Fetal ductus venosus flow assessment

Fetal ductus venosus flow assessment can be sonographically assessed in a number of situations in fetal ultrasound:

Of all the pre-cardial veins, the ductus venosus allows the most accurate interpretation of fetal cardiac function as well as myocardial haemodynamics 9.

Radiographic assessment

  • the fetus should be as still as possible
  • the probe is ideally focused so sampling is done where the umbilical vein joins the ductus venosus 
  • a right ventral mid-sagittal view of the fetal trunk should be obtained and colour flow mapping used to demonstrate the umbilical vein, ductus venosus and fetal heart
  • the probe is ideally angled to allow a mid sagittal plane or a transverse oblique plane through the fetal abdomen
  • the image should be magnified enough for the fetal thorax and abdomen to occupy the whole screen
  • do not contaminate the ductus venosus flow with the flow from the fetal inferior vena cava, for this the Doppler sample should be small (0.5-1 mm)
  • the insonation angle should be 30°
  • the sweep speed should be high (2–3 cm/s) so that the waveforms are spread allowing better assessment of the A-wave 

On Doppler ultrasound, the flow in the ductus venosus has a characteristic triphasic waveform where in a normal physiological situation flow should always be in the forward direction 7 (i.e. towards the fetal heart).

This triphasic waveform comprises of:

  • S wave: corresponds to fetal ventricular systolic contraction and is the highest peak
  • D wave: corresponds to fetal early ventricular diastole and is the second highest peak
  • A wave: corresponds to fetal atrial contraction and is the lowest point in the wave form albeit still being in the forward direction

See also

Ultrasound - obstetric
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Article information

rID: 13824
System: Obstetrics
Tag: cases
Synonyms or Alternate Spellings:
  • Ductus venosus flow assessment
  • Ductus venosus Doppler assessment
  • Doppler assessment of the ductus venosus

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Cases and figures

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    Figure 1: normal ductus venosus triphasic waveform
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  • Drag
    Case 1: ductus venosus flow (normal)
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    Case 2: reverse A wave
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