1
|
Koorn I, Heinrich H, Nelissen A, Denswil N, Linskens IH, Jansen CHJR, Wortelboer EW, Pajkrt E. 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. Prenat Diagn 2024; 44:595-613. [PMID: 38502055 DOI: 10.1002/pd.6538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/14/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES 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). METHODS 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. RESULTS 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 39 weeks in neither the cohort (38.7 weeks) nor the pooled literature (37.6 weeks). CONCLUSION An i-FIUVV in singletons is not associated with an increased IUFD risk up to 39 weeks 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 39 weeks of gestation. After 39 weeks of gestation, data on fetuses with i-FIUVV and their outcomes are lacking.
Collapse
Affiliation(s)
- Ian Koorn
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hanna Heinrich
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anne Nelissen
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Nerissa Denswil
- Department of Research Support - Medical Library, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingeborg H Linskens
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Charlotte H J R Jansen
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Esther W Wortelboer
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Ghalandarpoor Attar SN, Ghalandarpoor Attar SM. Partial molar pregnancy with a normal live fetus and umbilical cord abnormalities: A novel association with long-term follow-up: A case report. Clin Case Rep 2021; 9:e04839. [PMID: 34552746 PMCID: PMC8443415 DOI: 10.1002/ccr3.4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/22/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects.
Collapse
|
3
|
Abstract
Importance Fetal umbilical vein aneurysm is an uncommon anomaly that accounts for approximately 4% of umbilical cord abnormalities. The rate of intrauterine fetal death is reported to be approximately 4% to 5%, higher than the background rate of 0.7% that is generally reported during pregnancy. Objective The aim of this study was to review the pathophysiology, diagnosis, and clinical management of fetal umbilical vein aneurysm. Evidence Acquisition Advances in high-resolution ultrasound combined with color Doppler and 3-dimensional rendering have contributed to an increased understanding of the fetal venous circulation in recent years. Results When the diagnosis of umbilical vein aneurysm is made, the patient should undergo a detailed ultrasound evaluation of the fetal anatomy, including fetal echocardiography, to exclude associated anomalies. Amniocentesis should be offered when other anomalies are found. Patients should be informed about the potential for an unfavorable outcome of pregnancy and should undergo close ultrasound surveillance to assess the size of the aneurysm, as well as any evidence of thrombosis or signs of hydrops. Conclusions The main prognostic feature associated with a poor outcome of umbilical vein aneurysm seems to be the presence of other anomalies. Early diagnosis is associated with a somewhat worse prognosis, and most fetal deaths have been observed between 27 and 30 weeks of gestation. In the third trimester, it is reasonable to perform serial ultrasound examinations to assess fetal growth, the size of the aneurysm, and the blood flow pattern within the aneurysm.
Collapse
|
4
|
Ozek MA, Calis P, Bayram M, Karcaaltincaba D. Fetal intraabdominal umbilical vein varix: antenatal diagnosis and management. J Matern Fetal Neonatal Med 2017; 31:245-250. [DOI: 10.1080/14767058.2016.1278208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Murat Aykut Ozek
- Department of Obstetrics and Gynaecology, Gazi University School of Medicine, Ankara, Turkey
| | - Pinar Calis
- Department of Obstetrics and Gynaecology, Gazi University School of Medicine, Ankara, Turkey
| | - Merih Bayram
- Department of Obstetrics and Gynaecology, Gazi University School of Medicine, Ankara, Turkey
| | - Deniz Karcaaltincaba
- Department of Obstetrics and Gynaecology, Gazi University School of Medicine, Ankara, Turkey
| |
Collapse
|
5
|
Beraud E, Rozel C, Milon J, Darnault P. Umbilical vein varix: Importance of ante- and post-natal monitoring by ultrasound. Diagn Interv Imaging 2015; 96:21-6. [DOI: 10.1016/j.diii.2014.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Melcer Y, Wiener Y, Ben-Ami I, Levinsohn-Tavor O, Feldman N, Maymon R. The Triple Test Markers Profile Among Fetuses and Children Diagnosed With Umbilical Vein Varix. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314543559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Umbilical vein varix (UVV) is defined as a focal enlargement of the umbilical vein and represents approximately 4% of fetal umbilical cord malformations. The reported neonatal outcome of fetuses with UVV varies widely due to its rarity, hence the small sample sizes of the case series in the literature. Earlier studies reported high fetal mortality, but more recent reports have demonstrated no association between UVV and intrauterine fetal death. A recent study has described a possible association between UVV diagnosed prenatally and child developmental delay. The present study of fetuses with UVV was done to evaluate and compare the levels of triple test serum biomarkers used for Down syndrome screening (human chorionic gonadotropin, α-fetoprotein, and unconjugated estriol) between a group of fetuses with uneventful obstetric outcome versus a subgroup of children with developmental delay.
Collapse
Affiliation(s)
- Yaakov Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yifat Wiener
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orna Levinsohn-Tavor
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa Feldman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Deront-Bourdin F, Blanquiot JL, Checchi C, Nataf S, Bongain A. Thrombose d’un anévrysme de la veine ombilicale. ACTA ACUST UNITED AC 2014; 42:448-50. [DOI: 10.1016/j.gyobfe.2014.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/08/2014] [Indexed: 11/26/2022]
|
8
|
Brookfield KF, Osmundson SS, Chetty S, Chueh J, Blumenfeld YJ, Barth RA, El-Sayed YY. Isolated umbilical vein varix with a poor outcome despite close fetal surveillance. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1680-1682. [PMID: 23980233 DOI: 10.7863/ultra.32.9.1680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
9
|
Melcer Y, Ben-Ami I, Wiener Y, Livne A, Herman A, Maymon R. Long-term outcomes of children with umbilical vein varix diagnosed prenatally. Prenat Diagn 2013; 33:492-6. [DOI: 10.1002/pd.4098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Y. Melcer
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - I. Ben-Ami
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Y. Wiener
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - A. Livne
- Center for Pediatric Neurology, Child Development and Pediatric Neurological Rehabilitation; Assaf Harofeh Medical Center; Zerifin Tel-Aviv Israel
| | - A. Herman
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - R. Maymon
- Department of Obstetrics and Gynecology; Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| |
Collapse
|
10
|
Bas-Lando M, Rabinowitz R, Samueloff A, Latinsky B, Schimmel MS, Chen O, Grisaru-Granovsky S. The prenatal diagnosis of isolated fetal varix of the intra-abdominal umbilical vein is associated with favorable neonatal outcome at term: a case series. Arch Gynecol Obstet 2013; 288:33-9. [PMID: 23389248 DOI: 10.1007/s00404-013-2743-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Maayan Bas-Lando
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, The Hebrew University, 12 Bezek Road, 91031 Jerusalem, Israel.
| | | | | | | | | | | | | |
Collapse
|
11
|
Mankuta D, Nadjari M, Pomp G. Isolated fetal intra-abdominal umbilical vein varix: clinical importance and recommendations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:273-276. [PMID: 21266567 DOI: 10.7863/jum.2011.30.2.273] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This series describes a single center's experience in follow-up and management of fetuses with an isolated fetal intra-abdominal umbilical vein varix. All cases with a fetal intra-abdominal umbilical vein varix that were diagnosed or referred to our medical center over 15 years were followed and managed. The definition of a fetal intra-abdominal umbilical vein varix used was a segment dilated to 9 mm or greater or at least 50% wider than the diameter of the adjacent umbilical vein. Over the 15-year period, our center had approximately 65,000 births with 28 cases of isolated fetal intra-abdominal umbilical vein varices: a prevalence rate of 1 case per 2300 births. Three of the 28 cases (10.7%) had intrauterine growth restriction. Five of 30 fetuses (17%) showed turbulent flow in the varix. We had no cases of intrauterine fetal death, and 27 of the 28 neonates had good outcomes. In contrary to earlier reports, we found that when a fetal intra-abdominal umbilical vein varix is isolated, a good fetal outcome is expected. On the basis of our experience, we have changed our policy and do not recommend inducing preterm labor. Nevertheless, close fetal surveillance until delivery is warranted.
Collapse
Affiliation(s)
- David Mankuta
- Department of Obstetrics and Gynecology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel.
| | | | | |
Collapse
|
12
|
Sen J, Rohilla S, Mittal A, Singhal S, Dhaulakhandi DB. Favorable obstetric outcome in a fetus diagnosed with umbilical vein varix at 22 weeks' gestation. Taiwan J Obstet Gynecol 2010; 48:428-30. [PMID: 20045771 DOI: 10.1016/s1028-4559(09)60339-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
13
|
Weissmann-Brenner A, Simchen MJ, Moran O, Kassif E, Achiron R, Zalel Y. Isolated fetal umbilical vein varix-prenatal sonographic diagnosis and suggested management. Prenat Diagn 2009; 29:229-33. [DOI: 10.1002/pd.2219] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|