Abnormal ductus venosus waveforms
Abnormal ductus venosus waveforms can arise in a number of conditions ranging from aneuploidy to vascular malformations and fetal tumors. "A wave" reversal can be seen in 5% of euploid fetuses 9.
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Pathology
Abnormal waveforms in fetal ductus venosus flow assessment can occur in a number of situations:
-
aneuploidic anomalies
- Down syndrome: around 80% are thought to have abnormal waveforms
-
congenital cardiac anomalies
- fetal pulmonary arterial anomalies
- fetal arteriovenous malformations leading to shunting
- fetal tumors that lead to arteriovenous shunting
- twin-to-twin transfusion syndrome: recipient twin
- maternal diabetes: may exhibit increased PI values 7
Radiographic features
Abnormal waveforms include:
- absent flow in ductus venosus A wave
- reversal of flow in ductus venosus A wave
- abnormal indices:
- abnormal pulsatility index (PI)
- abnormal S wave to A wave ratio (S:A)
- abnormal peak velocity index
Treatment and prognosis
Growth restricted fetuses with abnormal ductus venosus flow have worse perinatal outcomes compared to those where the flow abnormality is confined to the umbilical or middle cerebral artery 8.
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Ultrasound - obstetric
- ultrasound (introduction)
- obstetric ultrasound
- first trimester and early pregnancy
- ectopic pregnancy
- multiple gestations
- subchorionic hematoma
- failed early pregnancy
-
second trimester
- fetal biometry
- fetal morphology assessment
- fetal echocardiography views
- non-visualization of the fetal stomach
-
soft markers
- nuchal fold thickness
- ventriculomegaly
- absent nasal bone
- choroid plexus cysts
- enlarged cisterna magna
- shortened fetal long bones
- echogenic intracardiac focus (EIF)
- echogenic fetal bowel
- aberrant right subclavian artery
- fetal pyelectasis / fetal renal pelvic dilatation
- single umbilical artery
- sandal gap toes
- amnioreduction
- Doppler ultrasound
- nuchal translucency
- 11-13 weeks antenatal scan
- chorionic villus sampling (CVS) and amniocentesis
- placenta
- other