الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
The venous system develops from three bilaterally symmetrical sets of veins in the embryo: the cardinal veins, the vitelline veins, and the left and right umbilical veins. Ductus venosus (DV) is a part of the umbilical veins and develops as a channel in the liver as the liver grows and impinges on the remaining left umbilical vein. This small, trumpet-shaped vessel allows blood to flow from the umbilical vein to the left side of the inferior vena cava (IVC), near the entrance to the heart. The left side of the IVC receives blood from the DV as well as the left and medial hepatic veins and further directs the blood flow in a vertical direction toward the foramen ovale.
In the present study, we determine role of Duct venosus doppler for the prediction of adverse perinatal outcome in intra uterine fetal growth restriction.
This prospective study was conducted according to the guidelines of the ethics committee of our university and was approved by our institutional review board, all females gave us written informed consent.
This prospective study was done between December 2018 till completion the cases including 60 pregnant females with their age ranging between 28 and 35 years, gestational age between 27 and 37 weeks of gestation (mean 33.02 Weeks), with high risk features, single viable fetus and growth retardation determined by fetal weight less than 10% for gestational age and abdominal circumference less than 5%.
All patients in the study were subjected to Doppler examination using 3.5 MHz transducer in a MINDRAY HD11 instrument of the middle cerebral artery (MCA), Ductus venosus (DV), and umbilical artery (UA).
The UA-EDF was preserved in 35 patients with normal PI (1.33–1.35),inpatientswithgestationalage27–28 weeksof gestation (2nd trimester) and 1.16–1.18 in more than 28 weeks ofgestation(3rdtrimester).Itwasincreasedto3.4–3.6in intactsurvivors (11 patient),5.07–5.09inmajormorbidity (13/22patient)and7.7–7.9instillbirth(2/22patient). UA- AEDF was present in 8 patients and UA-REDF was present in 6 patients.the sensitivity of high UA PI and UAEDF abnormalities is (56.5%), (30.4%) respectively.the specificity of high UA PI and UA EDF abnormalities is (67.6%), (81.1%) respectively.
The DV-PI was normal with positive a-wave in 35 patients (58.3%),high PI in 8 patients,absenta-wavewaspresentin 9 patients(15%),reversed a-wave was present in 8 patient (13.3%). the sensitivity of high DV PI and abnormal DV a-wave is (87.0%),(69.6%) respectively.the specificity of high DV PI and abnormal DV a-wave is (86,5%),(97,3%) respectively.
Abnormal DV findingshad highest sensitivity, NPV and Youden’s index(65.5%, 46.2% and 71.4% respectively), whileabnormal DV a-wavehad highest specificity and PPV(87.1% and 76.5% respectively) in predictingPH <7.2.
The MCA PI was normal in 40 patients and abnormal in 20 patients.the sensitivity of abnormal MCA PI is (60.9%)and the specificity is (83.8%).
Allparametersstudiedwerestrongly relatedtoperinatalmortality,however,nonehad100% sensitivity, the PIV in the DV is the best single indices to use in the prediction of perinatal mortality because it is easytocalculate. By qualitative evaluation, pulsations in a-wave abnormalities in the DV is most sensitive parameters for detection of perinatal mortality with higher PPV value than UA-PI. In the present study, the DV Doppler abnormalities is significantlyrelatedtopooroutcome parameter and perinatal mortality when compared with abnor- mal UA Doppler (p < 0.001).
We observed that venous Doppler is superior to arterial Doppler in predicting poor perinatal outcome and that the abnormal equivocal BPP scoring significantly correlated with adverse outcome. We also, concluded that multi-vessel Doppler Ultrasonography and BPP can effectively stratify IUGR fetuses with placental vascular insufficiency into risk categories. Fetal deterioration appears to be independently reflected in these two testing modalities; their combined use is likely to be complementary.