Varied Presentations of Absent Ductus Venosus, Their Associations, and Outcomes

Abstract

AbstractThe present study aimed at identification of fetuses with absent ductus venosus at prenatal screening ultrasound, determination of the type of umbilical venous drainage, and follow-up to assess their outcomes. This prospective study was conducted at CIMAR Hospital, Kerala, in antenatal women with singleton pregnancy, who underwent screening at 11 to 13 + 6 weeks, from November 2013 to January 2015. Ultrasonography was done according to Fetal Medicine Foundation (FMF) protocol. Absence of ductus venosus was diagnosed, when ductus venosus was not visualized connecting the portal sinus to the subphrenic confluence. The type of umbilical venous drainage was determined. Karyotyping was offered in all diagnosed cases and follow-up was obtained. Absent ductus venosus was diagnosed in three out of the 3691 women screened. Two of these had intrahepatic and the third had extrahepatic type of umbilical venous drainage. Karyotype was normal in all the three. The first patient with intrahepatic type of drainage developed polyhydramnios and ended up in intrauterine fetal demise at 26 weeks of gestation. In the second patient, malaligned ventricular septal defect and intestinal obstruction was detected in the anomaly scan. She underwent termination of pregnancy. The fetus with extrahepatic type of umbilical venous drainage developed cardiomegaly on follow-up. This baby underwent ligation of patent ductus arteriosus at third month of life. Our study suggests that absence of ductus venosus is associated with variable fetal outcome. Careful search of co-existing anomalies and follow-up is warranted in these cases.