Late-term fetuses with reduced umbilical vein blood flow volume: An under-recognized population at increased risk of growth restriction

Stampalija, Tamara; Monasta, Lorenzo; Barbieri, Moira; Chiodo, Antonella; Quadrifoglio, Mariachiara; Fantasia, Ilaria; Bello, Leila Lo; Barresi, Valentina; Ottaviani, Chiara; Martino, D. Di; Marangon, Eleonora; Bernardon, Maria; Ferrazzi, Enrico

doi:10.1016/j.ejogrb.2022.03.032

Cited by 5 publications

(11 citation statements)

References 32 publications

(52 reference statements)

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“…< 0.05] 52. Taken together, these results would suggest a potential role of umbilical vein blood flow assessment in stunted fetal growth.…”

mentioning

confidence: 67%

“…In a cohort of 29 healthy non-diabetic pregnant women who gave birth to neonates with birth weight above 90th centile, Ebbing and colleagues 48 found that umbilical vein blood flow was higher and, not only, both the ductus venosus systolic blood velocity and the left portal vein blood velocity were found to be significantly higher during the second half of pregnancy. Recently, based on these premises, Rizzo et al 47 52 A possible explanation might be that, due to lower umbilical vein blood flow, there is a lower nutrient and oxygen delivery that may lead to decreased fetal energy reserves, and as such to require complementary feeding in the immediate postnatal life. 56 It is still not known what kind of implication the exposition to varying degrees of oxygen and nutrient deprivation may have on the fetus and its growth velocity, but the latter has been shown to be associated with adverse perinatal outcome even in the absence of Doppler abnormalities.…”

Section: Fetal Macrosomiamentioning

confidence: 99%

“…Lower umbilical vein blood flow values have been found also in normally grown fetuses that underwent intrapartum distress 50–52 with a higher rate of emergency caesarean section or instrumental delivery, thus, suggesting a potential role for umbilical vein blood flow in prediction of distress in labor 53 . According to Parra‐Saavedra et al, 54 fetuses with an umbilical vein blood flow volume below 68 ml/min/kg had twice the risk of non‐reassuring fetal status in induced labor.…”

Section: Introductionmentioning

confidence: 99%

“…Umbilical vein blood flow was found to be significantly lower in late‐term appropriate for gestational age fetuses that had a drop in abdominal circumference compared to those that did not reduce their growth velocity [184 ml/min (IQR 143–225) and 55 ml/min/kg (IQR 42–66) versus 234 ml/min (IQR 184–278) and 64 ml/min/kg (IQR 50–75); p < 0.05] 52 . Taken together, these results would suggest a potential role of umbilical vein blood flow assessment in stunted fetal growth.…”

Section: Introductionmentioning

confidence: 99%

“…Taken together, these results would suggest a potential role of umbilical vein blood flow assessment in stunted fetal growth. Interestingly, umbilical vein blood flow was lower in fetuses that required formula milk supplementation at birth compared to those that did not require any supplementation [203 ml/min (IQR 154–240) and 56 ml/min/kg (IQR 44–66) versus 230 ml/min (IQR 178–277) and 62 ml/min/kg (IQR 47–74); p < 0.05] 52 . A possible explanation might be that, due to lower umbilical vein blood flow, there is a lower nutrient and oxygen delivery that may lead to decreased fetal energy reserves, and as such to require complementary feeding in the immediate post‐natal life 56 .…”

Section: Introductionmentioning

confidence: 99%

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Umbilical vein blood flow: State‐of‐the‐art

Barbieri

Martino

Ferrazzi

et al. 2023

J of Clinical Ultrasound

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Placental blood supply to the fetus can be measured by evaluating the umbilical vein blood flow. Despite its potential application in healthcare, the umbilical vein blood flow volume is still used only in research setting. One of the reasons is a concern regarding its reproducibility, partly due to technology issues. Nowadays, technology improvements make this evaluation accurate and reproducible. The aim of this review is to refresh basic elements of the physiology of umbilical vein blood flow and its analysis. Its evaluation in normal and abnormal fetal growth is also discussed.

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“…< 0.05] 52. Taken together, these results would suggest a potential role of umbilical vein blood flow assessment in stunted fetal growth.…”

mentioning

confidence: 67%

Section: Fetal Macrosomiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Umbilical vein blood flow: State‐of‐the‐art

Barbieri

Martino

Ferrazzi

et al. 2023

J of Clinical Ultrasound

Self Cite

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Association of umbilical vein flow with abnormal fetal growth and adverse perinatal outcome in low‐risk population: multicenter prospective study

Ramirez Zegarra,

Carbone,

Angeli

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesTo investigate the relationship between the umbilical vein flow (UVF) measured close to term, and abnormal fetal growth and adverse perinatal outcome in a cohort of low‐risk pregnancies.MethodsThis was a prospective multicentre observational study conducted across two tertiary maternity units. Patients with a singleton appropriate for gestational age fetus between 35‐38 weeks of gestation were included. Pregnancy at higher risk of placental insufficiency or with fetal anomalies were excluded. At ultrasound examination, the abdominal circumference (AC), umbilical vein diameter and peak velocity of the umbilical vein were measured, and from these variables, the UVF/AC were calculated. The primary outcome was the occurrence of stunted fetal growth, defined as a drop of over 40 percentiles of the AC between 3rd trimester ultrasound and delivery. The secondary outcome was the occurrence of adverse perinatal outcome, defined as one of the following: neonatal acidosis (umbilical artery pH<7.15 and/or base excess>12) at birth and/or 5‐min Apgar score<7 and/or neonatal resuscitation and/or neonatal intensive care unit (NICU) admission.ResultsBetween April 2021 and March 2023, 365 women were included. The mean UVF/AC was 6.4 ± 2.6 ml/min/cm, and 31 (9.5%) cases were affected by stunted fetal growth. Stunted fetal growth was associated with a lower mean UVF/AC (5.4 ± 2.6 vs 6.5 ± 2.6 ml/min/cm; p=0.02) and a higher frequency of an UVF/AC < 10th percentile (8/35 or 22.9% vs 28/335 or 8.5%, p=0.01). Moreover, the UVF/AC showed an AUC of 0.65 (95% CI 0.55 – 0.75; p=0.004) in predicting the occurrence of stunted fetal growth and the optimal cut‐off value of the UVF/AC discriminating between normal and stunted fetal growth was 7.2 ml/min/cm. This value was associated with a sensitivity and a specificity of 0.77 (95% CI 0.60 – 0.90) and 0.33 (95% CI 0.28 – 0.39); a positive and negative predictive value of 0.11 (95% CI 0.07 – 0.15) and 0.93 (95% CI 0.87 – 0.97); respectively.Regarding the occurrence of adverse perinatal outcomes, this was independently associated with maternal age (aOR 0.93, 95% CI 0.87 – 0.99; p=0.04), UVF/AC Z‐score (aOR 0.53, 95% CI 0.3 – 0.87; p=0.01), and augmentation of labor (aOR 2.69, 95% CI 1.28 – 5.69; p=0.009). The UVF/AC showed an AUC of 0.65 (95% CI 0.56 – 0.73, p=0.005) and the optimal cut‐off value of the UVF/AC discriminating between normal and adverse perinatal outcome was 6.7 ml/min/cm. This value was associated with a sensitivity and a specificity of 0.70 (95% CI 0.54 – 0.83) and 0.40 (95% CI 0.34 – 0.45); a positive and negative predictive value of 0.14 (95% CI 0.09 – 0.19) and 0.91 (95% CI 0.85 – 0.95); respectively.ConclusionsOur data demonstrates an association between reduced UVF close to term, and stunted fetal growth and adverse perinatal outcomes in a cohort of low‐risk pregnant women, with a moderate ability to rule out, and a poor ability to rule in either outcome. Further studies are needed to establish whether the assessment of UVF can improve the identification of fetuses at risk of subclinical placental insufficiency and adverse perinatal outcome.This article is protected by copyright. All rights reserved.

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