Low-resistance hepatic artery flow in first-trimester fetuses: an ominous sign

Authors

  • C. M. Bilardo,

    Corresponding author
    1. Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands
    2. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
    • Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Medical Centre Groningen, Homepostcode CB20, P. O. Box 30.001, 9700 RB Groningen, The Netherlands
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  • E. Timmerman,

    1. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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  • P. G. Robles De Medina,

    1. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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  • S. A. Clur

    1. Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
    2. Center for Congenital Heart Defects Amsterdam-Leiden (CAHAL), Leiden, The Netherlands
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Abstract

Objective

Low-resistance hepatic artery (HA) flow has been reported in severely growth-restricted fetuses. The same finding has been incidentally observed in first-trimester fetuses with enlarged nuchal translucency (NT). The aim of this study was to investigate HA flow in first-trimester fetuses.

Methods

Crown–rump length (CRL), NT, ductus venosus (DV) pulsatility index for veins (PIV) and HA pulsatility index (PI) were measured prospectively in fetuses at increased risk on first-trimester assessment for aneuploidy and in a control group of low-risk fetuses. Outcome of pregnancy was known in all cases. Independent sample t-test was used for intergroup comparison.

Results

NT, DV-PIV and HA-PI were measured prospectively in 59 fetuses. Thirty-four had an enlarged NT and underwent karyotyping, which was abnormal in 16 cases (trisomy 21, n = 12; trisomy 18, n = 3; 47,XXY, n = 1). Two pregnancies were terminated in view of fetal anomalies. In three other infants an abnormality was confirmed after birth (Noonan syndrome, unspecified genetic syndrome and cardiac defect). The remaining 13 fetuses with enlarged NT and the 25 with normal NT had an uneventful pregnancy outcome. HA-PI was significantly and inversely correlated with NT and DV-PIV. Mean HA-PI was significantly lower in fetuses with adverse outcome (chromosomal anomalies 1.60; chromosomally normal fetuses with adverse outcome 1.66) than in controls (2.03).

Conclusions

Low-resistance HA flow can be observed in first-trimester fetuses and, based on its association with adverse outcome, it can be regarded as an ominous sign. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

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