International Journal of Anatomy Radiology and Surgery (Nov 2023)

Doppler Spectral Wave Patterns of Ductus Venosus: Do they Change with Foetal Position in the First Trimester?

  • Harshavardan,
  • V Ram Sanjith,
  • SC Sanjay,
  • Srinivas Shentar

DOI
https://doi.org/10.7860/IJARS/2023/61515.2958
Journal volume & issue
Vol. 12, no. 6
pp. RO11 – RO14 waveforms in different positions of the foetus may not alter the risk assessment for aneuploidies, potentially reducing examination time. REFERENCES [1] Remien K, Majmundar SH. Physiology, Fetal Circulation. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. [2] Braga M, Moleiro ML, Guedes-Martins L. Clinical significance of ductus venosus waveform as generated by pressure- volume changes in the fetal heart. Curr Cardiol Rev. 2019;15(3):167-76. [3] Turan S, Turan OM. Harmony behind the trumped-shaped vessel: The essential role of the ductus venosus in fetal medicine. Balkan Med J. 2018;35(2):124-30. [4] Wiechec M, Nocun A, Matyszkiewicz A, Wiercinska E, Latała E. First trimester severe ductus venosus flow abnormalities in isolation or combination with other markers of aneuploidy and fetal anomalies. J Perinat Med. 2016;44(2):201-09. Doi: 10.1515/jpm-2014-0323. PMID: 25720039. [5] Gürses C, Karadag˘ B, Isenlik BST. Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies. J Matern Fetal Neonatal Med. 2020;33(8):1288-94. Doi: 10.1080/14767058.2018.1517323. Epub 2018 Oct 1. PMID: 30153762. [6] Marty M, Kerndt CC, Lui F. Embryology, Fetal Circulation. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. [7] Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR. Ductus venosus-A longitudinal Doppler velocimetric study of the human fetus. J Matern Fetal Invest. 1992;2:05-11. [8] Kiserud T. Fetal venous circula on-An update on hemodynamics. J Perinat Med. 2000;28(2):90-96. [9] Pruksanusak N, Kor-anantakul O, Suntharasaj T, Suwanrath C, Hanprasertpong T, Pranpanus S, et al. A reference for ductus venosus blood flow at 11-13+6 weeks of gestation. Gynecol Obstet Invest. 2014;78(1):22-25. Doi: 10.1159/000362273. Epub 2014 May 17. PMID: 24852007. PARTICULARS OF CONTRIBUTORS: 1. Associate Professor, Department of Radiology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. 2. Senior Resident, Department of Radiology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. 3. Professor, Department of Radiology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. 4. Chief Radiologist, Department of Radiology, Delta Diagnostics, Bengaluru, Karnataka, India. PLAGIARISM CHECKING METHODS: [Jain H et al.] • Plagiarism X-checker: Dec 03, 2022 • Manual Googling: Apr 17, 2023 • iThenticate Software: Apr 20, 2023 (12%) NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Etymology: Author Origin Harshavardan, Associate Professor, Department of Radiology, Kempegowda Institute of Medical Sciences, Bengaluru-560070, Karnataka, India. E-mail: [email protected] Date of Submission: Nov 18, 2022 Date of Peer Review: Jan 02, 2023 Date of Acceptance: Apr 21, 2023 Date of Publishing: Nov 01, 2023 Author declaration : • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes Emendations : 7

Abstract

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Introduction: The ductus venosus is a branch of the umbilical vein that carries oxygenated blood to the foetus’s right atrium. Assessing the ductus venosus during the first trimester is used as one of the soft markers to detect aneuploidy. Since, operators often have to wait for extended periods for the foetus to assume the desired position. Prolonged scanning increases costs and reduces efficiency by extending scan times. Therefore, it is crucial to determine whether the foetal position affects the ductus waveform. In India, where the number of qualified operators is limited compared to the high demand for scans, efficiency is particularly important. Aim: To observe the spectral flow patterns on colour Doppler of the ductus venosus in supine, prone, and oblique positions of the foetus. Materials and Methods: The authors conducted a prospective observational study at Kempegowda Institute of Medical Sciences and Delta Diagnostics, Bengaluru, Karnataka, India, between August 2021 and December 2021. The study included 100 pregnant women who underwent routine first-trimester antenatal scans between 11 weeks and 13 weeks and six days. Colour Doppler flow mapping was used to visualise the umbilical vein, ductus venosus, and foetal heart. Spectral flow patterns of the ductus venosus were obtained in the supine, prone, and oblique positions of the foetus. The parameters studied were peak systolic velocity, end-diastolic velocity, and ductus venosus pulsatility index. Friedman’s Test followed by Wilcoxon Signed Rank Post hoc test was used to compare the mean values of systolic and diastolic velocity and pulsatility index between different foetal positions. Results: A total of 100 singleton pregnancies were included, mean gestational age was 12 weeks and four days. There was no difference in the subjective evaluation of the waveforms obtained in different positions. All foetuses exhibited type 1 spectral waveform. There were no false positives in the subjective evaluation for ‘a’ wave reversal. However, there was a significant difference in the systolic and diastolic velocities of the ductus venosus with different foetal positions, with a p-value of less than 0.001. The mean systolic velocities in supine, prone, and oblique positions were 60.09 cm/s, 51.59 cm/s, and 31.38 cm/s, respectively. The mean diastolic velocities in supine, prone, and oblique positions were 25.23 cm/s, 22.05 cm/s, and 19.05 cm/s, respectively. There was no significant difference in the pulsatility index among the supine, prone, and oblique positions. Conclusion: Radiologists do not need to wait for the foetus to be in the horizontal position to assess the ductus venosus waveforms. The waveforms can be evaluated in other foetal positions without affecting the assessment of aneuploidy risk.

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