Prenatal diagnosis of fetal intra‐abdominal umbilical vein varix: Report of 2 cases

Abstract

Fetal intra-abdominal umbilical vein varix (FIUVV) is a focal aneurysmal dilatation of the umbilical vein. Its clinical importance has not yet been clearly established, but it has been reported to be associated with increased fetal death rate (in nearly 44% of cases) and chromosomal abnormalities (in 12% of cases). We report 2 cases of FIUVV diagnosed via sonography in the third trimester. 1,2 With the development of sonography and Doppler sonography, diagnosis has become easier than in the past.The clinical importance of FIUVV has not yet been clearly established, but it has been reported to be associated with increased fetal death rate (in nearly 44% of cases) and chromosomal abnormalities (in 12% of cases).1-3 We report 2 cases of FIUVV diagnosed via sonography in the third trimester. CASE REPORTS Case 1A 31-year-old healthy woman, gravida 2, para 1, was referred to our radiology department for sonographic examination. Her first pregnancy was normal. A second-trimester sonographic examination at another institution was unremarkable. The examination was performed with a Voluson 730 Expert (GE Medical Systems, Milwaukee, WI) equipped with a 2-5-MHz curved-array probe. A normal intrauterine fetus of nearly 29 weeks' gestational age was present according to the patient's last menstrual period and sonographic measurements. The biparietal diameter was 69 mm, the femur length was 55 mm, and the abdominal circumference was 248 mm. The estimated fetal weight was 1,300 g with normal amniotic fluid index, umbilical artery, and uterine artery pulsatility index. However, intra-abdominal umbilical vein varix with transverse diameter of 11 mm over an 18-mm segment was diagnosed near the anterior abdominal wall ( Figure 1A). Color Doppler analysis also showed turbulent flow in the varicose segment ( Figure 1B). Otherwise, the fetus was structurally normal. The patient declined chromosomal investigation. Weekly sonographic monitoring was recommended, but the patient did not return for follow-up examinations. She delivered a healthy girl weighing 2,600 g via cesarean section peformed at 35 gestational weeks at another institution. Case 2A 29-year-old woman, gravida 1, para 0, was referred for sonographic examination at approximately 36 weeks' gestation according to her last menstrual period and sonographic measurements. The patient had a second-trimester examination at another institution that was reportedly

Fetal Intra-abdominal Umbilical Vein Varix: A Case Report and Literature Review

“…Current evidence supports the hypothesis that it is a developmental rather than a congenital malformation [8]. The most likely etiology and the only pathologic finding in most cases is thinning of the vessel wall near the anterior abdominal wall due to intrinsic weakness of the umbilical vein wall [2].…”

“…The incidence is low, ranging from 0.4 to 1.1/1000 [1]. It accounts for about 4% of the malformations of the umbilical cord in the fetus [2]. Must be distinguished two forms: the isolated FIUVV and that associated with other malformations, these two forms have a different prognosis.…”

Isolated fetal umbilical vein varix—prenatal sonographic diagnosis and suggested management

“…Other consequences of UVV may be non-reassuring fetal monitoring and emergent delivery (Zalel et al, 2000), fetal hemolytic anaemia (Batton et al, 2000), and neonatal thrombocytopenia resulting from a blood clot in the UVV (Benoist et al, 2007). Nevertheless, in many studies the fetal prognosis was fair (Benoist et al, 2007;Ipek et al, 2008). In one of the largest series recently reported Rahemtullah et al described 23 fetuses with UVV, none of whom died in utero.…”

“…Summarizing the 109 cases of UVV from these series and case reports, the outcome of most cases with UVV both isolated (including our present study) and with associated anomalies was fair. As much as 62.4% had term deliveries of normal infants, 11% had preterm deliveries with normal outcome, 2.7% had postnatal complications, and 13.7% fetuses died in utero, five of them had associated chromosomal or anatomical abnormalities (Fuster et al, 1985;Estroff and Benacerraf, 1992;Mahony et al, 1992;Rizzo and Arduini, 1992;Allen et al, 1998;Sepulveda et al, 1998;Batton et al, 2000;Zalel et al, 2000;Rahemtullah et al, 2001;Valsky et al, 2004;Viora et al, 2004;Fung et al, 2005;Benoist et al, 2007;Ipek et al, 2008).…”

“…In some reports it is associated with poor fetal outcome including non-reassurine fetal monitoring and intrauterine fetal demise (IUFD) (Sepulveda et al, 1998;Batton et al, 2000;Zalel et al, 2000;Valsky et al, 2004;Fung et al, 2005), whereas in others the fetal prognosis is good (Rahemtullah et al, 2001;Benoist et al, 2007; *Correspondence to: Alina Weissmann-Brenner, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel. E-mail: alinabrenner@yahoo.com Ipek et al, 2008). There are no known specific risk factors to the high-risk cases; therefore prediction of complications due to UVV is difficult.…”