Murat CEVİK, Ruya DEVEER

The role of ductus venosus doppler, fetal liver length and placental thickness in gestational diabetes

To detect the possible adaptive changes that may have an impact on placenta and fetus in the presence of gestational diabetes mellitus using ultrasonography. We compared ductus venosus peak systolic flow velocity, fetal liver length and placental thickness between 25 healthy pregnants and 25 pregnants with gestational diabetes mellitus; diagnosed by 75 gram oral glucose tolerance test during their 24–28 weeks of pregnancy. Measurements were conducted with a 2 D transabdominal convex probe. In addition, gravida, parity, type of birth, gestational diabetes mellitus story, diabetes mellitus story in family, body mass index and demographic characteristics were also compared. In the demographic characteristics, family history of diabetes mellitus and personal history of Gestational Diabetes Mellitus were significantly higher in the group with gestational diabetes than the control group. No statistically significant difference was found between other demographic features The mean ductus venosus peak systolic flow was measured 35 cm/s in group with gestational diabetes mellitus while it was 45 cm/s in the control group, hence significantly lower in the group with gestational diabetes mellitus. The mean fetal liver length was measured 48 mm in group with gestational diabetes mellitus while it was 44 mm in the control group, thus higher in the group with gestational diabetes. The mean placental thickness was measured 40 mm in group with gestational diabetes while it was 37 mm in control group. There was no statistically significant difference in placental thickness between pregnants with gestational diabetes and healthy controls. Ductus venosus peak systolic flow and fetal liver length measurements are different in patients with gestational diabetes than healty controls.

PDF

___

1. Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Chicago, Illinois, USA. 14-16 March 1997. Diabetes Care. United States; 1998. p. B1-167.

2. Ozyurt R, Asıcıoglu O. The Prevalence of Gestational Diabetes Mellitus in Pregnant Women Who were Admitted to İstanbul Teaching and Research. JOPP Derg. 2013;5:7-12.

3. Hartling L, Dryden DM, Guthrie A, et al. Screening and diagnosing gestational diabetes mellitus. Evid Rep Technol Assess (Full Rep). 2012;210:1-327.

4. Dantas AMA, Palmieri ABS, Vieira MR, et al. Doppler ultrasonographic assessment of fetal middle cerebral artery peak systolic velocity in gestational diabetes mellitus. Int J Gynaecol Obstet. 2019;144:174-9.

5. Wong CH, Chen CP, Sun FJ, et al. Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2019;32:3784-91.

6. Garcia-Flores J, Cruceyra M, Cañamares M, et al. Predictive value of fetal hepatic biometry for birth weight and cord blood markers in gestational diabetes. J Perinatol. 2016;36:723-8.

7. Saha S, Biswas S, Mitra D, et al. Histologic and morphometric study of human placenta in gestational diabetes mellitus. Ital J Anat Embryol. 2014;119:1-9.

8. Edu A, Teodorescu C, Gabriela Dobjanschi C, et al. Placenta changes in pregnancy with gestational diabetes. Rom J Morphol Embryol. 2016;57:507-12.

9. Haugen G, Hanson M, Kiserud T, et al. Fetal liver-sparing cardiovascular adaptations linked to mother’s slimness and diet. Circ Res. 2005;96:12-4.

10. Kiserud T. Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol. 1999;84:139-47.

11. Haugen G, Kiserud T, Godfrey K, et al. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol. 2004;24:599-605.

12. Turan Ş, Turan ÖM. Harmony Behind the Trumped-Shaped Vessel : the Essential Role of the Ductus Venosus in Fetal Medicine. 2018;124-30.

13. Kessler J, Rasmussen S, Hanson M, et al. Longitudinal reference ranges for ductus venosus flow velocities and waveform indices. Ultrasound Obstet Gynecol. 2006;28:890-8.

14. Turan OM, Turan S, Sanapo L, et al. Semiquantitative classification of ductus venosus blood flow patterns. Ultrasound Obstet Gynecol. 2014;43:508-14.

15. Stuart A, Amer-wåhlin I, Gudmundsson S, et al. Ductus venosus blood flow velocity waveform in diabetic pregnancies. Ultrasound Obstet Gynecol. 2010;36:344-9.

16. Perovic MD, Gojnic M, Arsic B, et al. Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus. J Diabetes 2015;7:497-505.

17. Hisham Mirghani M, Reem Zayed M. Gestational Diabetes Mellitus: Fetal Liver Length Measurements Between 21 and 24 Weeks’ Gestation. J Clin Ultrasound. 2007;35:27-33.

18. İlhan G, Gultekin H , Kubat A, et al. Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus. J Obstet Gynaecol. 2018;3615:1-5.

19. Tongprasert F, Srisupundit K, Luewan S, et al. Normal length of the fetal liver from 14 to 40 weeks of gestational age. J Clin Ultrasound. 2011;39:74-7.

20. Huynh J, Yamada J, Beauharnais C, et al. Type 1, type 2 and gestational diabetes mellitus differentially impact placental pathologic characteristics of uteroplacental malperfusion. Placenta. W.B. Saunders. 2015;36:1161-6.

21. Dashe JS, BL H. Callen’s Ultrasonography in Obstetrics and Gynecology. Philadelphia: Elsevier; 2017;674-703

22. Berceanu C, Tetileanu AV, Ofiteru AM, et al. Morphological and ultrasound findings in the placenta of diabetic pregnancy. Rom J Morphol Embryol = Rev Roum Morphol Embryol. Romania. 2018;59:175-86.

23. Perovic M, Garalejic E, Gojnic M, et al. Sensitivity and specificity of ultrasonography as a screening tool for gestational diabetes mellitus. J Matern Fetal Neonatal Med. England. 2012;25:1348-53.