Updated Reference Ranges for the Ductus Venosus Pulsatility Index at 11–13 Weeks

Abstract

Objective: To update the reference ranges for the ductus venosus pulsatility index (DVPI) at 11+0 to 13+6 gestational weeks. Methods: DVPI was calculated in 14,444 singleton fetuses at 11+0 to 13+6 weeks in two Fetal Medicine Centers, during a 4-year period. Using previously described medians, DVPI evolution was assessed both over the study period on a yearly basis and over gestation, grouping fetuses according to 5-mm crown-rump length (CRL) ranges. Weighted DVPI medians, the 5th and 95th percentiles and distribution parameters for unaffected and trisomy 21 fetuses were newly calculated. Results: A significant DVPI multiple of the median decrease was observed over both the study period (p < 0.01) and over gestation (p < 0.01) using previous medians, in the two centers. Newly calculated weighted medians were lower than those previously described, decreasing with CRL. Distribution parameters calculated using the new medians were different from those previously described. Conclusion: DVPI reference ranges were lower than those previously reported and decreased with CRL. Updated medians and distribution parameters should be considered to include the DVPI as a Gaussian marker in trisomy 21 screening and for quality control purposes.

Doppler assessment of the ductus venosus and the tricuspid valve at 11-13+6 weeks: Reference ranges and development of sonographic quality assurance standards

“…Over the past decade there have been at least seven reported 11–14 week DV PIV reference ranges . Two of these lie above the current study mean and four lie below it, including three of the most recent publications.…”

“…This study was specifically designed to construct a reference range by a single, highly experienced operator where the measurement criteria were strictly enforced, with a relatively high number of subjects excluded as a consequence. This is unlikely to be the case where reference ranges are drawn from large cohorts in a routine screening service using multiple machines and operators . Technical improvements in Doppler imaging, magnification and tracing have resulted in considerable improvements in resolution over the years thus modification of reference ranges may be appropriate over time in the same institution .…”

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

“…Several studies investigated the diagnostic value of ductus venosus blood flow in detection of fetuses with congenital heart disease, hypoxic or congestive fetal myocardial diseases both from a clinical and a scientific point of view. There is now a well-documented association between abnormal DV flow and complicated monochrionic multiple gestation, chromosomal anomalies, and adverse fetal outcome [1][2][3]14].…”

“…Ductus venosus has characteristic wave forms characterized by two peaks during systole (S wave) and diastole (D wave). In contrast to the neighboring inferior vena cava and hepatic veins, the blood flow normally remains orthograde during atrial contraction giving another peak during atrial contraction in late diastole (A wave) [2,3].…”

First Trimester Ultrasound Assessment for Fetal Aneuploidy

“…90 Assuming this is independent of other factors, the likelihood ratio can then be applied to the risk algorithm for combined first trimester screening. [92][93][94] Assessment of populations of euploid and aneuploid fetuses have shown that, similar to nuchal translucency, DVPI is bimodal, but the relative proportion of fetuses distributed around the ''high DVPI'' median is increased in all trisomies. There is, however, some recent data that suggest that the ductus venosus can be used as a continuous variable, by measuring the pulsatility index (DVPI) rather than purely categorizing the shape of the waveform.…”