Objective: To examine the umbilical arterial Doppler flow patterns in late third-trimester fetuses with trisomy 21. Methods: This is a retrospective study on fetuses with trisomy 21 that were evaluated after 33 weeks' gestation at the Department of Obstetrics and Gynaecology of the University of Tuebingen, Germany. The umbilical and the middle cerebral artery (UA and ACM) pulsatility index (PI) measurements and the abdominal circumference were transformed into z-values. Results: Forty-two fetuses met the study criteria. The mean gestational age at the time of the first and the second visit was 35.0 and 36.6 weeks, respectively. The mean UA PI was 1.31 and 1.38, which corresponds to z-values of 2.20 and 2.70. In 24 (57.1%) cases, both PI measurements were above the 95th centile. A linear regression analysis demonstrated that the mean of both UA PI was not dependent on the abdominal circumference or on any other examined maternal and pregnancy characteristics. The mean ACM PI at the first and the second visit was 1.62 and 1.48, respectively, corresponding to mean z-values of -0.59 and -0.75, and in none of the cases was it below the 5th centile. Conclusion: In half of the third-trimester fetuses with trisomy 21, the resistance in the UA is increased - even in the absence of placental insufficiency.

Gil MM, Quezada MS, Revello R, Akolekar R, Nicolaides KH: Analysis of cell-free DNA in maternal blood in screening for fetal aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 2015;45:249-266.
Gil MM, Akolekar R, Quezada MS, Bregant B, Nicolaides KH: Analysis of cell-free DNA in maternal blood in screening for aneuploidies: meta-analysis. Fetal Diagn Ther 2014;35:156-173.
Gratacós E, Nicolaides K: Clinical perspective of cell-free DNA testing for fetal aneuploidies. Fetal Diagn Ther 2014;35:151-155.
Janvier A, Couture E, Deschenes M, Nadeau S, Barrington K, Lantos J: Health care professionals' attitudes about pregnancy termination for different fetal anomalies. Paediatr Child Health 2012;17:e86-e88.
Siljee JE, Knegt AC, Knapen MFCM, Bekker MN, Visser GHA, Schielen PCJI: Positive predictive values for detection of trisomies 21, 18 and 13 and termination of pregnancy rates after referral for advanced maternal age, first trimester combined test or ultrasound abnormalities in a national screening programme (2007-2009). Prenat Diagn 2014;34:259-264.
Verweij EJJ, Oepkes D, de Boer MA: Changing attitudes towards termination of pregnancy for trisomy 21 with non-invasive prenatal trisomy testing: a population-based study in Dutch pregnant women. Prenat Diagn 2013;33:397-399.
Stoll C, Alembik Y, Dott B, Roth MP: Study of Down syndrome in 238,942 consecutive births. Ann Genet 1998;41:44-51.
Weijerman ME, van Furth AM, Vonk Noordegraaf A, van Wouwe JP, Broers CJM, Gemke RJBJ: Prevalence, neonatal characteristics, and first-year mortality of Down syndrome: a national study. J Pediatr 2008;152:15-19.
Flöck A, Remig I, Müller A, Nadal J, Berg C, Gembruch U, et al: Conflicting umbilical artery Doppler findings in fetuses with trisomy 21. Arch Gynecol Obstet 2015:1-5.
Magann EF, Doherty DA, Chauhan SP, Busch FWJ, Mecacci F, Morrison JC: How well do the amniotic fluid index and single deepest pocket indices (below the 3rd and 5th and above the 95th and 97th percentiles) predict oligohydramnios and hydramnios? Am J Obstet Gynecol 2004;190:164-169.
Acharya G, Wilsgaard T, Berntsen GKR, Maltau JM, Kiserud T: Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 2005;192:937-944.
Baschat AA, Gembruch U: The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003;21:124-127.
Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK: Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 1984;150:535-540.
Wong G, Levine D: Fetuses with trisomy 21 having conflicting findings on antenatal testing for fetal well-being. J Ultrasound Med 2005;24:1541-1545.
Rochelson B, Kaplan C, Guzman E, Arato M, Hansen K, Trunca C: A quantitative analysis of placental vasculature in the third-trimester fetus with autosomal trisomy. Obstet Gynecol 1990;75:59-63.
Qureshi F, Jacques SM, Johnson MP, Hume RF, Kramer RL, Yaron Y, et al: Trisomy 21 placentas: histopathological and immunohistochemical findings using proliferating cell nuclear antigen. Fetal Diagn Ther 1997;12:210-215.
Kuhlmann RS, Werner AL, Abramowicz J, Warsof SL, Arrington J, Levy DL: Placental histology in fetuses between 18 and 23 weeks' gestation with abnormal karyotype. Am J Obstet Gynecol 1990;163:1264-1270.
Brown R, Di Luzio L, Gomes C, Nicolaides KH: The umbilical artery pulsatility index in the first trimester: is there an association with increased nuchal translucency or chromosomal abnormality? Ultrasound Obstet Gynecol 1998;12:244-247.
Zoppi MA, Ibba RM, Putzolu M, Floris M, Monni G: First trimester umbilical artery pulsatility index in fetuses presenting enlarged nuchal translucency. Prenat Diagn 2000;20:701-704.
Rizzo G, Pietropolli A, Capponi A, Arduini D, Romanini C: Chromosomal abnormalities in fetuses with absent end-diastolic velocity in umbilical artery: analysis of risk factors for an abnormal karyotype. Am J Obstet Gynecol 1994;171:827-831.
Savchev S, Figueras F, Gratacós E: Survey on the current trends in managing intrauterine growth restriction. Fetal Diagn Ther 2014;36:129-135.
Figueras F, Gratacós E: Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014;36:86-98.
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