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Archives of Gynecology and Obstetrics

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01-09-2015 | Maternal-Fetal Medicine

Conflicting umbilical artery Doppler findings in fetuses with trisomy 21

Authors: A. Flöck, I. Remig, A. Müller, J. Nadal, C. Berg, U. Gembruch, Annegret Geipel

Published in: Archives of Gynecology and Obstetrics | Issue 3/2015

Abstract

Objective

To assess differences between fetuses with isolated and non-isolated trisomy 21 in umbilical artery (UA) Doppler findings in the second and third trimester and to correlate those with placental histology.

Methods

Retrospective analysis of UA pulsatility index (PI) in 281 fetuses with trisomy 21. Cases were divided into isolated trisomy 21 (group I, n = 148, 52.7 %) and non-isolated trisomy 21 (group II, n = 133, 47.3 %). UA measurements were evaluated in five different time periods (A–E; <20 + 0 to ≥35 + 0 weeks) and were assigned histopathology of the placenta.

Results

In 118/281 (42 %) cases, UA measurement was abnormal. The frequency of PI values above the 95th percentile increased significantly with gestational age in both groups (period A 32.9 % vs. period E 63.6 %, p < 0.0001). There was neither a difference in abnormal UA PI values between isolated and non-isolated cases [37.8 % (56/148) vs. 46.6 % (62/133)] nor a correlation to placental findings.

Conclusions

Fetuses with trisomy 21 often present with elevated UA PI in the late second or third trimester, irrespective of small for gestational age growth, malformations or histopathological findings of impaired placentation.

Loane M, Morris JK, Addor MC et al (2013) Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening. Eur J Hum Genet 21:27–33PubMedCentralPubMedCrossRef

Sherman SL, Allen EG, Bean LH et al (2007) Epidemiology of Down syndrome. Ment Retard Dev Disabil Res Rev 13:221–227PubMedCrossRef

Irving C, Basu A, Richmond S et al (2008) Twenty-year trends in prevalence and survival of Down syndrome. Eur J Hum Genet 16:1336–1340PubMedCrossRef

Cocchi G, Gualdi S, Bower C et al (2010) International trends of Down syndrome 1993–2004: births in relation to maternal age and terminations of pregnancies. Birth Defects Res A Clin Mol Teratol 88:474–479PubMedCrossRef

Clementi M, Calzolari E, Turolla L et al (1990) Neonatal growth patterns in a population of consecutively born Down syndrome children. Am J Med Genet Suppl 7:71–74PubMed

Weijerman ME, van Furth AM, Noordegraaf A et al (2008) Prevalence, neonatal characteristics, and first-year mortality of Down syndrome: a national study. J Pediatr 152:15–19PubMedCrossRef

Malassiné A, Frendo JL, Evain-Brion D (2010) Trisomy 21-affected placentas highlight prerequisite factors for human trophoblast fusion and differentiation. Int J Dev Biol 54:475–482PubMedCrossRef

Pidoux G, Gerbaud P, Cocquebert M et al (2012) Review: human trophoblast fusion and differentiation: lessons from trisomy 21 placenta. Placenta 33(Suppl):S81–S86PubMedCrossRef

Qureshi F, Jacques SM, Johnson MP et al (1997) Trisomy 21 placentas: histopathological and immunohistochemical findings using proliferating cell nuclear antigen. Fetal Diagn Ther 12:210–215PubMedCrossRef

10.

Rochelson B, Kaplan C, Guzman E et al (1990) A quantitative analysis of placental vasculature in the third-trimester fetus with autosomal trisomy. Obstet Gynecol 75:59–63PubMed

11.

Wenstrom KD, Weiner CP, Williamson RA (1991) Diverse maternal and fetal pathology associated with absent diastolic flow in the umbilical artery of high-risk fetuses. Obstet Gynecol 77:374–378PubMed

12.

Trudinger BJ, Cook CM (1985) Umbilical and uterine artery flow velocity waveforms in pregnancy associated with major fetal abnormality. Br J Obstet Gynaecol 92:666–670PubMedCrossRef

13.

Rizzo G, Pietropolli A, Capponi A et al (1994) Chromosomal abnormalities in fetuses with absent end-diastolic velocity in umbilical artery: analysis of risk factors for an abnormal karyotype. Am J Obstet Gynecol 171:827–831PubMedCrossRef

14.

Jauniaux E, Gavrill P, Khun P et al (1996) Fetal heart rate and umbilico-placental Doppler flow velocity waveforms in early pregnancies with a chromosomal abnormality and/or an increased nuchal translucency thickness. Hum Reprod 11:435–439PubMedCrossRef

15.

Zoppi MA, Ibba RM, Putzolu M et al (2000) First trimester umbilical artery pulsatility index in fetuses presenting enlarged nuchal translucency. Prenat Diagn 20:701–704PubMedCrossRef

16.

Martinez Crespo JM, Comas C, Ojuel H et al (1996) Umbilical artery pulsatility index in early pregnancies with chromosome anomalies. Br J Obstet Gynaecol 103:330–334PubMedCrossRef

17.

Acharya G, Erkinaro T, Mäkikallio K et al (2004) Relationships among Doppler-derived umbilical artery absolute velocities, cardiac function, and placental volume blood flow and resistance in fetal sheep. Am J Physiol Heart Circ Physiol 286:1266–1272CrossRef

18.

Baschat AA, Gembruch U (2003) Development of fetal cardiac and extracardiac Doppler flows in early gestation. In: Yagel S, Silverman NH, Gembruch U (eds) Fetal cardiology. Martin Dunitz, London, pp 121–139

19.

Borell A, Martinez JM, Farre MT et al (2001) Reversed end-diastolic flow in the first trimester umbilical artery: an ominous new sign for fetal outcome. Am J Obstet Gynecol 185:204–207CrossRef

20.

Brown R, Di Luzio L, Gomes C et al (1998) The umbilical artery pulsatility index in the first trimester: is there an association with increased nuchal translucency or chromosomal abnormality? Ultrasound Obstet Gynecol 12:244–247PubMedCrossRef

21.

Martinez JM, Borrell A, Antolin E et al (1997) Combining nuchal translucency with umbilical Doppler velocimetry for detecting fetal trisomies in the first trimester of pregnancy. Br J Obstet Gynaecol 104:11–14PubMedCrossRef

22.

Hecher K, Spernol R, Wimmer-Hebein D et al (1992) Doppler ultrasound of the umbilical artery in fetuses with sonographically abnormal findings and/or chromosome abnormalities. Geburtshilfe Frauenheilkd 52:275–282PubMedCrossRef

23.

Wong G, Levine D (2005) Fetuses with trisomy 21 having conflicting findings on antenatal testing for fetal well-being. J Ultrasound Med 24:1541–1545PubMed

24.

Robinson WP, Peñaherrera MS, Jiang R et al (2010) Assessing the role of placental trisomy in preeclampsia and intrauterine growth restriction. Prenat Diagn 30:1–8PubMedCrossRef

25.

Meise C, Germer U, Gembruch U (2001) Arterial Doppler ultrasound in 115 second- and third-trimester fetuses with congenital heart disease. Ultrasound Obstet Gynecol 17:398–402PubMedCrossRef

26.

Gaziano EP, Knox GE, Wager GP et al (1990) Pulsed Doppler umbilical artery waveforms: significance of elevated umbilical artery systolic/diastolic ratios in the normally grown fetus. Obstet Gynecol 75:189–193PubMed

27.

Berkowitz GS, Mehalek KE, Chitkara U et al (1988) Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynecol 71:742–746PubMed

28.

Vedmedovska N, Rezeberga D, Teibe U et al (2011) Microscopic lesions of placenta and Doppler velocimetry related to fetal growth restriction. Arch Gynecol Obstet 284:1087–1093PubMedCrossRef

Title: Conflicting umbilical artery Doppler findings in fetuses with trisomy 21
Authors: A. Flöck
I. Remig
A. Müller
J. Nadal
C. Berg
U. Gembruch
Annegret Geipel
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-015-3703-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conflicting umbilical artery Doppler findings in fetuses with trisomy 21

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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