Authors :
Dr Devendra Patil; Dr Sachin Dagade; Dr Prashant Naik; Dr Poorva Patil; Abhijeet Jadhao
Volume/Issue :
Volume 8 - 2023, Issue 3 - March
Google Scholar :
https://bit.ly/3TmGbDi
Scribd :
https://bit.ly/3nvbWOE
DOI :
https://doi.org/10.5281/zenodo.7793035
Abstract :
The ductus venosus is a vascular shunt situated
within the fetal liver parenchyma, connecting the
umbilical vein to the inferior vena cava. This vessel acts
as a bypass of the liver microcirculation and plays a
critical role in the fetal circulation. The ductus venosus
allows oxygenated and nutrient rich venous blood to flow
from the placenta to the myocardium and brain.
Increased impedance to flow in the fetal ductus venosus
is associated with fetal aneuploidies, cardiac defects and
other ad-verse pregnancy outcomes. This review serves
to improve our understanding of the mechanisms that
regulate the blood flow redistribution between the fetal
liver circulation and fetal heart and the clinical
significance of the ductus venosus waveform as
generated by pressure-volume changes in the fetal heart.
Materials and Methods:
A cross sectional study was performed at Fetal
Medicine Department, SKNMC, Pune, from August
2021 to December 2022. Total 400 women were screened
at routine antenatal visit during this period, out of which
225 were selected. Fetal Doppler was performed using a
Siemens Acuson X300 ultrasound machine with a 3.5
MHz convex probe. The umbilical artery, fetal middle
cerebral artery and the fetal ductus venosus were
sampled. The pulsatility indices were measured. Follow
up of these fetuses were done and the perinatal outcome
were obtained.
Results:
An abnormal DV was associated with an overall
increased for birth by emergency caesarean (CS).
Overall caesarean rate is increased for delivering babies
between 28 - 32 weeks gestation irrespective of dv values
possibly due to policy of caesarean section in preterm
deliveries. Whereas abnormal DV values at 28 - 32
weeks, 32 - 37 weeks & 37 - 42 weeks has shown clear cut
increased in caesarean section rate, NICU admission and
duration of stay in NICU, intrauterine deaths, low birth
weight. We have categorically identified that DV values
< 5th centile and >95th centile increases perinatal
morbidity & mortality. We have seen that there is
substantial increase in intrauterine and neonatal deaths
at < 5th centile.
Conclusion:
In conclusion, the DV acts as a bypass of the liver
microcirculation and plays a critical role in the fetal
circulation. The DV allows oxygenated and nutrient-rich
venous blood to flow from the placenta to the
myocardium and brain. Increased impedance to flow in
the fetal DV is associated with fetal aneuploidies, cardiac
defects and other adverse pregnancy outcomes. Further
research is necessary to determine the importance of the
DV Doppler assessment in improving perinatal
outcomes.
Keywords :
Fetal Hypoxemia, Diastolic Reversal, Ductus Venosus, Perinatal Outcome.
The ductus venosus is a vascular shunt situated
within the fetal liver parenchyma, connecting the
umbilical vein to the inferior vena cava. This vessel acts
as a bypass of the liver microcirculation and plays a
critical role in the fetal circulation. The ductus venosus
allows oxygenated and nutrient rich venous blood to flow
from the placenta to the myocardium and brain.
Increased impedance to flow in the fetal ductus venosus
is associated with fetal aneuploidies, cardiac defects and
other ad-verse pregnancy outcomes. This review serves
to improve our understanding of the mechanisms that
regulate the blood flow redistribution between the fetal
liver circulation and fetal heart and the clinical
significance of the ductus venosus waveform as
generated by pressure-volume changes in the fetal heart.
Materials and Methods:
A cross sectional study was performed at Fetal
Medicine Department, SKNMC, Pune, from August
2021 to December 2022. Total 400 women were screened
at routine antenatal visit during this period, out of which
225 were selected. Fetal Doppler was performed using a
Siemens Acuson X300 ultrasound machine with a 3.5
MHz convex probe. The umbilical artery, fetal middle
cerebral artery and the fetal ductus venosus were
sampled. The pulsatility indices were measured. Follow
up of these fetuses were done and the perinatal outcome
were obtained.
Results:
An abnormal DV was associated with an overall
increased for birth by emergency caesarean (CS).
Overall caesarean rate is increased for delivering babies
between 28 - 32 weeks gestation irrespective of dv values
possibly due to policy of caesarean section in preterm
deliveries. Whereas abnormal DV values at 28 - 32
weeks, 32 - 37 weeks & 37 - 42 weeks has shown clear cut
increased in caesarean section rate, NICU admission and
duration of stay in NICU, intrauterine deaths, low birth
weight. We have categorically identified that DV values
< 5th centile and >95th centile increases perinatal
morbidity & mortality. We have seen that there is
substantial increase in intrauterine and neonatal deaths
at < 5th centile.
Conclusion:
In conclusion, the DV acts as a bypass of the liver
microcirculation and plays a critical role in the fetal
circulation. The DV allows oxygenated and nutrient-rich
venous blood to flow from the placenta to the
myocardium and brain. Increased impedance to flow in
the fetal DV is associated with fetal aneuploidies, cardiac
defects and other adverse pregnancy outcomes. Further
research is necessary to determine the importance of the
DV Doppler assessment in improving perinatal
outcomes.
Keywords :
Fetal Hypoxemia, Diastolic Reversal, Ductus Venosus, Perinatal Outcome.
