Fetal splenic cysts are rare images, always isolated, usually unique and mainly found during third trimester of pregnancy. Their evolution is to disappear spontaneously during pregnancy or at 6 months of age leaving only half of them to remain beyond that age but without any symptoms.
Objectives: To investigate the outcome of fetuses with intra-abdominal umbilical vein varix (FIUVV). Methods: A retrospective cohort study of cases of FIUVV followed in a tertiary university hospital was carried out. A systematic review and a meta-analysis of the existing literature were also performed to assess the incidence of chromosomal anomalies, Small for Gestational Age (SGA) infants and Intra-Uterine Fetal Demise (IUFD) and to pool relative risk (RR) estimates on the relationship between the presence of associated additional ultrasound anomalies and the occurrence of these outcomes. The potential relationship between ultrasound characteristics of the varix and IUFD in fetuses with isolated FIUVV was also tested. Results: Thirteen cases of FIUVV were included in the cohort. A total of 12 studies with 336 cases was included in the systematic review comprising our cohort. FIUVV was associated with other US anomalies in 55/336 (16%) of cases. The rate of chromosomal anomalies was 7.5% (95% CI 2.2-15.7) and the overall the rate of IUFD was 6.5% (95% CI 2.3-12.7). The fetuses with additional ultrasound anomalies had an increased risk of chromosomal anomalies (RR 9.50; 95% CI 3.5-25.3, p<0.0001) and IUFD (RR 3.07; 95% CI 1.2-7.7) compared with those with an isolated FIUVV. In fetuses with isolated FIUVV, the incidence of IUFD was 2.8% (95% CI 1.2-5.5). There was no factor predictive of IUFD, comparing gestational age at diagnosis (23.1 ±3.5weeks vs. 26.8 ± 5.7 weeks, p=0.09), varix size at diagnosis (10.5 ± 2.3 mm vs. 10.9 ±4.0 mm, p=0.79), appearance before 22 weeks (12.5% vs. 9.1% p=0.77) and thrombosis of the varix (12.5% vs. 0% p=0.4) in cases with and without fetal demise respectively. Conclusions: The presence of associated ultrasound anomalies is an important prognostic factor for chromosomal anomalies and IUFD in fetuses with FIUVV. Isolated FIUVV also require close antenatal surveillance for an increased risk of IUFD with no known predisposing factor.
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