Isolated Fetal Intra-Abdominal Umbilical Vein Varix

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.

Another “double bubble” sign or “double bladder” sign: fetal intra-abdominal umbilical vein varix

“…The present case showed a nonreassuring fetal heart rate pattern at 32 weeks, which led to preterm delivery. Although it cannot be confirmed whether hospitalization may have worked well in early detection of this sign and thus protected against fetal demise in this case, close vigilance for fetal well-being is necessary in this condition: this view agrees with other researchers' opinions [1,2]. Detection of FIUV varix may at least lead to detection of coexisting fetal malformations.…”

“…Data indicate that FIUV varix occurs in approximately 0.03% [1] to 0.04% [2] of fetuses, and is sometimes associated with fetal jeopardy: in an extreme case, intrauterine fetal death may occur [1]. Although the reason for fetal jeopardy is unclear, coexisting fetal malformations, especially cardiac malformations, or thrombus formation within a varix, have been considered the culprit [1].…”

“…A recent study [2] indicated that fetuses with FIUV varix without coexisting malformations had good outcome, and that inducing preterm delivery may not be recommended solely based on the presence of FIUV varix. However, increased fetal vigilance is recommended [2]. The present case showed a nonreassuring fetal heart rate pattern at 32 weeks, which led to preterm delivery.…”

Intra-Abdominal Umbilical Vein Varix Associated with Fetal Cardiac Failure: A Pitfall to the Prenatal Diagnosis of Alpha-Zero-Thalassemia

“…Intrauterine growth retardation may be associated with UV varix [9]. However, these associations may be related to a bias as only worsened cases are reported [6]. Therefore, these cases may justify fetal karyotype assessment and second-line detailed fetal ultrasound examination [8].…”

“…Doppler-color-map and spectral analysis enable identification of this dilatation as a part of the UV. Diagnosis criteria encompass a >50% enlargement of the intrahepatical UV diameter, and verification of its continuation with the UV [6,7,8]. Aneurysm of the UV has been reported in isolated cases in association with fetal abnormalities, such as cardiac malformations, abnormal systemic venous connections to the fetal heart and aneuploidies.…”