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(Circulation. 1996;94:1372-1378.)
© 1996 American Heart Association, Inc.

Articles

Fetal Atrioventricular Flow-Velocity Waveforms and Their Relation to Arterial and Venous Flow-Velocity Waveforms at 8 to 20 Weeks of Gestation

Paula van Splunder, MD; Theo Stijnen, PhD; Juriy W. Wladimiroff, MD, PhD

the Department of Obstetrics and Gynecology (P.v.S., J.W.W.) and Institute of Epidemiology and Biostatistics (T.S.), University Hospital Rotterdam-Dijkzigt, Netherlands.

Correspondence to Juriy W. Wladimiroff, MD, PhD, Professor of Obstetrics and Gynecology, University Hospital Rotterdam-Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.

Background Doppler ultrasonography was used to determine the nature and gestational age-related changes of human fetal AV flow-velocity waveforms and to establish their relationship with arterial impedance indexes and venous flow velocities in normal human fetuses between 8 and 20 weeks of gestation.

Methods and Results Flow-velocity waveform recordings were attempted in 318 singleton pregnancies. After the exclusion criteria were applied, data on 214 women were available for further analysis. Differentiation between E wave and A wave became possible at 9 weeks, whereas distinction between transmitral and transtricuspid valve flow velocities was first achieved at 10 to 11 weeks. A statistically significant nonlinear gestational age-dependent increase was established for all AV waveform parameters, which became linear when related to logarithmically estimated fetal crown-to-rump length. Transtricuspid valve flow velocities were significantly higher than transmitral valve flow velocities. Transmitral valve time-averaged flow velocities were positively correlated with peak diastolic velocities and time-velocity integral of late-diastolic reverse flow in the inferior vena cava. No correlation existed between AV time-averaged velocities and arterial impedance indexes.

Conclusions Monophasic AV flow-velocity waveforms can be recorded as early as 8 weeks of gestation and become biphasic as early as 8 weeks. They demonstrate a linear increase relative to logarithmically estimated fetal crown-to-rump length, suggesting that fetal growth-related increase in volume flow plays a role in this velocity rise. Transtricuspid valve A-wave and E-wave velocities suggest right ventricular predominance as early as the late first trimester of pregnancy. AV flow velocities are not related to arterial downstream impedance.

Key Words: pregnancy • blood flow • arteries • veins • echocardiography

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