Comparison of Doppler Indices in Patients With Umbilical Vein Varix (UVV) to Standard Doppler Indices [08O

Abstract

INTRODUCTION: There is little consensus on antenatal management of umbilical vein varices (UVV). Our study reviewed biophysical profile (BPP) scores, Doppler indices, and maternal/neonatal demographics. METHODS: Following approval by our Institutional Review Board, we retrospectively reviewed singleton pregnancies with UVV from 1/1/2012 to 6/1/2019. Of those with Doppler studies, we compared middle cerebral artery (MCA), umbilical artery (UA), and ductus venosus (DV) values to the 50th percentile of standard indices. We reviewed BPP scores, fetal abnormalities, mode of delivery, maternal comorbidities, neonatal intensive care unit (NICU) admission, and APGARs. Basic descriptive statistics were conducted. RESULTS: Overall, 84 women were identified with UVV at an average gestational age of 32 weeks. Notably, 40.5% had used tobacco. Of the fetuses, 13.1% had intrauterine growth restriction, 6% tricuspid regurgitation, 31% anatomic abnormalities. No abnormal BPPs and fetal demises were identified. Sixty-two percent had an abnormal doppler value, with the MCA Doppler differing most from standard indices. Average gestational age at time of delivery was 37 weeks and the cesarean section rate was 26% with a minority due to non-reassuring fetal status (27%). There were three indicated preterm deliveries secondary to umbilical vein thrombus. For the neonates, 31% were admitted to the NICU. Only one had a 5-minute APGAR score <5. CONCLUSION: Doppler abnormalities are common in pregnancies affected by UVV with MCA being the most commonly abnormal. None had abnormal BPPs and few required interventions such as indicated cesarean section due to fetal status. This raises the question: is antenatal testing and Doppler testing of any utility?