed screen positive rate of 5%, the addition of the DV assessment improves the DR from 85 to 94% and, for a fixed DR of 85%, it reduces the number of unnecessary invasive tests from 3.7 to 3.2%. Conclusion:Early evaluation of DV can be introduced to standard DS screening strategies in experienced centers as a first level test to reduce invasive test rate derived from the existing protocols.

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Screening for fetal abnormalities with ultrasound

Abstract: Screening for fetal abnormalities continues to evolve with the introduction of novel techniques and the further refinement of previously proposed screening tools. How these modalities are implemented into routine clinical practice remains to be seen.

Cited by 12 publications

References 41 publications

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Reference values for ductus venosus flow in normal gestation among an Egyptian population

Fetal structural anomalies diagnosed during the first, second and third trimesters of pregnancy using ultrasonography: a retrospective cohort study

Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit

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