Original Article Does abnormal ductus venosus pulsatility index at the first-trimester effect on adverse pregnancy outcomes? $ Şafak Yılmaz Baran a, *, Hakan Kalaycı a , Gülşen Do  gan Durda  g a , Selçuk Yetkinel a , Alev Arslan b , Esra Bulgan Kılıçda  g a a Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey b Department of Pediatrics, Divison of Pediatric Cardiology, Başkent University Faculty of Medicine, Adana, Turkey A R T I C L E I N F O Article history: Received 27 October 2019 Received in revised form 24 April 2020 Accepted 29 June 2020 Available online xxx Keywords: 1st trimester ultrasound screening for aneuploidy and anomalies Doppler-diagnostic Diagnostic ultrasound and prenatal diagnosis A B S T R A C T Aim: The ductus venosus pulsatility index for veins (DV PIV) has become a popular marker of the first- trimester scan. The aim of this study is to search for any difference between groups with normal and abnormal DV PIV values in terms of adverse pregnancy outcomes. Methods: We retrospectively evaluated 556 women whose first-trimester scan was performed. The ductus venosus pulsatility indices were examined at singleton pregnancies between 11 and 14 weeks of gestation. Patients were categorized as Group-I with normal DV PIV (DV PIV  0.73, 1.22) and as Group- II with abnormal DV PIV. Group-II was subgrouped as Group-IIA which composed of patients with DV PIV < 0.73 and as Group-IIB with DV PIV > 1.22. Results: There were 451 subjects in Group-I and 105 subjects in Group-II (Group-IIA = 32 and Group-IIB = 73). The comparisons between major groups revealed a statistically significant increase about miscarriage (p = 0.002), stillbirth (p < 0.001), small for gestational age (p = 0.033), low birth weight (p < 0.001), fetal growth restriction (p = 0.048), and major congenital heart defect (p=<0.001) in Group-II. This difference is mainly due to Group-IIB. There is no difference in preterm delivery, preeclampsia and gestational diabetes between Group I and II. Conclusion: Routinely monitoring DIV PIV as a first-trimester screening should provide valuable information regarding adverse pregnancy outcomes such as miscarriage, stillbirth, small for gestational age, low birth weight, fetal growth restriction and major congenital heart defect. © 2020 Elsevier Masson SAS. All rights reserved. Introduction Ductus venosus (DV) provides oxygenated blood to fetal heart and brain bypassing the hepatic circulation. Doppler Ultrasonog- raphy of the fetal DV was first described by Kiserud et al. [1]. 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 [2]. 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 [3]. Measurement of DV blood flow is an optional part of first- trimester screening [4]. 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 [5–7]. Abnormal DV blood flow pattern could be a useful marker to predict adverse outcome and manage early growth restricted fetuses [8,9]. As a basis of presented study, we recently published reference values for ductus venosus pulsatility index for the veins (DV PIV) at first-trimester. Our statistical analysis had shown that the mean DV PIV was 0.98 for our cohort, which comprised 458 singleton pregnancies with absence of structural abnormalities on the ultrasound examination and absence of chromosomal abnormalities. The 5th and 95th percentile values were 0.73 and 1.22 (2 SD) [10]. $ This study was approved by Başkent University Institutional Review Board with the project number KA19/121. * Corresponding author at: Adana Seyhan Başkent Hastanesi, Kadın Do gum Klini gi, Gazi Paşa Mah. Baraj Cad. No: 7, Seyhan, Adana, Turkey. E-mail addresses: safakyilmazbaran@gmail.com, sayilmaz129@hotmail.com (Ş. Yılmaz Baran). http://dx.doi.org/10.1016/j.jogoh.2020.101851 2468-7847/© 2020 Elsevier Masson SAS. All rights reserved. Journal of Gynecology Obstetrics and Human Reproduction xxx (2019) xxx–xxx G Model JOGOH 101851 No. of Pages 5 Please cite this article in press as: S. Yılmaz Baran, et al., Does abnormal ductus venosus pulsatility index at the first-trimester effect on adverse pregnancy outcomes?, J Gynecol Obstet Hum Reprod (2020), https://doi.org/10.1016/j.jogoh.2020.101851 Available online at ScienceDirect www.sciencedirect.com