الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 104 |  |  |
| | | from | 104 | | |
Abstract
Ductus venosus (DV) provides oxygenated blood to fetal heart and brain bypassing the hepatic circulation. Anatomic location of DV reflects the pressure gradient between umbilical vein and right atrium, and measurement of DV blood flow velocity waveforms indirectly reflects fetal cardiac functions and well-being. Ductus venousus plays an important role in the fetal cardiovascular system to distribute the cardiac output when necessary. The first-trimester screening is a standard care of pregnancy only in some countries, which has a paramount importance to reveal fetal chromosomal and structural anomalies in the fetus. Measurement of DV blood flow is an optional part of first-trimester screening. The aim of this study was to evaluate the value of ductus venosus pulstality index of veins in early pregnancy in prediction of adverse pregnancy outcomes. This study was conducted at Department of Obstertrics and Gynecology at Tanta University Hospital, on 50 pregnant women with single viable fetus at first trimester 13-24wks. During the first and second trimester, an ultrasound examination is used to screen the fetal malformations and assess the fetal growth disorders, a problem which is commonly encountered in pregnancy associated medical disorders namely, diabetes, pre-eclampsia, hematological diseases, cardiac problems and many others with a resultant maternal morbidity and premature iatrogenic deliveries. Doppler ultrasound has emerged as a beneficial tool in the assessment of the fetal and placental circulation thus helping for prediction of poor pregnancy outcome to decrease the figure of emergency operations, hospital admissions, and hospital stay for both the mother and the newborn especially with cases of suspected intrauterine growth restriction (IUGR). Also, in timing delivery of severely growth-restricted fetuses by promoting the use of ductus venosus (DV) Doppler study. Doppler ultrasound study for fetal circulations would be a useful addition to the obstetrician cata-log of tests for antenatal fetal well-being and timely intervention that might be effective in reducing mortality and major morbidity in high-risk pregnancy. Integration of the abnormal DV blood flow patterns (reversed/absent a-wave or increased pulsatility index for veins) to the first-trimester screening improve the prediction of the chromosomal abnormalities, major congenital heart defects (CHD) and poor pregnancy outcome such as miscarriage, stillbirth, small for gestational age, low birth weight, fetal growth restriction and major congenital heart defect. The results of this study showed that 43 women (86.0%) had normal outcome or delivery, while 7 cases (14.0%) show abnormal delivery out come including congenital heart defects, congenital malformation, low birth weight, major congenital heart defects and stillbirth. On comparing the normal and abnormal out come groups, it was found that the demographic, basic clinical data and clinical history data was matched in the two studied groups. The U/S findings showed that a significant decrease in PI and S/A ratio in abnormal group less than the normal group, the cut off value of both PI and S/A ratio was less than 0.55 and less than 1.90, respectively. The sensitivity, specificity and accuracy of both PI and S/A ratio was 92.0, 88.0 and 90.0% for PI and 87.0%, 82.0% and 85.0% for S/A ratio.