'Reverse Flow in Ductus Venosus' - 12 week scan at FMC

[Toppy]

I am posting this in the hope that someone may have been in a similar position and can help me understand the implications of my 12 week scan - apologies for the long post.

I have just been for a 12 week scan at the Foetal Medicine Centre where one of the markers they check is the Ductus Venosus flow. My baby's flow is reverse flow. This can be an indicator of Downs. We were told that 80% of Downs babies have this condition bu that 3% of 'chromosomally normal' babies also have reverse flow. Once combined with my age, blood results or other markers (nuchal fold, nasal bone) we were given a very low risk of Downs, Edwards and Patau.

DH is very happy with these results but I can't stop worrying about what this reverse flow means outside of the context of the Nuchal scan. The sonographer said we could do nothing more than wait for the 20 week scan and focused on my low chromosomal defect risk.

Now I am home I am worried about what might await us at the 20 week scan as reverse flow can be indicative of heart defects. This has just caused the most ENORMOUS row between me and DH. He can only see the facts: in the context of the 12 week scan this anomaly has been cancelled out to by other good indicators to give an overall low risk whereas I, worrier that I am, can only think about why the anomaly is there at all.

I know there is nothing I can do but wait for the 20 week scan and google (bad bad idea) but I was hoping someone else further on down the line might have had this experience that they could share.

I think we had this - but I think they called this Tricuspid regurgitation - is that the same? Not sure. But you sound exactly like I did.

I was having our baby at Kings College and it is one of the few places that really examine the baby's heart. I went for my 12 wk scan and was told that this is what my baby had, but all other markers were low and I should try "not to worry". I was ok at the time, but within days I was a complete wreck thinking my baby could have DS or a heart condition. I could not sleep and I wanted a CVS. However, my husband felt okay and did not want one. It was awful, I was in tears and it made my husband really annoyed and cross. He just could not understand how I felt.

Anyway, I phoned the hospital back and told them how I felt and thankfully they agreed to do another scan at 16 weeks (at KCH they normally see you again at 22 weeks). I had the scan and a specialist in fetal cardiology said he looked fine. In fact she questioned whether he ever had it to start with - and it could of been a misdiagnosis.

I felt much better, but in all honesty it played on my mind throughout my whole pregnancy and it was the first question I asked when he was born....in fact I started crying whilst I was in labour about this. He was born a healthy beautiful boy.

I think if I had my time again I would have pushed for the test, because of the stress it gave me during the pregnancy. Although - obviously there are risks. It is an impossible decision.

I would definitely phone your docter and explain how you are feeling and see if they can see you again earlier.

I really hope you are ok. My heart goes out to you as I know how stressful this can be.

Take care

Hi Clare123,
Thanks for your message.

I've stopped worrying for the time being - seeing as there is nothing I can do about it and I do keep feeling baby moving about, which is so lovely!

I can't thank everyone enough who has replied on this thread - this more than anything at hospital, midwife or GP has given me peace of mind.

I am ringing for my blood results and have another scan booked for 5 November, so until then just trying to enjoy the "blooming" phase.

Thanks again!

Hi

After a few weeks of worrying and googling I thought I would share my wifes and my feelings on the 11-13 scan.

We had our 11-13 week scan with the NHS and were given an NT of 3.5mm. We were'nt happy with the scan at the time - the baby (we call it prawn) was quite inactive and difficult to get in the correct position. We felt the measurement was rushed at the end, and believe it was only taken once.

Her bloods were sent off for urgent testing and our overall result was 1:98 for downs which is relatively high, especially compared to a friends 1:26000 a week earlier. It made us feel extremely upset and unlucky. The general feeling we had was that everything was very focused on a negative outcome - we already had an appointment booked for an amnio and consultant when we received the news.

The day we got the results we asked for a second scan for NT but were declined. So we decided to get a second opinion at the FMC and managed to get an appointment the same day so we left immediately for london (this was yesterday).

After waiting 3 1/2 hrs (it was their emergency day the day the professor was in so generally popular) we had the scan. I can only say this is the best £150 we have ever spent. The staff are excellent and positive, the equipment is not from 1997 when the NHS first started NT scans. They test for so much more the NHS are not trained for, don't have the equipment for or are ignorant of (our midwife hadnt heard of the nasal bone detection let alone the rest).

Our new NT ranged from 2.6 - 3.2mm over approx 8 separate measurements (never 3.5mm and it was a week older, 6mm longer CRL). They take the worst case scenario based on this, some fresh bloods (half a vile tested immediately vs NHS 6 viles tested 2 days later) and all the extra tests we were given 1:4400. What an amazing and reassuring difference. We also had the professor himself visit us to reassure us of the difference between their tests and NHS tests and answer any questions. The sonographer was also gentle, funny and very knowledgeable. His name was also Jesus which gave me a glimmer of reassurance!!

Our main concern is how many NHS patients must be given inaccurate high risks and then go on to have a normally even higher risk of miscarriage with CVS or Amnio tests (1-2% is 1:100 - 1:50 which is much higher than the 1:250 threshold for it being offered.)

So please if you are reading this, spend £150 at the FMC (or an FMC/FMF accredited clinic) and make sure its the right thing to do. After our experience we are in no doubt that we will also have out 20wk scan there too.

Don't get me wrong I'm not knocking the NHS - they do the best they can with what they have. But it is worrying that 12 years of advancement and research has taken place since they were introduced in 1997 and the NHS seem to have ignored all of it. Surely it costs more in unnecessary amnio/cvs tests, miscarriages and consultancy than it does for new equipment and training.

Hi - just thought I'd update for those of you who have followed this thread for a while & let you know the my baby (Lucas) was born by ELCS on 21st October 2009.

He is gorgeous & absolutely fine although considerably smaller than his big brother was - this is unclear as to whether the reverse flow in the ductus venosus affected the blood flow to the placenta making it less efficient or whether my age (37) played a part in me making a smaller baby. However he has not had any heart issues picked up and the consultant has reassured me that he is likely to pick up weight and will probably end up just as big and strapping as the other men in my family! So for now we are getting on with enjoying our lovely new boy & putting the worry behind us.

Good luck with your pregnancies and new babies.xx

Massive congrats Bex - I had a rare spare moment and just popped back to see if there were any updates so I am delighted to hear your fantastic news. Yet more reassurance for anyone who is faced with the confusing result of a reverse flow in the DV.

Take comfort in the consultant's advice - my 6lb 3oz daughter was in the bottom 10% and 12 weeks later is now in the top 10% and is a real little fatty puff. Enjoy Lucas (gorgeous name) xToppy

Hi I followed and contributed to this thread a while back having had one of my twins identified with reverse flow at 12 weeks. By 16 it had corrected itself of its own accord and heart scans were clear at 23 weeks (at 23 they just did heart scans and did not specifically look at the flow). That said I still could not shake the thought that it might mean something but I wish I had as I am very happy to report that both my twins were born on 26 October in fine health and in fact the twin with reverse flow had the most robust and healthy heart beat leading up to birth. Thank you again to everyone and particularly Toppy (congratulations!) and to bexincornwall for all the comforting advice that got me through those dreadful days of needless worry. Now a whole new set of worries has begun! Good luck to all those still due I am sure all will be fine and have a great Christmas!xx

Bex-just re-read the thread. Congratulations and I love the name Lucas. I had that marked for mine which I was convinced were boys...!

Hi, just following up an earlier posting when I was in mid-panic about reverse flow: a lot of worry for what would appear to be nothing! Now 34 weeks 1 day and baby doing fine with regular heart and 4 good chambers! Good luck to anyone else who encounters this diagnosis. I think the hospital do a wonderful job even though anomalous results cause much concern.

This thread is the only thing that has been keeping me sane for the last 6 weeks! I had my 12 week scan at King's at the end of November and was given a calculated risk of 1 in 9 for Down's. I opted to have a CVS immediately. Fortunately after a 3 day wait for the results it was good news the baby didn't have any major chromosomal abnormalities. However, one of the markers was this reverse ductus venosus thing and being in such a state on the day of my scan didn't really question what this could mean. Of course once home, I started googling madly (bad idea) and then convinced myself my baby has a heart defect. I have to go back to King's in a couple of weeks for the 20 week scan which includes a detailed cardiac scan but am trying to be positive and tell myself all will be fine. The fact that so many of you on here had the same worries with a positive outcome really helps ! I will update when I've had my scan as this is the only helpful thing I've been able to find on this subject - the rest of it I either don't understand or it frightens the life out of me !! Good luck to everyone.

I can't tell you how happy I am to have found this thread!! I am in the same situation, but I live in the US, and I think there is even less information and expertise here with abnormal DV. We traveled to a large regional medical facility to have the 1st trimester screen because we wanted them to observe the nasal bone and the OB nurse at our hospital had never even heard of it, much less DV or the other Downs soft markers.

At my scan last week I was also told that the DV flow was reversed and that there was pericardial effusion (a pocket of fluid around the heart). They did not see tricuspid regurgitation - or could not get a good enough view. All else was normal, and my screen result was 1:781 for downs and 1:1301 for 13/18, which they told me are good numbers for my age (42). They used the presence of the nasal bone in the odds calculation, but not the reversed DV, since they do not have the statistical capabilities to do so and because of concerns about the accuracy of the measurement/observation of DV flow. However, instead of telling me not to worry, that abnormal DV often corrects itself, the doctor acted quite discouraged and I was strongly urged to get CVS or amnio as well as a detailed cardio scan at 16 weeks. The doctor did not seem overly concerned about the pericardial effusion, suggesting that it often rectifies itself, but that it may be a symptom related to the abnormal DV.

I would like to have CVS - less waiting, but DH is opposed because of the m/c risks and because the hospital here does not do that many of them. We could take the private route for the CVS and go to a large hospital with lots of experience, but that will cost $5000 (£3000), so we will likely do amnio in 4 weeks.

Like many on these posts, I am a bit less worried about downs or 13/18 than I am about a heart problem. So now I am in the painful 4-6 week wait. We would like to get an early heart scan/echocardiogram, but our health plan only allows for one at 20 weeks, so we are looking into private consultation. Unfortunately, these run $3000 (£1800), and we may need to fly to another city. It's no wonder people can't afford health care in this country!

It is so reassuring to hear that others in this thread have had abnormal DV at 12 weeks and have gone on to deliver healthy babies!! Despite my fanatical google efforts I had not read that abnormal DV often corrects itself, so this is a huge relief and gives me hope. Thank you to all who have posted their stories and to Toppy for starting this much needed discussion. I will keep you posted on my results.

Hi Toppy,
I had 12 week scan at fetal medical centre and was given a 1 in 2 chance of downs. Had cvs and results were clear so we were told it could indicate a heart defect. We have been to St Thomas' for 3 heart scans & finally today, we have been told that they are almost certain there is a heart defect but they can't confirm it til the baby is born. They will need to operate at some point but it might not be necesary until the baby is a few years old.
I know this sounds bad but my point is I am now 34 weeks and still don't really know for sure what is happening so my advice, although hard, is try not to get stressed about it, there is every chance it will be nothing and, if it is something, they can do amazing things. St Thomas' have been brilliant and are monitoring my baby every step of the way, even though there might be nothing wrong. Every appointment is stressful because there is always something else to worry about but 28 weeks is a long time to be thinking about something which (hopefully) could be minor and easily dealt with. I have learnt from these heart scans the amazing skills and knowledge the doctors have, even before the baby is born, & you just have to trust that they will look after your baby. Please try to enjoy your pregnancy & not feel too stressed throughout. I'm a firm believer in positive thinking and trying not to worry about things that might not happen. Our babies are tough & you are lucky they have detected a possible problem so early that they will be looking after you and checking everything.
Sorry to ramble, but I have had a lot of tears myself today when we heard the news and I feel better for typing it!! I hope everything works out for you & try not to worry in the meantime

Sorry, I've just seen the date of the original message so my reply is totally irrelevant!! put it down to a stressful day.

Well, I went to King's for my 20 week scan today which included a detailed heart scan and I am happy to report that everything looks absolutely fine. I was so nervous having the heart scan especially as they are very quiet throughout (obviously because they are concentrating)but the relief when they said everything appeared normal was fantastic. I didn't even question the diagnosis of the reverse ductus venosus thing as if it was still a problem they would have said so. Now I can think logically, I reckon that if everyone had such a detailed scan at 12 weeks, this reverse thing would be picked up much more frequently. And although it was awful having a CVS at the time, in hindsight I am glad that it took away any doubt regarding the down's or other chromosomal abnormality as it was one less thing to worry about over the past 8 weeks! Although a CVS carries a risk of 1%, they did tell me at King's that they've never lost one yet which goes to show what a fab hospital they are although I realise not everyone is able to go there. Anyway, I'm waffling now, but wanted to update the thread so that anyone else googling 'reverse ductus venosus' can read about another positive outcome especially as I had such a high risk result in the 1st place. Wishing everyone as much good fortune as me, I can now stop my morbid googling obsession and start enjoying my pregnancy!! x

Lindsay123 - what wonderful news! I am so happy for you. We had a meeting with the head perinatologist at our hospital on Friday and he said the exact same thing about "if everyone had such a detailed 12 week scan... these types of findings, often meaningless, would be picked up a lot more often". He also said that at the 20 week scan they typically do not look at DV as by that point there are much better and clearer indicators of a problem if there is one. He said reverse DV is more of a symptom than an issue in and of itself, its just that it can be measured earlier than some of the actual problems (if present). Again, thank you for sharing your story and its happy ending!

I have also had a 12 week scan this week and it indicated ductus venosus reverse flow too. The ultrasound practicioner immediately booked me for another scan with a cardiac specialist. Unfortunately it is at 20 weeks so we have a long wait, but it is in addition to the 22 week scan.
I would suggest you request the same. I have looked at the Fetal Medicine Foundation webiste, their guidance to sonographers in the case of reverse flow is that patients should be referred to have a specialist fetal cardiac scan.

Best wishes

8thfloor - hi, I just wanted to say that its probably worth looking through the whole of this thread as over the last year many of us who were worried with the same thing went through the whole process (including 20 week scans with a fetal cardiologist etc) and have now given birth to perfectly healthy babies, there are a lot of positive outcomes on here and it might be reassuring to read our stories. Good luck, I know how agonising the wait is regardless of any reassurances.

Oh and thanks for the messages of congrats Toppy & Lissy2 - the same to you, so glad it worked out in the end! Just to let you know Lucas has had brilliant weight gain so we are very happy! xx

I just wanted to add my experience. In Dec 2008 I had my 12 wk scan at UCLH, NT was 3.5, no nasal bone was detected and I was told baby had reserve flow ductus venosus. All research I did on the internet basically said baby would have DS or other abnormality, I went ahead and had CVS test. After a very long 3 wk wait I was told that results appeared normal and I was given a further scan at 15 wks and 20 wks, again I was told all appeared normal. With all 3 detectors found abnornal on my 12 wk scan I worried for my whole pregnancy. My baby was born in June 2009 and is perfectly healthy. If you are reading this after an "abnormal" scan result I hope this gives you a positive perspective on the situation and some hope. All the best x

Hi lizlemon,
I just saw your post written on 10-03-09 where you were told at the 12 week scan that your baby had no visible nasal bone although other DS markers appeared good. I am 39 years old and this is my second pregnancy (mum to beautiful patrick 1 year old). I have just had the same experience having gone for my 12 week scan last Thursday. I have been so worried ever since although my hubby says I'm overreacting as other markers were good. I rang my midwife and although I was trying to stay calm and positive she picked up on the fact that I was quite upset about it. She agreed to book me in for a re-scan in the next two weeks which I really appreciated her doing. I would love to know how your pregnancy progressed? I would also love to know did you have a beautiful baby boy or girl. All the best.

I thought I would follow up to my post 20-Jan. At my 12 week they saw reversed DV flow and pericardial effusion (fluid around the heart). I had the 20 week scan and fetal echo on Friday and all is normal!! The DV flow was normal, the tricuspid flow was normal and there was no pericardial effusion. It all went away!! I did have a scan at 16 weeks that also showed no pericardial effusion, but they were not able to get a good look at the DV or tricuspid at that time (although what they did observed looked fine). I decided not to do CVS or amnio as the 12-week scan (blood, NT and nasal bone) was negative as was the integrated screen at 18 weeks (1 in 15,000 for Down syndrome), and there were no other markers on the ultrasound. I wont know 100% until birth, but things look very promising at this point, and I can begin to forget the torturous anxiety of the last 8 weeks!

I hope my experience can serve as reassurance to others that receive an abnormal DV diagnosis on their 12 week scan. Best wishes to everyone!

I came across this thread after a visit to the FMC with my wife for her 12 week scan. As with Charlie11 back in 09 there was reverse flow in the dutucs valve and no apparent nose bone which resulted in a 1 in 17 chance of chromsome abnormality. A terrifying statistic and not great news.

After a CVS we got the results back and everything was fine and told to go about the preganancy as normal and do a further check at 20 weeks. So great news and big relief. What did we learn from the experience well 1) using the internet is a dangerous way to add anxiety espeically if you have limited medical knowledge and more importantly in this case limited understand of statistics. 2) was it a good idea to go to FMC when if we had gone to the NHS the scan would have shown normal NT, normal heart beat, normal length etc. and we would have been told risk of Downs was low 3) it appears from this thread that the reverse flow indicator is certainly one that shows on many scans but few cases of things not working out ok - however when I pressed the FMC on this point they just empahsised that we were extremely lucky and it was rare to have reverse flow and a healthy baby. I did also ask if they used the results from our experience to feed back into the algorithm they use to calculate instances.

I suppose as most of you have found out this is a confusing subject and one that is not a pleasant experience to go through. However I have to thank Toppy and the others for contributing as just hearing others in a similar place defintely does help, so thank you. Happy babymaking...

I came across this thread after a visit to the FMC with my wife for her 12 week scan. As with Charlie11 back in 09 there was reverse flow in the dutucs valve and no apparent nose bone which resulted in a 1 in 17 chance of chromosome abnormality. A terrifying statistic and not great news.

After a CVS we got the results back and everything was fine and told to go about the pregnancy as normal and do a further check at 20 weeks. So great news and big relief. What did we learn from the experience well 1) using the internet is a dangerous way to add anxiety especially if you have limited medical knowledge and more importantly in this case limited understand of statistics. 2) was it a good idea to go to FMC when if we had gone to the NHS the scan would have shown normal NT, normal heart beat, normal length etc. and we would have been told risk of Downs was low 3) it appears from this thread that the reverse flow indicator is certainly one that shows on many scans but few cases of things not working out ok - however when I pressed the FMC on this point they just emphasised that we were extremely lucky and it was rare to have reverse flow and a healthy baby. I did also ask if they used the results from our experience to feed back into the algorithm they use to calculate instances.

I suppose as most of you have found out this is a confusing subject and one that is not a pleasant experience to go through. However I have to thank Toppy and the others for contributing as just hearing others in a similar situation definitely does help, so thank you. Happy baby making.

Hi i'm Helene and this is the first time of posting here.
I am 13+5 weeks pregnant and have also been told i have a reversed A-wave in the ductus venosus.
There was always a chance of carrying a Down's baby as i am 45, but it was a chance i was willing to take to have one last baby (this will be #8)
What i don't understand are my odds i have been given 1:5!!! I can only think my age is
the reason. The nuchal measurement was 2.6mm which isn't brilliant but ok, there was a nasal bone present, the baby was spot on for dates and the heart looked great so this is an isolated positive marker.
I am not overly worried, although the very fact i searched google and found this board means i must be right??
But its been wonderful to hear such brilliant outcomes, thank you so much Toppy and to everyone who has contributed with their stories. I had never even heard the name until this morning and i feel i'm quite well informed now :-)
My next step is an anomaly scan at Heartlands in Birmingham in 6 weeks and a detailed heart scan at 24 weeks...a long time to wait.

Looking forward to hearing how everyone is when i pop back in a few days :-)

Hi Helen
I wouldnt worry so much about the reverse flow. I was also told about that on my 12 weeks scan. After researching on internet I was sure there was something wrong with my baby's heart. At 16 weeks I went for a very early heart scan and everything was fine. Another positive outcome as you can see. Best of lucks!

Hello - I just want to say how informative this thread has been and how relieved I was to find it! I too have recently had my 12 week scan at UCH only to discover I have reverse flow in the ductus venosus. This is my third child and I have been devestated. All other tests were normal. I am now going through the agonizing wait until my 16 week cardiac scan. This is a very hard wait.