Doppler En Obstetricia

Ultrasound Obstet Gynecol 2010; 36: 350–354
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.7744

Ductus venosus velocimetry in monitoring pregnancy
in women with pregestational diabetes mellitus
S. F. WONG*, S. G. PETERSEN*, N. IDRIS*, M. THOMAE† and H. D. McINTYRE†
*Department of Maternal Fetal Medicine, University of Queensland, Mater Mothers’ Hospitaland †Department of Endocrinology and
Mater Clinical School – School of Medicine and Diamantina Institute, University of Queensland, Mater Adult Hospital, South Brisbane,
QLD, Australia

K E Y W O R D S: diabetes mellitus; Doppler; ductus venosus; perinatal outcome

ABSTRACT
Objective The purpose of this research was to assess
the ability of ductus venosus (DV) Doppler velocimetry
topredict adverse perinatal outcome in pregnancies
complicated by pre-existing diabetes mellitus.
Methods This was a prospective study conducted at a
tertiary referral obstetric facility in Brisbane, Australia.
The study group included women with pregestational
diabetes mellitus who delivered in the hospital between
1 January 1995 and 31 December 2006. The DV
Doppler index was defined as abnormalif the DV peak
velocity index for veins (PVIV) was equal to or greater
than the 95th percentile for gestation. Adverse perinatal
outcome included one or more of the following criteria:
small-for-gestational-age infant; Cesarean section for nonreassuring fetal status; fetal acidemia at delivery; a 1-min
Apgar score of ≤ 3; a 5-min Apgar score of < 7; hypoxic
ischemic encephalopathy; andstillbirth or neonatal death.
The maternal characteristics and perinatal outcomes of
pregnancies with normal or abnormal DV Doppler indices
were compared.
Results Eighty-two pregestational diabetic pregnancies
were studied and an abnormal DV-PVIV was identified
in 25 (30.5%). Adverse perinatal outcome was identified
in eight of 25 (32.0%) pregnancies with an abnormal
DV-PVIV compared to seven of57 (12.3%) pregnancies
with a normal DV-PVIV (P < 0.05). The sensitivity of
the DV-PVIV in predicting adverse perinatal outcomes
in pregestational diabetic pregnancies was 53.3%, the
specificity was 74.6%, the positive predictive value was
32.0% and the negative predictive value was 87.7%.
Conclusion It may be useful to include DV-PVIV in
the antenatal screening of pregnancies complicated bypregestational diabetes. Copyright  2010 ISUOG.
Published by John Wiley & Sons, Ltd.

INTRODUCTION
In recent years, improved antenatal management of
diabetic pregnancies has resulted in an overall reduction
in morbidity and mortality rates for mothers and their
babies. Nevertheless, up to 25% of the babies currently
born to mothers with pregestational diabetes have
neonatalcomplications1 .
The best antenatal screening method for pregnancies
in diabetic mothers remains elusive. Currently, umbilical
artery Doppler velocimetry is widely used to monitor
high-risk pregnancies because it is considered to be the
best available method of fetal surveillance; however,
it has not been shown to be as effective as a test
of fetal well-being in diabetic pregnancies. Umbilicalartery Doppler velocimetry reflects placental blood-flow
resistance. Given that most adverse perinatal outcomes
in diabetic pregnancies are not associated with chronic
placental insufficiency, assessment of the umbilical artery
by Doppler for monitoring fetuses of diabetic pregnancies
may be of limited use. Our group has shown previously
that umbilical artery Doppler velocimetry is not a
goodpredictor of adverse perinatal outcome in diabetic
pregnancies2 . Only 30% of pregnancies associated with
adverse perinatal outcome had abnormal umbilical
arterial Doppler.
The ductus venosus (DV) is an important fetal vessel
through which oxygenated blood is directed from the
umbilical vein towards the foramen ovale. Approximately
20–30% of the umbilical venous blood flow bypasses
the...