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Obstet Gynecol. 2008 Sep;112(3):598-605. doi: 10.1097/AOG.0b013e3181834608.

Screening for adverse pregnancy outcome by ductus venosus Doppler at 11-13+6 weeks of gestation.

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Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.



To estimate the independent contribution of abnormal flow in the ductus venosus at 11 to 13+6 weeks of gestation in the prediction of major fetal abnormalities and fetal death.


This was a prospective assessment of singleton pregnancies by maternal history, serum free beta-hCG, pregnancy-associated plasma protein A (PAPP-A), fetal nuchal translucency thickness, and ductus venosus Doppler. The patients were subdivided into five groups: normal outcome (n=10,120), miscarriage or fetal death (n=185), abnormal karyotype (n=95), and major cardiac (n=20) or noncardiac defect (n=70). Regression analysis was performed to determine the significance of the contribution to adverse outcome of reversed a-wave in the ductus venosus, maternal characteristics, fetal delta nuchal translucency, maternal serum log PAPP-A multiples of the median, and log free beta-hCG multiples of the median.


The prevalence of reversed a-wave was significantly higher in the groups with miscarriage or fetal death (10.8%), abnormal karyotype (62.1%), and fetal cardiac defect (25.0%) than in the normal outcome group (3.7%), but not noncardiac defect (4.3%). An adverse outcome was observed in 2.7% of the fetuses with nuchal translucency at or below the 95th centile (in 2.6% of those with normal a-wave and in 7.0% of those with reversed a-wave) and in 19.3% of the fetuses with nuchal translucency above the 95th centile (in 8.9% of those with normal a-wave and in 70.9% of those with reversed a-wave).


Reversed a-wave is associated with increased risk for chromosomal abnormalities, cardiac defects, and fetal death. However, in about 80% of cases with reversed a-wave, the pregnancy outcome is normal.

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