2092070 Ultrasound Diagnosis of Persistent Right Umbilical Vein: The Struggle to Determine Significance Remains

Abstract

Retrospective study of incidence and outcomes of prenatally diagnosed persistent right umbilical vein (PRUV). Between 1/2009 and 9/2014, a detailed sonographic examination was performed on 14,360 patients with mixed risk for fetal anomalies at a single University Medical Center. Persistent right umbilical veins were recorded. All patients with persistent right umbilical vein were offered fetal echo. If an additional anomaly was seen, genetic counseling was offered. All neonates were evaluated by a pediatrician post delivery. Persistent right umbilical vein was detected in 24/14,360 patients. Twenty five percent (6/24) had additional significant malformations. Eighty-three percent (5/6) were detected antenatally, and 67% (4/6) were cardiac anomalies. Eleven percent (2/18) of patients with isolated persistent right umbilical vein had fetal growth restriction (estimated fetal weight less than the tenth percentile for gestational age) on follow-up ultrasound. No other adverse perinatal outcomes found. The overall incidence of persitent right umbilical vein was 1/598. However, outcomes were generally favorable. Nonethless, fetal echocardiogram is suggested for all cases of PRUV due to increased risk of cardiac malformations, and fetal growth assessment is suggested in the third trimester due to increased risk of fetal growth restriction.Tabled 1Ultrasound Diagnosis of persistent right umbilical veinMean maternal age24.0 +/- 5.9 yearsMean gestational age at diagnosis25 5/7 +/- 6/7 weeksMale/female7:4Mean gestational age at delivery39 0/7 +/- 1 3/7 weeksMean birth weight3260 +/- 602 gramsMode of delivery33% Cesearean delivery67% vaginal deliveryAdditional anomalies1 Dandy Walker with persistent vena cava1 Tetralogy of Fallot1 hydronephrosis1 dextrocardia and lung hypoplasia1 large atrial septal defect (diagnosed postnatally)Genetic findings3/24 had genetic consultation0/24 opted for invasive diagnosisFetal echocardiogram21/24 opted for fetal echo5/24 had an abnormal fetal echoFetal Growth Restriction (EFW< 10%)20/24 had follow up growth ultrasounds(54% at 28 weeks and 77% at 32 weeks)2/18 isolated PRUV had fetal growthrestriction1/6 PRUV with associated significantanomaly had fetal growth restrictionIntrauterine fetal demise0Preterm delivery < 34 weeks0Low birth weight (<2,500 grams)2/6 with associated anomalies0/18 isolated PRUV Open table in a new tab