VP20.01: Altered course of umbilical‐portal‐DV complex in type‐2 DV‐systemic shunts: a cause of concern

Abstract

Aim of the study was to evaluate the outcome of fetuses who showed the downward and upward displacement of umbilical-portal-DV complex in type-2 DV-systemic shunts as they have an association with Trisomy 21 and poor obstetric outcome. 1050 showing normal umbilical-portal-DV complex on the sagittal view of abdomen and seven patients with altered course of DV complex were included in the second trimester. Normal direction of DV complex (figure 1) seen in 1050 feti. Seven showed altered direction of DV complex. Four of these 7 feti showed downward displacement of DV complex with umbilical vein draining into IVC via a narrow channel (figure 2 a, b). Two of the four had Trisomy 21 and two had normal outcome. Three out of the seven feti showed upward displacement of DV complex with umbilical vein showing short constriction with aliasing before opening into the IVC and spectral Doppler showed triphasic flow as of ductus venosus (figure 3 a, b and c). One out of the three feti with upward displacement of DV had Trisomy 21 and the other had associated structural anomalies and opted for abortion and the third fetus had a normal outcome. All seven cases showed presence of Intrahepatic portal venous system (figure 4). Not only the presence DV but also the alteration in the direction of DV complex is important in type-2 DV-systemic shunts as they have an association with Trisomy 21 and poor outcome. Hence these patients need to be offered amniocentesis to establish chromosomal normalcy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.