Longitudinal reference ranges for umbilical vein blood flow at a free loop of the umbilical cord

Flo, Kari; Wilsgaard, Tom; Acharya, Ganesh

doi:10.1002/uog.7730

Cited by 35 publications

(74 citation statements)

References 68 publications

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“…25,44,45 Published data indicated that the largest umbilical vein diameter occurs during the third trimester, somewhere between 32 and 42 weeks GA. 50 The majority of published work over the last 17 years has modelled the relationship between the intra-abdominal or intra-amniotic umbilical vein velocity and GA as a positive linear trend, 12,[29][30][31]51 similar to that found in this research. 27,29,46 In this research, the diameter reached a peak value at 37 weeks GA and remained relatively stable until 40 weeks GA, before declining.…”

Section: Discussionsupporting

confidence: 73%

“…43,44 The ICC is considered superior to Pearson's and Spearman's analyses as it takes into account the differences between observers 42 and the variance of all measurements. 27,29,46 In this research, the diameter reached a peak value at 37 weeks GA and remained relatively stable until 40 weeks GA, before declining. 25,44,45 Published data indicated that the largest umbilical vein diameter occurs during the third trimester, somewhere between 32 and 42 weeks GA.…”

Section: Discussionsupporting

confidence: 47%

“…However, there is some variation in opinion as to whether this substantial increase continues up and past 40 weeks or whether there is a decline in the later weeks of pregnancy. 27,29,30 The decline after 40 weeks GA documented in this research for both the UCV diameter and Qucv may be the result of a small number of observations during the 40-42 week period. The reference range trend was very similar to that produced in pioneering work undertaken by Gill et al (1984).…”

Section: Discussionmentioning

confidence: 69%

“…and Sutton et al; 26 while Boito et al collected to 36 weeks, 8 Barbera et al to 38 weeks 31 and others to 40 weeks GA 21,29,30. …”

mentioning

confidence: 99%

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Reference ranges for the intra‐amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population

Spurway

Logan

Pak

et al. 2017

Australas J Ultrason Med

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Aim: To construct gestational age (GA)-related reference ranges of the intra-amniotic umbilical cord vein (UCV) diameter, peak velocity (PV) and blood flow (Qucv) using a Central West New South Wales population. Materials and Methods: This was a prospective, quasi-experimental study of low risk, singleton pregnancies (n = 321) between 16 and 42 weeks of gestation. Participation was voluntary following informed consent. The UCV diameter and PV were measured using B mode and duplex Doppler respectively, and Qucv calculated. Percentile values and reference range graphs were established using quantile regression modelling in R statistical software. Intraclass correlation coefficients (ICCs) were calculated to assess the intra and intersonographer reliability. Results: Reference ranges for the UCV diameter, PV and Qucv were established and graphed. All three UCV measurements increased with advancing GA, with both diameter and Qucv exhibiting a decline in the late third trimester. The intrasonographer and intersonographer ICCs for the UCV diameter and PV showed almost perfect agreement within and between sonographers. Conclusion: Gestational age-related reference ranges for the UCV diameter, PV and Qucv were developed using quantile regression from a cohort of low risk, singleton pregnancies in Central West NSW. These reference ranges have the potential to assist in the diagnosis and monitoring of fetal growth restriction.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 69%

“…and Sutton et al; 26 while Boito et al collected to 36 weeks, 8 Barbera et al to 38 weeks 31 and others to 40 weeks GA 21,29,30. …”

mentioning

confidence: 99%

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Reference ranges for the intra‐amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population

Spurway

Logan

Pak

et al. 2017

Australas J Ultrason Med

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“…The oxygenated nutrient‐rich blood returns to the fetus via a single umbilical vein (UV). The UV is a thin‐walled blood vessel, which has a sonographically measured average diameter of approximately 1.0–2.5 mm during 11–18 weeks and 2.5–6.7 mm in the intra‐abdominal portion and 3.5–8.0 mm in the free loop of the umbilical cord at 18–41 weeks of gestation. The mean diameter of UV measured within 5‐s after delivery in the umbilical cord is reported to be approximately 6.6 mm at term .…”

Section: Feto‐placental Circulationmentioning

confidence: 99%

Hemodynamic aspects of normal human feto‐placental (umbilical) circulation

Acharya

Sonesson

Flo

et al. 2016

Acta Obstet Gynecol Scand

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Understanding the changes in normal circulatory dynamics that occur during the course of pregnancy is essential for improving our knowledge of pathophysiological mechanisms associated with feto‐placental diseases. The umbilical circulation is the lifeline of the fetus, and it is accessible for noninvasive assessment. However, not all hemodynamic parameters can be reliably measured in utero using currently available technology. Experimental animal studies have been crucial in validating major concepts related to feto‐placental circulatory physiology, but caution is required in directly translating the findings of such studies into humans due to species differences. Furthermore, it is important to establish normal reference ranges and take into account gestational age associated changes while interpreting the results of clinical investigation. Therefore, it is necessary to critically evaluate, synthesize and summarize the knowledge available from the studies performed on human pregnancies to be able to appropriately apply them in clinical practice. This narrative review is an attempt to present contemporary concepts on hemodynamics of feto‐placental circulation based on human studies.

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The umbilical vein in the human fetus has a non‐linear growth pattern across gestation

Najafzadeh

Jacoby

Mattes

et al. 2016

Australas J Ultrasound Med

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Introduction and Objectives: Estimation of the umbilical venous blood flow volume relies on the diameter of the vein, which has been reported to be reduced in severely growth restricted fetuses. However, there is only limited information on the growth pattern of this vessel in the normal human fetus. The aim of this study is to examine the growth pattern of the umbilical vein across gestation in low-risk human pregnancies. Methods: In a prospective, longitudinal ultrasound study of 136 low-risk pregnancies, the internal diameter of the intra-amniotic portion of the umbilical vein was measured at 18, 26 and 34 weeks of gestation. To investigate the growth pattern of the venous diameter, the ratios of diameters at 26 weeks to diameters at 18 weeks (ratio 1) and the ratios at 34 to 26 weeks (ratio 2) were also calculated. A paired-sample t-test was performed to compare the means of the two ratios. Results: The mean diameter of the umbilical vein at 18 weeks was 2.8 mm (SD 0.40), 5.8 mm (SD 0.67) at 26 weeks and 7.6 mm (SD 0.98) at 34 weeks. The mean of ratio 1 was 2.06 (95% CI 2.01-2.14), which was significantly higher than ratio 2 (mean 1.33, 95% CI 1.29-1.36), P < 0.001. Conclusion: The umbilical venous diameter demonstrates a non-linear growth pattern between 18 and 34 weeks of gestation. The diameter doubled in size between 18 and 26 weeks but grew at a slower rate between 26 and 34 weeks of gestation. This study provides new data on the normal growth pattern of the umbilical vein by identifying a period of gestation where its growth is accelerated.

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Longitudinal reference ranges for umbilical vein blood flow at a free loop of the umbilical cord

Abstract: ABSTRACT

Cited by 35 publications

References 68 publications

Reference ranges for the intra‐amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population

Reference ranges for the intra‐amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population

Hemodynamic aspects of normal human feto‐placental (umbilical) circulation

The umbilical vein in the human fetus has a non‐linear growth pattern across gestation

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