This study allows us to identify severe early onset of FGR at the end of the second trimester and the beginning of the third. Oxygenated blood from the placenta enters the umbilical vein, then into the ductus venosus, the upper part of the inferior vena cava and into the right atrium. The diameter of the ductus venosus is much smaller than the diameter of the umbilical vein and inferior vena cava, and the blood flow speed in it increases.

A connection has been established between certain changes in blood flow parameters and severe fetal pathology.

To study these vessels, it is necessary that the device has color Doppler mapping functions with a pulse-wave mode.

In the second half, with a physiological flow in the umbilical vein, continuous blood flow is observed at a low speed without pulsation. Ripple is detected in early pregnancy or due to compression of the umbilical cord or fetal hypoxia. Low-amplitude pulsation is associated with the respiratory movements of the fetus, so measurements are not performed during this period.

Ripple reflects cardiac function rather than vascular resistance in the placenta. When the umbilical cord is compressed, pulsation is observed during systole. Pulsation at the end of the diastole phase is an ominous sign and indicates severe fetal hypoxia.

In the ductus venosus the speed of blood flow is higher. This vessel is located closer to the heart, so blood flow in it reflects the function of the atrium. The shape of the blood flow velocity is a three-phase curve. During fetal hypoxia, the minimum value of the blood flow wave increases due to back pressure caused by atrial contraction. As a result, there is a decrease in blood flow velocity in the late diastole phase, down to zero or negative values.

The inferior vena cava is characterized by a similar three-phase curve, and during atrial contraction, reverse blood flow is often detected here, so the value of Doppler mapping of this vessel is minimal.

1. The umbilical cord and umbilical vein are visualized. In order to study the blood flow velocity curve in the umbilical cord vein, a control volume is set on the vessel image, it is checked that the insonation angle is not the smallest, and the blood flow spectrum is recorded.
2. The umbilical vein is traced along its entire length from its entry into the anterior abdominal wall to its entry into the liver.
3. Using color Doppler scanning, an increase in blood flow velocity is detected in the final section of the umbilical vein, where the immediate continuation of the latter is the narrower ductus venosus.
4. The control volume is established on the image of the initial segment of the ductus venosus. In order to obtain a good signal, the direction of the insonation angle is adjusted so that it is less than 30°. The ductus venosus differs from the adjacent inferior vena cava and hepatic veins by its slightly hissing sound.

• Protocol for Doppler examination of the umbilical artery

• Free-floating umbilical cord loop

• Setting the reference volume on the umbilical artery image

• Subacute insonation angle scanning

Need to remember

1. Examination of the umbilical cord artery is the best way to predict the condition of the fetus.
2. Of greater clinical importance is the absence of diastolic blood flow in the umbilical cord artery or its reverse direction, rather than various indices.
3. A decrease in blood flow velocity in the venous duct during the late diastole phase to zero or negative values ​​indicates fetal hypoxia.
4. Pathological pulsation in the umbilical vein, corresponding to the diastolic component of blood flow in the umbilical artery, indicates severe fetal hypoxia.
5. The appearance of an early diastolic notch in the uterine arteries during Doppler ultrasound may indicate an increased risk of developing preeclampsia and FGR.

(ductus venosus, PNA, JNA)
see Ductus venosus.

View value Duct venosus in other dictionaries

Venous- venous, venous (anat.). Adj. to vein. Deoxygenated blood.
Ushakov's Explanatory Dictionary

Duct— see leak and pierce.
Dahl's Explanatory Dictionary

Venous Adj.— 1. Correlative in meaning. with noun: vein, connected with it. 2. Characteristic of a vein, characteristic of it.
Explanatory Dictionary by Efremova

Duct M.— 1. A river branch, a stream connecting two bodies of water. 2. Narrow connecting cavity, canal (in the body).
Explanatory Dictionary by Efremova

Venous— see Vienna.
Kuznetsov's Explanatory Dictionary

Duct- -A; m.
1. River branch; stream, river connecting two bodies of water. The lakes are connected by a deep channel. In the lower reaches the river splits into many channels.
2. Anat. Narrow........
Kuznetsov's Explanatory Dictionary

Allanoid Duct— (dutus allantoicus, LNE) a canal lined with epithelium connecting the cavity of the hindgut with the cavity of the allantois; in the human embryo the AP is reduced.
Large medical dictionary

Anastomosis Venous- (a. venosa) A., connecting two venous vessels.
Large medical dictionary

Arantsiev Channel- (G. S. Aranzi, 1530-1589, Italian anatomist and surgeon) see List of anatomists. terms.
Large medical dictionary

Ductus arteriosus- (ductus arteriosus, PNA; ductus arteriosus (Botalli), BNA; synonym Botalli proto) blood vessel connecting the pulmonary trunk of the fetus with the aorta; formed from the left sixth (aortic) branchial........
Large medical dictionary

Bartolin's Channel— (S. Bartholin, 1655-1738, Danish anatomist) see Large sublingual duct.
Large medical dictionary

Botall's Channel- (ductus arteriosus (Botalli), BNA; L. Botallo, 1530-1600, Italian surgeon and anatomist) see Ductus arteriosus.
Large medical dictionary

Warton's Channel- (ductus Whartonianus; Th. Wharton, 1614-1673, English anatomist) see Submandibular duct.
Large medical dictionary

Venous Return- blood circulation indicator: volumetric blood flow velocity in the right atrium; Normally, it strictly corresponds to the cardiac output.
Large medical dictionary

Venous Return Cardiotomy- sharply increased venous return, observed after some heart surgeries (pericardiectomy, mitral commissurotomy, etc.).
Large medical dictionary

Venous Return Coronary- coronary circulation indicator: volumetric blood flow velocity in the coronary sinus; normally equal to 50-80% of the volumetric blood flow velocity in the coronary arteries.
Large medical dictionary

Venous Stagnation— (stasis venosa) see Venous hyperemia.
Large medical dictionary

Ductus Venosus— (ductus venosus, PNA, JNA) see List of anat. terms.
Large medical dictionary

Venous Sinus of the Sclera— (sinus venosus sclerae, PNA, BNA, JNA; synonym: venous sinus of the sclera, Laut canal, scleral canal, Schlemm’s canal) a circular venous vessel located in the thickness of the sclera on the border with........
Large medical dictionary

Venous Angle- (angulus venosus; synonym Pirogov venous angle) the confluence of the subclavian and internal jugular veins, forming the brachiocephalic vein.
Large medical dictionary

Virzungow Channel- (ductus Wirsungianus; J. G. Wirsung, 1600-1643, German anatomist) see Pancreatic duct.
Large medical dictionary

Wolffian Channel- (ductus Wolffi; S. F. Wolff, 1733-1794, morphologist) see Duct of the primary kidney.
Large medical dictionary

Hensen's duct- (V. Hensen) see Connecting duct.
Large medical dictionary

Hepatopancreatic Duct- (ductus hepatopancreaticus, LNE; hepato- + Greek. pankteas, pankreatos pancreas) section of the embryonic common bile duct from the place where the duct of the ventral anlage enters it.......
Large medical dictionary

Thoracic Duct- (ductus thoracicus, PNA, BNA, JNA) lymphatic vessel through which lymph flows into the venous bed from the legs, pelvis, walls and organs of the abdominal cavity, left arm, left half of the chest,........
Large medical dictionary

Vitelline Duct- see Vitelline duct.
Large medical dictionary

Vitelline Duct- (ductus vitellinus, LNE; synonym: vitelline-intestinal duct, umbilical-intestinal duct) a canal in the vitelline stalk, lined with endodermal epithelium, connecting the cavity of the middle........
Large medical dictionary

Bile duct- (ductus choledochus) - Common bile duct.
Large medical dictionary

Bile Duct Common— (ductus choledochus, PNA, BNA, JNA; synonym bile duct) extrahepatic gland, formed by the connection of the hepatic and cystic ducts; opens on the major duodenal papilla.
Large medical dictionary

Female Duct— see Paramesonephric duct.
Large medical dictionary

FETAL BLOOD CIRCULATION

The blood circulation of the fetus is otherwise called placental circulation: in the placenta, an exchange of substances occurs between the blood of the fetus and the maternal blood (in this case, the blood of the mother and the fetus does not mix). In the placenta, placenta, begins with its roots umbilical vein, v. umbilicalis, through which arterial blood oxidized in the placenta is directed to the fetus. Following as part of the umbilical cord (umbilical cord), funiculus umbilicalis, to the fetus, the umbilical vein enters through the umbilical ring, anulus umbilicalis, into the abdominal cavity, goes to the liver, where part of the blood through venous duct, Arantiev (ductus venosus) reset to inferior vena cava v. cava inferior, where it mixes with venous blood ( 1 mix ), and the other part of the blood passes through the liver and through the hepatic veins also flows into the inferior vena cava ( 2 mixing ). Blood through the inferior vena cava enters the right atrium, where its main mass, through the valve of the inferior vena cava, valvula venae cavae inferioris, passes through oval hole, foramen ovale, interatrial septum into the left atrium. From here it follows into the left ventricle, and then into the aorta, through the branches of which it is directed primarily to the heart, neck, head and upper limbs. In the right atrium, except for the inferior vena cava, v. cava inferior, brings venous blood to the superior vena cava, v. cava superior, and coronary sinus of the heart, sinus coronarius cordis. Venous blood entering the right atrium from the last two vessels is sent, together with a small amount of mixed blood, from the inferior vena cava into the right ventricle, and from there into the pulmonary trunk, truncus pulmonalis. The arch of the aorta, below the place where the left subclavian artery departs from it, flows into ductus arteriosus, ductus arteriosus (Botallov duct), through which blood from the latter flows into the aorta. From the pulmonary trunk, blood flows through the pulmonary arteries into the lungs, and its excess through the arterial duct, ductus arteriosus, is sent to the descending aorta. Thus, below the confluence of the ductus arteriosus, the aorta contains mixed blood ( 3 mixing ), entering it from the left ventricle, rich in arterial blood, and blood from the ductus arteriosus with a high content of venous blood. Through the branches of the thoracic and abdominal aorta, this mixed blood is directed to the walls and organs of the thoracic and abdominal cavities, pelvis and lower extremities. Part of the said blood follows two paths - right and left - umbilical arteries, aa. umbilicales dextra et sinistra , which, located on both sides of the bladder, exit the abdominal cavity through the umbilical ring and, as part of the umbilical cord, funiculus umbilicalis, reach the placenta. In the placenta, the fetal blood receives nutrients, releases carbon dioxide and, enriched with oxygen, is again sent through the umbilical vein to the fetus. After birth, when the pulmonary circulation begins to function and the umbilical cord is ligated, a gradual desolation of the umbilical vein, venous and arterial ducts and distal parts of the umbilical arteries occurs; all these formations become obliterated and form ligaments.

Umbilical vein, v. umbilicalis , forms round ligament of the liver, lig. teres hepatis; ductus venosus - venous ligament lig. venosum; ductus arteriosus, ductus arteriosus - ligament arteriosus lig. arteriosum and from both umbilical arteries, aa. umbilicales , cords are formed, medial umbilical ligaments, lig g . umbilicalia medialia , which are located on the inner surface of the anterior abdominal wall. Overgrown also foramen ovale, foramen ovale , which turns into fossa oval, fossa ovalis , and the valve of the inferior vena cava, valvula v. cavae inferioris, which has lost its functional significance after birth, forms a small fold stretched from the mouth of the inferior vena cava towards the fossa ovale.

Fig. 113. Fetal circulation

1 - placenta; 2 - umbilical vein (v. umbilicalis); 3 - portal vein (v. portae); 4 - ductus venosus (ductus venosus); 5 - hepatic veins (vv. hepaticae); 6 - oval hole (foramen ovale); 7 - ductus arteriosus (ductus arteriosus); 8 - umbilical arteries (aa. umbilicales)

The blood circulation of a fetus is significantly different from that of an adult.

The fetus is in the womb, which means it does not breathe with its lungs - the ICC does not function in the fetus, only the BCC works.

The fetus has communications, they are also called fetal jesters, these include:

1. foramen ovale (which drains blood from the RA into the LA)
2. arterial (Batalov) duct (duct connecting the aorta and pulmonary trunk)
3. ductus venosus (this duct connects the umbilical vein to the inferior vena cava)

These communications close over time after birth, and when they are not closed, congenital malformations are formed.

Now we will analyze in detail how blood circulation occurs in a child.

The baby and mother are separated from each other by the placenta; the umbilical cord, which contains the umbilical vein and umbilical artery, goes from it to the baby.

Oxygen-enriched blood travels through the umbilical vein as part of the umbilical cord to the fetal liver; in the fetal liver, the umbilical vein is connected to the inferior vena cava through the DUCT VENOUS. We remember that the inferior vena cava flows into the RA, in which there is an OVAL WINDOW, and through this window blood flows from the RA into the LA, where the blood mixes with a small amount of venous blood from the lungs. Then from the LA through the left interventricular septum into the LV, and then enters the ascending aorta, then through the vessels to the upper part of the body. Collecting in the SVC, the blood of the upper half of the body enters the RA, then into the RV, then into the pulmonary trunk. Let us remember that the ATRERIAL DUCT connects the aorta and the pulmonary trunk, which means that the blood that entered the pulmonary table, for the most part, due to the high resistance in the vessels of the ICC, will not go into the lungs as in an adult, but through the ductus arteriosus into the descending part of the aortic arch. About 10% is thrown into the lungs.

The umbilical arteries carry blood from the fetal tissues to the placenta.

After ligation of the umbilical cord, the ICC begins to function as a result of the expansion of the lungs, which occurs with the child’s first breath.

Closing communications:

• First, the ductus venosus closes by the 4th week, and in its place the round ligament of the liver is formed.
• The ductus arteriosus then closes as a result of vasospasm due to hypoxia for 8 weeks.
• The oval window is the last to close, during the first half of life.

1

Using Doppler sonography, quantitative indicators of blood flow velocity in the fetal venous duct in various phases of the cardiac cycle were studied in healthy women from 11 to 14 weeks of pregnancy. At the same time, the concentration in the blood of the pregnant woman of pregnancy-associated plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (beta-CG) was taken into account. It was found that in healthy pregnant women, linear blood flow velocities in the fetal venous duct have a significant (almost twofold) variation range, which excludes the dependence of these indicators on the gestational age in weeks and on the thickness of the chorion. A weak negative correlation has been established between the content of specific proteins and pregnancy hormones (PAPP-A and beta-CG) in a woman’s blood and the relative angle-independent parameters of blood flow in the fetal venous duct - the ratio of blood flow velocities in systole and early diastole, as well as the venous velocity index and index vein resistance. The identified dependence gives grounds to use angle-independent parameters of blood flow velocity curves in the fetal venous duct, determined at the turn of the first and second trimesters of pregnancy, as an additional criterion for predicting prenatal risk.

pregnancy

dopplerography

fetal ductus venosus

blood flow velocity curves

1. Altynnik N.A. The value of Doppler assessment of blood flow in the fetal venous duct in early pregnancy for the formation of a high-risk group for the birth of children with chromosomal abnormalities. Bulletin of Volgograd Medical Sciences. university. – 2012. – No. 4. – P. 66–68.

2. Lisyutkina E.V. Diagnostic value of Dopplerography of blood flow in the venous duct of the fetus at different stages of pregnancy: abstract of thesis. dis. ...cand. honey. Sci. – M., 2013. – 18 p.

3. The procedure for providing medical care in the field of “obstetrics and gynecology (except for the use of assisted reproductive technologies).” Order of the Ministry of Health of the Russian Federation dated November 1, 2012 No. 572n.

4. Radzinsky V.E. Obstetric aggression. – M.: Publishing house of the magazine Status Praesens, 2011. – 618 p.

5. ISUOG Practice Recommendations: Use of Doppler Ultrasound Technologies in Obstetrics. International Society of Ultrasound Diagnostics in Obstetrics and Gynecology (ISUOG) / A. Bride, G. Acharya, C. M. Bilardo, etc. // Ultrasound and functional diagnostics. – 2014. – No. 5. – P. 87–98.

6. Maiz N. Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies / N. Maiz, I. Staboulidou, A.M. Leal et al. // Obstet. Gynecol. – 2009. – Vol. 113. – R. 860–865.

The relevance of the problem of early prediction and prevention of the development of obstetric complications in order to reduce perinatal and infant morbidity and mortality determines the search for new predictors of problematic outcomes of pregnancy and childbirth. Over the past decade, medical institutions have been widely equipped with ultrasound scanners equipped with color Doppler mapping and reducing the total radiation exposure to the fetus to a safe threshold. This makes it possible to expand the scope of standard screening ultrasound examination of pregnant women for the early formation of high-risk groups. Among the Doppler parameters determined in the first trimester of pregnancy, the study of blood flow velocity curves (BVR) in the fetal venous duct has attracted the greatest attention of researchers. The high prognostic value of studying the spectrum of CSC in this vessel at the end of the first - beginning of the second trimester of pregnancy has been proven in relation to the presence of chromosomal abnormalities, congenital heart defects in the fetus and the outcome of multiple pregnancies. But these studies concerned only the qualitative study of CSC (registration of retrograde or unidirectional blood flow). Quantitative normative parameters of blood flow velocity in the fetal venous duct at the turn of the first and second trimesters of pregnancy in various phases of the cardiac cycle still remain unknown. This limits the possibility of using this method to predict other types of obstetric pathology. The existing problem indicated the direction of the research.

The purpose of the work is to determine the normative parameters of fetal blood flow rates in 11-14 weeks of pregnancy.

Material and research methods

The subject of the study consisted of 72 somatically healthy women with a physiological course of singleton pregnancy, having from 11 weeks. + 0/7 days up to 13 weeks. + 6/7 days of gestation. Criteria for inclusion in the study:

a) age from 18 to 35 years;

b) pregnancy from 11 to 14 weeks;

c) bearing one fetus;

d) location of the chorion in the fundus or along the side walls of the uterus;

e) absence of extragenital pathology in the stage of sub- and decompensation;

f) spontaneous conception;

g) the absence of an episode of threatening termination of the observed pregnancy both at the time of the study and at its earlier stages.

The study of blood circulation in the fetal venous duct was carried out using a Voluson E8 ultrasound device (USA), in compliance with the ALARA (As Low As Reasonably Achievable) principle - “As Low As Reasonably Achievable”, i.e. using the most prudently low output power possible. Registration of blood flow in the fetal venous duct was carried out by specialists who have the appropriate Certificate from the Fetal Medicine Foundation. The velocity of blood flow was measured in systole (S), diastole (E) of the ventricles of the heart, as well as during contraction of the vestibules of the heart, i.e. in late diastole (A).

The ratios of phase blood flow velocities (S/E and S/A), as well as angle-independent indices - the venous resistance index (VRI) and the venous velocity index (VVI) were calculated. The study was conducted as an addition to the standard examination in the first trimester of pregnancy, determined by the “Basic spectrum of examination of pregnant women” of the federal Procedure for the provision of medical care in the field of “obstetrics and gynecology (except for the use of assisted reproductive technologies)”. In addition to the data from the clinical examination of patients, the work took into account the content of pregnancy-related plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (beta-hCG) in the blood of women on the day of examination, both in quantitative values ​​and in the form of “multiple” of median" (MoM).

The recorded data were processed using the method of correlation and variation analysis and are presented as “mean ± standard deviation” (M ± SD) and 95% confidence interval (95% CI).

Research results and discussion

The data obtained indicate that the speed of blood flow in the ductus venosus in the fetus at the turn of the first and second trimesters of gestation during a physiological pregnancy varies widely (table).

In various phases of the fetal cardiac cycle, individual characteristics in the group of subjects determined a more than twofold discrepancy in the recorded parameters. At the same time, the linear parameters of blood circulation did not depend on either the gestational age in weeks or the thickness of the chorion measured by ultrasound scanning. There were no cases of retrograde blood flow in the ductus venosus in the fetus (a marker of intrauterine hypoxia or hereditary pathology) in the examined women.

Indicators of blood flow velocity curves in the fetal ductus venosus in various phases of the cardiac cycle in the early stages of physiological pregnancy

The ratios of blood flow velocities in systole and early diastole (S/E) in healthy pregnant women were less variable - the discrepancies in the indicators were no more than 11%. This made it possible to identify a weak inverse correlation between this indicator and the concentration of human chorionic gonadotropin in the blood of a pregnant woman (r = -0.3; p< 0,05). Соотношение скоростей кровотока в венозном протоке плода в систолу и позднюю диастолу (S/А) также имело большую вариабельность (почти двухкратное превышение максимального значения над минимальным), что не позволило определить взаимосвязь этого показателя с другими результатами стандартного обследования беременных. Размах вариации индексов скоростей вен и резистентности вен был намного меньше - в пределах 46 и 37 % соответственно. Это определило наличие отрицательной корреляционной связи между сравниваемыми параметрами кровотока в венозном протоке плода и продукцией специфических гормонов и белков беременности - бета-ХГ и РАРР-а (коэффициенты корреляции соответственно равны - 0,41 (р < 0,05) и - 0,34 (р < 0,05). При этом не имел преимуществ вид представления бета-ХГ и РАРР-а (количественные значения или МоМ); связь указанных параметров была слабой, но доказанной посредством проверки нулевой гипотезы. Так как определение продукции бета-ХГ и РАРР-а в МоМ используется в качестве одного из критериев прогноза пренатального риска с ранних сроков беременности , выявленная взаимосвязь открывает перспективы использования для этих целей и числовых значений исследования кровотока в венозном протоке плода. Но оценка эффективности нового прогностического критерия становится возможной только при условии четкого представления о нормативных значениях КСК в указанном кровеносном сосуде.

Conclusion

The data obtained are preliminary, however, they show that the curves of blood flow velocities in the fetal ductus venosus in early pregnancy can be subjected not only to qualitative analysis (identification of retrograde and zero blood flow), but can also be presented in the form of numerical values ​​for early prediction gestational complications.

Reviewers:

Agarkova L.A., Doctor of Medical Sciences, Professor, Director, Research Institute of Obstetrics, Gynecology and Perinatology, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk;

Sotnikova L.S., Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology, Faculty of Education and Training, State Budgetary Educational Institution of Higher Professional Education "Siberian State Medical University" of the Ministry of Health of the Russian Federation, Tomsk.

The work was received by the editor on February 12, 2015.

Bibliographic link

Mikheenko G.A., Yuryev S.Yu., Korotkova Yu.Yu. PHASE PARAMETERS OF BLOOD FLOW VELOCITY IN THE DUCTUUS VENOUS OF THE FETAL IN HEALTHY WOMEN AT 11–14 WEEKS OF PREGNANCY // Fundamental Research. – 2015. – No. 1-1. – P. 107-109;
URL: http://fundamental-research.ru/ru/article/view?id=36777 (access date: 12/13/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"