Fetal Intra-abdominal Umbilical Vein Research Articles

Spontaneous echo contrast and decreased umbilical vein blood flow may predict thrombus formation in fetal intra-abdominal umbilical vein varix.

Fetal intra-abdominal umbilical vein varix (FIUVV) can cause thrombosis, fetal growth restriction (FGR), and intrauterine fetal death (IUFD). However, its management and evaluation to avoid fetal risks have not been elucidated. The aim of this study was to develop a novel method to evaluate fetal risks, including FGR and fetal dysfunction via frequent ultrasound examinations. A 28-year-old pregnant woman was diagnosed with FIUVV via ultrasound at 26weeks of gestation and admitted to our hospital. Ultrasound examinations were performed two to three times weekly to evaluate size and shape of the FIUVV and umbilical vein blood flow at the inflow and outflow sites of the FIUVV. The outflow site of the FIUVV was constricted and collapsed, and the blood flow velocity at the inflow site of the FIUVV was decreased. At 32weeks of gestation, spontaneous echo contrast (SEC), which indicates increased echogenicity, appeared. At 35weeks of gestation, the patient noticed decreased fetal movement, and CTG showed non-reassuring fetal status. SEC in the FIUVV was remarkable. Fetal movement could not be confirmed at ultrasound. Cesarean section was performed and a 1,854-g healthy infant was delivered with an umbilical cord arterial pH of 7.266. The echographic changes, such as decreased umbilical vein blood flow and SEC, in FIUVV observed in this case could indicate thrombus formation, which can lead to fetal dysfunction. Frequent ultrasound examinations can help determine the timing of delivery and improve the neonatal prognosis.

Isolated fetal umbilical vein varix and the association with intrauterine fetal death and fetal growth restriction: A systematic review, meta-analysis, and nested retrospective cohort study.

To assess the risk of intrauterine fetal death (IUFD) and fetal growth restriction (FGR) in fetuses with an isolated fetal intra-abdominal umbilical vein varix (i-FIUVV). A retrospective cohort study combined with a systematic review and meta-analysis of the literature was performed. In the retrospective cohort study, all singleton fetuses with an i-FIUVV in the fetal medicine units of the Amsterdam UMC (between 2007 and 2023) were analyzed. The primary outcome measures were IUFD and FGR. The sample proportions of IUFD and FGR were depicted as risk percentages. The IUFD proportion was compared to the regional reference population and the FGR proportion was compared to the reported proportions in Europe. The secondary outcome measures were gestational age at diagnosis, initial and maximal FIUVV diameter, fetal monitoring in pregnancy, turbulent flow in the varix, thrombus formation in the varix, induction of labor, gestational age at birth, and birthweight centile. The proportion of fetuses with a birthweight below the 10th centile was compared with that of the regional reference population. The systematic review included all cases from eligible literature published between 2007 and 2023 supplemented by the data of our retrospective cohort study. In the systematic review and meta-analysis, the pooled proportions of IUFD and FGR were assessed in fetuses with i-FIUVV. The retrospective cohort included 43 singletons with an i-FIUVV. The IUFD risk was 0% [Confidence Interval, CI: 0%-8.2%], which did not differ significantly from 0.3% in the reference population, p=1.0. The risk of FGR was 16.3% [CI: 6.8%-30.7%] in the studied population, which is higher than the reported incidence of FGR in Europe ranging from 5%-10%. The proportion of fetuses with birthweights below the 10th centile was higher in our cohort compared with the reference population (23.3 vs. 9.9%, p<0.01). The systematic review included 12 articles, three abstracts, and our current cohort. In total, 513 cases with an i-FIUVV were included. The pooled risk was 0.4% [CI: 0.1%-1.7%] for IUFD and 5.2% [CI: 1.1%-21.3%] for FGR. The mean gestational age at birth did not exceed 39weeks in neither the cohort (38.7weeks) nor the pooled literature (37.6weeks). An i-FIUVV in singletons is not associated with an increased IUFD risk up to 39weeks of gestation but is possibly associated with FGR. The incidence of FGR in our cohort was higher than in the pooled literature (16.3% vs. 5%) but FGR definitions in the included studies varied. The proportion of birthweights below the 10th percentile in our cohort was significantly higher than in the reference group. Thus, based on these findings, we suggest conducting sonographic growth assessments while simultaneously assessing the i-FIUVV. No further monitoring and follow-up are indicated up to 39weeks of gestation. After 39weeks of gestation, data on fetuses with i-FIUVV and their outcomes are lacking.

Isolated fetal intra-abdominal umbilical vein varix: A population-based review of obstetrical and neonatal outcomes.

To assess obstetrical and neonatal outcomes associated with isolated fetal intra-abdominal umbilical vein varix (FIUVV).

Z-Score Reference Ranges for Umbilical Vein Diameter and Blood Flow Volume in Normal Fetuses.

To establish Z-scores for the diameter and blood flow volume of the umbilical vein (UV) in normal fetuses. This was a prospective study involving 907 normal fetuses. We measured the diameter (Duv) of two different segments of the UV (FUV: the free loop of the UV; FIUV: the fetal intra-abdominal UV). Next, we calculated the blood flow volume (Quv). Z-scores were created for both Duv and Quv using gestational age, femur length, and biparietal diameter as independent variables. We successfully acquired 858 (94.6%) normal fetal measurements. Between 20 and 39 weeks, the Duv of the FUV and FIUV increased from 0.38 to 0.80 cm and from 0.33 to 0.70 cm, respectively. The Quv of the FUV and FIUV increased from 32.66 to 381.88 ml/min and from 31.50 to 360.15 ml/min, respectively. Linear or quadratic regression models were best fitted between the parameters of UV and the independent variables. Z-scores were successfully determined for both the Duv and Quv. The calculation of Z-scores for the Duv and Quv is simple by applying standard statistical methods. These Z-scores may be useful to evaluate placental circulation and provide a rationale for monitoring and evaluating the prognosis of fetuses.

VP02.24: Umbilical vein varix: does it really need stringent monitoring?

Fetal intraabdominal umbilical vein varix (FIUVV) is a focal dilatation of the intraabdominal but extrahepatic portion of the umbilical vein. Here we present two cases where FIUVV was detected in the third trimester – one at 29 weeks and the other at 37 weeks. The detailed structural analysis was normal. Monitoring was done in the form of daily kick count, fortnightly antenatal visits and four weekly ultrasounds. We did not observe any increase in the size of the varix, turbulence in the flow or thrombosis during follow up scans. One was delivered at 37 weeks due to severe FGR and other at 38 weeks due to reduced fetal movements. FIUVV mandates a detailed anatomical survey. Invasive testing is recommended only if there are associated abnormalities. There is no or minimal increased risk of complications during pregnancy. The frequency of monitoring during pregnancy is still not established. Later the diagnosis of the varix, less frequent is the monitoring and better is the outcome. Supporting information can be found in the online version of this abstract Supporting Information 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.

Fetal intra-abdominal umbilical vein varix: retrospective cohort study and systematic review and meta-analysis.

To investigate the ultrasound characteristics and outcome of pregnancies with fetal intra-abdominal umbilical vein varix (FIUVV). Cases of FIUVV managed at our tertiary university hospital over an 8-year period were reviewed. Information retrieved included gestational age and diameter of the umbilical varix at diagnosis, increase in varix diameter, associated ultrasound or chromosomal anomalies and pregnancy outcome. Furthermore, a systematic review and meta-analysis of series of FIUVV in the literature was performed to assess the incidence of chromosomal anomalies, small-for-gestational age infants and intrauterine fetal demise (IUFD), and to pool odds ratio (OR) estimates on the relationship between the incidence of these outcomes and the presence of additional associated ultrasound anomalies. Thirteen cases of FIUVV were included in the cohort study. Additional ultrasound anomalies were found in two (15.4%) of 13 cases. One case of IUFD was observed and no case of chromosomal anomaly or thrombosis of varix was recorded. A total of five studies comprising 254 cases met the inclusion criteria of the systematic review. FIUVV was associated with additional ultrasound anomalies (non-isolated FIUVV) in 19% (95% CI, 10.9-29.1%) of cases. No case of chromosomal abnormality or IUFD was reported in fetuses with isolated FIUVV. In contrast, in the group of non-isolated FIUVV, the incidence of chromosomal anomalies was 19.6% and that of IUFD was 7.3%, with ORs of 14.8 (95% CI, 2.9-73.0) and 8.2 (95% CI, 1.05-63.1), respectively, when compared with the group of isolated FIUVV. When isolated, the outcome of cases affected by FIUVV is usually favorable. In about 20% of cases, additional ultrasound anomalies are found, which are associated with an increased risk for chromosomal abnormalities and IUFD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Fetal Intra-abdominal Umbilical Vein Varix: A Case Report and Literature Review

Fetal intra-abdominal umbilical vein (FIUV) varix is a rare malformation of the umbilical cord. This is a critical situation due to discrepancies in outcomes varying from normal to high rates of complications and fetal mortalities. We report the observation of a FIUVV vein diagnosed precociously at 22 weeks with a quiet increasing of the diameter by 31 weeks. The outcome was favourable and close monitoring after birthshowed no anomalies. Despite a good prognosis it seems that a close monitoring is essential in antenatal period.

Intra-Abdominal Umbilical Vein Varix – A Case Report

AbstractThe incidence of the fetal intra-abdominal umbilical vein varix condition is very rare and has been associated with fetal hydrops, IUGR and still birth A 26-year-old primigravida was referred for routine antenatal scan. The scan at 30 weeks showed an intra-abdominal ovoid structure superior to the fetal bladder. Color flow Doppler revealed venous flow in continuity with the umbilical vein. A diagnosis of umbilical varix was made. The venous flow was present throughout the lesion, suggesting the absence of thrombi. There was no evidence of fetal hydrops. Subsequent scans at regular intervals showed no increase in size of the umbilical varix. The patient had an uneventful elective cesarean section at 39 weeks. Postnatal assessment and a follow-up neonatal cardiac echo scan were normal. Our case supports the new emerging evidence that pregnancy outcome in cases of isolated fetal umbilical vein varix is generally good. Caution must be exercised against unnecessary early induction and costly preterm births

Fetal Intra-abdominal Umbilical Vein Varix Complicated with Patent Ductus Venosus and Atrial Septal Defect

Umbilical vein varix has diverse clinical features and an unpredictable course during the pregnancy and/or perinatal period. We report a rare case of isolated fetal varix of the intra-abdominal umbilical vein, which was associated with fetal cardiomegaly. After birth, the umbilical vein varix remained with continuous blood flow through the patent ductus venosus. In addition, persistent cardiomegaly was complicated with an atrial septal defect.

P15.01: Umbilical cord anomalies: detection and expectations

Fetal ultrasonographic screening has to include assessment of the umbilical cord for possible abnormalitiesthat can be: hypercoiled cord and nuchal cord, abnormal length and thickness of the cord, anomalies of the placental insertion site, vascular abnormalities and primary tumors of the cord. These conditions may be associated with fetal anomalies, chromosomal anomalies and intrauterine growth restriction. In our study we describe and analyze the ultrasound diagnosis and management of major umbilical cord abnormalities, considering the current knowledge on physiologic and pathologic aspects of each of them. A retrospective study was conducted in Universitary Emargency Hospital Bucharest over a 3-year period. We found 18 cases of single umbilical arteries, 6 cases of velamentous cord insertion, 3 of them associated with placental adherence abnormalities, partial placenta previa and one with vasa previa, 16 cases of more than 2 loops nuchal cord, 7 cases of true knot cord with 2 ultrasound undiagnosed cases, 5 true cord cysts and 3 cases of fetal intra-abdominal umbilical vein dilatation. A pregnancy with umbilical cord anomalies is more likely to be complicated with polyhydramnios, preterm delivery under 34 weeks, low birthweight, Caesarean delivery for fetal distress, perinatal death, admission to NICU and placental abnormalities compared with a pregnancy with a normal umbilical cord. We sustain that prenatal detection of umbilical cord abnormalities will decrease the number of emergent Caesarean sections and intrauterine fetal death. Safe fetal delivery, fetal echocardiography and karyotype analysis should be offered depending on risk associated to each umbilical cord abnormality. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities, whereas 3D/4D Doppler US of the fetal umbilical cord and abdominal vasculature allows a high accurate diagnosis of vascular abnormalities.

Clinical characteristics and outcomes of antenatal fetal intra-abdominal umbilical vein varix detection.

ObjectiveThis study reviewed clinical characteristics of fetal intra-abdominal umbilical vein (FIUV) varices that were detected during antenatal ultrasound examinations.MethodsBetween January 2006 and January 2012, 121 cases of FIUV varices were detected and 7 cases were lost to follow-up. We retrospectively reviewed the medical records of 114 patients and neonates.ResultsFrom a total 96,553 ultrasound examinations in 43,995 pregnancies, 121 cases of FIUV varices were identified (2.8 per 1,000 pregnancies). Gestational age at diagnosis was 32.0 ± 2.9 weeks (range, 20.1-36.3 weeks), the mean diameter of the FIUV varix was 12.6 ± 2.1 mm (range, 8.0-21.0 mm) at initial diagnosis and the mean maximal diameter was 13.1 ± 2.3 mm (range, 8.0-21.0 mm) during follow-up. The most severe pregnancy complications included one case of intrauterine fetal death and another case of fetal hydrops. Associated fetal anomalies (n = 11, 9.6%) detected by ultrasonography included bilateral renal pelvis dilatation, ventriculomegaly, cryptorchidism, incomplete renal duplication and pulmonary sequestration. A total of 104 cases (91.2%) were delivered at term and 10 cases (8.8%) were preterm deliveries before 37 weeks of gestation.ConclusionFIUV varices that are not associated with fetal anomalies based on ultrasound examination during prenatal care have favorable pregnancy outcomes. Nevertheless, close fetal monitoring is recommended to decrease perinatal complications.

Placental mesenchymal dysplasia associated with androgenetic/biparental mosaicism

Placental mesenchymal dysplasia associated with androgenetic/biparental mosaicism

Fetal intra-abdominal umbilical vein varix: a case report

The incidence of the fetal intra-abdominal umbilical vein varix condition is very rare. Its significance in pregnancy is still unknown, but it has been associated with fetal hydrops, IUGR and still birth. However, in most isolated cases, the outcome is good. A 31-year-old primigravida was referred to the antenatal clinic at 28 weeks of gestation as her uterus was measuring small for gestational age. Her anomaly scan at 20 weeks was normal. The scan at 28 weeks showed growth below the lower 10th centile with normal liquor volume and umbilical Doppler wave velocity. However, an intra-abdominal ovoid structure measuring 28 mm × 10 mm was seen superior to the fetal bladder. Color flow Doppler revealed venous flow in continuity with the umbilical vein. A diagnosis of umbilical varix was made. The venous flow was present throughout the lesion, suggesting the absence of thrombi. There was no evidence of fetal hydrops. Subsequent scans at 32, 34 and 36 weeks showed no increase in size of the umbilical varix and progressive fetal growth, although growth remained below the lower 10th centile with normal Doppler results and liquor volume. The patient had an uneventful emergency cesarean section at 37 weeks for failed induction of labor and reduced fetal movements. Postnatal assessment and a follow-up neonatal cardiac echo scan were normal. Our case supports the new emerging evidence that pregnancy outcome in cases of isolated fetal umbilical vein varix is generally good. Caution must be exercised against unnecessary early induction and costly preterm births.

Three- and four-dimensional sonographic diagnosis of fetal intra-abdominal umbilical vein varix.

Fetal intra-abdominal umbilical vein (FIUV) varix is a rare sonographic finding of a focal dilatation of the umbilical vein. Diagnostic criteria are as follows: an FIUV varix diameter [50 % wider than the adjacent umbilical vein’s diameter, and an intra-abdominal umbilical vein diameter [9 mm [1]. We present antenatal three(3D) and fourdimensional (4D) sonographic diagnoses of FIUV varix. A 30-year-old pregnant Japanese woman, gravida 1, para 0, was referred to our ultrasound clinic at 20 weeks and 3 days of gestation due to a sonographic finding of bilateral choroid plexus cysts. A thorough two-dimensional (2D) sonographic anatomical scan confirmed the presence of bilateral choroid plexus cysts, but there were no other abnormalities. Anatomical re-evaluation at 27 weeks and 3 days revealed the disappearance of the previously noted choroid plexus cysts. However, a dilatation of the intraabdominal portion of the umbilical vein (11.5 mm) was identified between the fetal abdominal wall and inferior edge of the liver. 3D power Doppler (3D HD-flow) with the glass-body mode (Voluson E8; GE Medical Systems, Milwaukee, Wi, USA; curved array transabdominal transducer, 2–8 MHz) revealed the widening and course of the FIUV varix and spatial relationships between the FIUV varix and surrounding vessels (Fig. 1). The 3D inversion mode highlighted the presence of the dilated portion of the vessel in comparison with the adjacent normal segment (Fig. 2). Several follow-up examinations were conducted until term, and a decrease in the size of the cystic portion to a normal diameter was confirmed. A healthy female infant weighing 3,648 g was delivered vaginally at 41 weeks and 3 days of gestation, with an umbilical artery pH of 7.229, and an Apgar score of 7/9 at 1 and 5 min, respectively. No cord or other abnormalities were identified. Image reconstruction of the intra-abdominal anechoic mass positively identified the diagnostic criteria for FIUV varix in the present patient. The 3D/4D color/power Doppler modality, even though diagnostically useful, effectively supports the sonographic diagnosis. However, 2D sonography is difficult to interpret in some cases based on the characteristics of varices. In the abdominal area, this vascular anomaly can be differentiated from other cystic lesions using 2D color/power Doppler sonography [1]. 3D/ 4D color/power Doppler clarified the entire varix and affected vein’s shape and contour. The 3D inversion mode provides data on the anatomy and pathology of fetal fluidfilled structures (digital casts) not possible with standard 2D sonography [2]. This, to our knowledge, is the first report of a FIUV varix imaged using the 3D inversion mode as a sonographic adjunct to 3D/4D color/power Doppler. 3D/4D technology has allowed sonologists to more effectively visualize fetal structures employing multiplanar reconstruction, not previously achievable with conventional 2D sonography. The additional information it yields aids physicians and couples by supporting the diagnosis, allowing better visualization, and improving understanding of and counselling for fetal anomalies. It must be remembered that 3D/4D technology is a supplementary modality, whose use does not ultimately alter the diagnosis, outcome, or counseling provided. B. S. Austria U. Hanaoka M. Sato T. Hata (&) Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa 761-0793, Japan e-mail: toshi28@med.kagawa-u.ac.jp

Four cases of fetal intra-abdominal umbilical vein varix: A single centre's approach to management

Fetal intra-abdominal umbilical vein (FIUV) varix is a rare prenatal abnormality characterised by a focal intrahepatic or extrahepatic dilatation of the intra-abdominal portion of the umbilical vein. Usually, it is an isolated finding, but in some cases it can be associated to other fetal anomalies. Thrombosis is a possible complication of FIUV varix and it can lead to poor fetal or neonatal outcome. We describe four consecutive cases of FIUV varix diagnosed in our Unit and managed with low-dose aspirin (LDA) prophylaxis until the 35th week of gestation. None of the fetuses developed thrombosis of the varix and the neonatal outcomes were good in all the cases.

The prenatal diagnosis of isolated fetal varix of the intra-abdominal umbilical vein is associated with favorable neonatal outcome at term: a case series

Varix of the fetal intra-abdominal umbilical vein (VFIUV) has been reported to be associated with an increased risk of adverse perinatal outcome and especially with intra-uterine fetal demise (IUFD). Induction of preterm birth, as early as 32-34 weeks gestation has been suggested to minimize this risk. We aimed to evaluate our center experience with the antenatal diagnosis of VFIUV and review the relevant literature. This is a retrospective case series of all cases (between 2004 and 2009) where the sonographic antenatal diagnosis of VFIUV was registered at any gestational age (GA). Ultrasound, maternal and newborn electronic medical records were used. Descriptive statistics were employed as appropriated and correlation coefficient (r) calculated. We identified 24 women with fetuses, with isolated VFIUV (excluding one lost-to-follow-up). GA at diagnosis was 30.5 ± 4.4 weeks; 13 (56.5 %) cases were diagnosed <32 weeks. The mean VFIUV diameter was 13 ± 2.9 (range 9-20) mm and turbulent flow was reported in 7 cases (30.4 %). GA at birth was 37 ± 2.5 weeks. The small for gestational age rate was 4 % (1/23), while no case of IUFD occurred. The group induction of labor rate was 65.2 %, while 43 % (10/23) due to the diagnosis of VFIUV alone: 17 % (4/23) preterm and 26 % (6/23) at term. The cesarean rate was 17 % (4/23) and NICU admission was required for five neonates (21.7 %). The preterm induction of birth was related to a significantly increased risk for cesarean and neonatal morbidity (p = 0.015; p = 0.029, respectively). The mode of delivery was not associated with the GA at diagnosis, size/type of flow of VFIUV (r = 0.101; r = 0.727; r = 0.671, respectively) overall (r) = 0.4. All fetuses were live-born with normal follow-up at 2-60 months. Isolated VFIUV has a favorable perinatal outcome at term, unrelated to the structural and flow characteristics of VFIUV. We show that follow-up for growth abnormalities with no preterm induction of birth is a safe maternal and neonatal approach.

Intra-abdominal Umbilical Vein Varix Thrombus

Fetal intra-abdominal umbilical vein varix (FIUVV) is an uncommon finding with poorly understood clinical significance. Numerous fetal complications are associated with this anomaly. This case report demonstrates FIUVV in which thrombus develops leading to early induction of labor for successful delivery. The literature regarding FIUVV is reviewed and discussed with implications for sonographic follow-up during pregnancy and patient management.

Ultrasonographic Evidence of Intra-Abdominal Umbilical Vein Dilatation: Is It a True Varix?

Fetal intraabdominal umbilical vein (FIUV) dilatation, or varix, is a rare ultrasonographic (US) finding of focal dilatation of the umbilical vein. This article describes FIUV tortuosity in cases with suspected varix and provides ultrasonographic criteria for its diagnosis. Cases of suspected FIUV varix referred to our unit for final diagnosis and follow-up were studied. Each woman underwent comprehensive US evaluations that included basic grayscale scan and color Doppler scan. In 12 singleton pregnancies, primary grayscale scan confirmed FIUV dilatation. Supplementary color Doppler scans, however, revealed linear bidirectional blood flow and FIUV tortuosity in all cases. Color Doppler scans did not depict true FIUV dilatations or varix but rather a tortuous course of the vein. A normal pregnancy outcome can be expected in these cases.

Two‐ and three‐dimensional sonographic diagnosis of fetal intra‐abdominal umbilical vein varix: A case report

Fetal intra-abdominal umbilical vein varix is a rare condition characterized by focal dilatation of the umbilical vein of the fetus. We report a case of fetal intra-abdominal umbilical vein varix associated with additional sonographic abnormalities and detected at 31 weeks' gestation. Several follow-up sonographic examinations were performed, and the prenatal findings were confirmed on postnatal ultrasound. The diagnosis was facilitated by the use of three-dimensional power Doppler sonography.

Another "double bubble" sign or "double bladder" sign: fetal intra-abdominal umbilical vein varix.

Fetal intra-abdominal umbilical vein varix increases the incidence of fetal/neonatal morbidity and mortality. Its early diagnosis may be clinically important. For a case of this disorder, we have proposed the new name of "double bladder" sign; "another double bubble" sign may also illustrate this disorder.