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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:979-982 • 0278-4297

Second-Trimester Ductus Venosus Measurement and Adverse Perinatal Outcome in Fetuses With Congenital Heart Disease

Katherine Bianco, MD, Maria Small, MD, Svena Julien, MD, Trace Kershaw, PhD, Maaike Michon, MD and Joshua Copel, MD

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California USA (K.B.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut USA (M.S., M.M., J.C.); Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois USA (S.J.); and Yale University School of Public Health, New Haven, Connecticut USA (T.K.).

Address correspondence to Katherine Bianco, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 505 Parnassus Ave, Box 0132, San Francisco, CA 94143 USA. E-mail: biancok{at}obgyn.ucsf.edu

Objective. The purpose of this study was to determine whether Doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). Methods. We conducted a retrospective cohort study of all pregnant women undergoing fetal echocardiography for CHD in a single perinatal center during a 2-year period. We compared outcomes for fetuses having a diagnosis of CHD in the second trimester and abnormal DV Doppler velocimetric findings with those having CHD and normal DV Doppler findings. Karyotype, gestational age at delivery, fetal loss rate, and rate of termination were assessed. The referral value for an abnormal DV pulsatility index was above the 95th percentile for gestational age. Statistical analysis included the t test, Fisher exact test, and {chi}2 test. Results. The incidence of CHD in our population was 7%. There were 98 patients with CHD; of those, 31 had DV measurement. A total of 9 patients had an abnormal DV. Three of this group (33%) had intrauterine fetal death or perinatal death. In patients with CHD and normal DV measurements, 83% had living children versus 33% in the group with an abnormal DV (P < .05). There was no statistically significant difference in the rate of aneuploidy between the normal DV (15%) and abnormal DV (20%) groups (P = .65). The mean gestational age at delivery was similar between the normal (37.63 weeks) and abnormal (38.33 weeks) DV groups (P = .71). There was no difference in the rate of pregnancy termination. Conclusions. Abnormal second-trimester DV measurements are predictive of adverse perinatal outcome in patients with CHD, independent of karyotype or gestational age at delivery. This information may have a role in the counseling of parents with CHD.

Key Words: congenital heart defects • ductus venosus waveforms • second-trimester Doppler sonography

Abbreviations: CHD, congenital heart disease • DV, ductus venosus • IUFD, intrauterine fetal death • NT, nuchal translucency • PI, pulsatility index

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Copyright © 2006 by the American Institute of Ultrasound in Medicine.