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

Barbieri, Moira; Martino, D. Di; Ferrazzi, E.; Stampalija, Tamara

doi:10.1002/jcu.23412

Cited by 7 publications

(4 citation statements)

References 74 publications

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“…There is still relatively little known on the development of the umbilical vessels. While blood flow velocity was measured in several species, including mouse and human ( Table 3 ) ( Mu and Adamson, 2006 ; Osol and Mandala, 2009 ; Linask et al, 2014 ; Zhou et al, 2014 ; Downs, 2022 ; Barbieri et al, 2023 ), a thorough investigation of hemodynamic forces and their impact on vascular development and remodeling in the umbilical cord and placenta is yet to be performed. To study vascular development quantitatively, one can measure vessel and blood flow parameters such as the pulsatility index and refractive index, as well as end-diastolic velocity, end-systolic velocity, and peak systolic velocity ( Linask et al, 2014 ), among others.…”

Section: Discussionmentioning

confidence: 99%

Origin and flow-mediated remodeling of the murine and human extraembryonic circulation systems

Van Schoor,

Bruet,

Jones

et al. 2024

Front. Physiol.

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The transduction of mechanical stimuli produced by blood flow is an important regulator of vascular development. The vitelline and umbilico-placental circulations are extraembryonic vascular systems that are required for proper embryonic development in mammalian embryos. The morphogenesis of the extraembryonic vasculature and the cardiovascular system of the embryo are hemodynamically and molecularly connected. Here we provide an overview of the establishment of the murine and human vitelline and umbilico-placental vascular systems and how blood flow influences various steps in their development. A deeper comprehension of extraembryonic vessel development may aid the establishment of stem-cell based embryo models and provide novel insights to understanding pregnancy complications related to the umbilical cord and placenta.

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Section: Discussionmentioning

confidence: 99%

Origin and flow-mediated remodeling of the murine and human extraembryonic circulation systems

Van Schoor,

Bruet,

Jones

et al. 2024

Front. Physiol.

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“…The umbilical vein initially exists as a paired vessel consisting of the right and left umbilical vein during early fetal life; then during the 4th week of fetal development, the proximal ends of the two veins gradually obliterate, while the distal end of the left one persists and enlarges to accompany the umbilical artery. In the 6th week of the development, the umbilical vein enters the abdominal cavity of the fetus and a portion of it drains into the sagittal portion of the left portal vein curving like an L-shaped tube towards the right to supply nutrients to the liver; the other part of it drains into the ductus venosus and then to the proximal end of the inferior vena cava and then the right atrium [9,10]. Due to pressure changes after birth, the umbilical vein obliterates and its fibrous remnant forms a cord that becomes the round ligament of the liver [11].…”

Section: Embryonic Development Of the Umbilical Veinmentioning

confidence: 99%

The Value of Antenatal Ultrasound in Diagnosing Anatomical and Morphological Abnormalities of the Fetal Umbilical Vein

Zhang,

Zhao,

Wang

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Normally, fetal umbilical vein (UV) starts from the capillary network in the chorionic villus and accompanies the umbilical artery (UA). After leaving the placenta, it courses along within the umbilical cord. As the embryo develops, the proximal segment of both the right and left umbilical veins obliterate, and the distal end of the left umbilical vein enters the liver. The microvessels passing through the liver gradually merge and communicate with the hepatic sinus to form the ductus venosus, which then drains into the inferior vena cava (IVC). UV anatomical and morphological abnormalities in complex and variable forms often lead to poor fetal prognosis. In light of this, a thorough prenatal ultrasound providing detailed information on UV abnormalities is potentially clinically significant. Methods: The sonographic features and clinical data of fetuses diagnosed with abnormal umbilical vein anatomy and morphology by antenatal ultrasonography from January 2016 to December 2021 in Sichuan Provincial Maternity and Child Health Care Hospital were retrospectively analyzed. Results: A total of 403 fetuses were included in the study. Among them, 318 cases were diagnosed with intrahepatic persistent right umbilical vein, and 44 cases experienced intracardiac malformations, 34 cases with extracardiac malformations, and 14 cases with both intra-and extracardiac malformations. Three cases had double umbilical veins; 1 case with intracardiac malformation and 1 case with extracardiac malformation. Eighty cases were diagnosed with umbilical vein varix (manifested as intra-or extra-abdominal vein varix or umbilical vein aneurysm); 2 cases with intracardiac malformations and 11 cases with extracardiac malformations. Two cases were diagnosed with umbilical vein stenosis, with neither of them combined with other malformations. Among the 403 fetuses, 86 received genetic testing with 8 of them confirmed with chromosomal abnormalities and the remaining 78 being normal. Of the 8 cases, 7 were diagnosed with persistent right umbilical vein (PRUV) and 1 had umbilical vein stenosis. As related to pregnancy outcomes, 386 fetuses had no obvious abnormalities being observed during the subsequent 2 years' follow-up and 17 cases were terminated due to serious malformations. Conclusions: Antenatal ultrasound assists in the accurate diagnosis of anatomical and morphological abnormalities of the umbilical vein. For cases with no other malformations or chromosomal abnormalities, a better prognosis can be expected and careful follow-up is required, whereas for those with severe malformations or chromosomal abnormalities, the prognosis is often poor. Prenatal ultrasound should provide careful examination to determine whether the fetal umbilical vein has normal anatomy and morphology, thereby supporting better prenatal outcomes.

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“…Normal fetal growth is the result of a combination of genetic-related growth potential and placental function 1,2 . Placental insufficiency is the most common cause of fetal growth impairment and is associated with an increased risk of adverse perinatal outcomes, including stillbirth 3,4 .…”

Section: Introductionmentioning

confidence: 99%

“…Umbilical vein flow (UVF) is the main determinant of oxygen and nutrient transport from the placenta to the fetus and has been shown to impact on intrauterine fetal growth 1,2,10,11 . Recently, the assessment of UVF has been suggested for the identification of subclinical placental insufficiency in fetuses considered appropriate-for-gestational age (AGA).…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 7 publications

References 74 publications

Origin and flow-mediated remodeling of the murine and human extraembryonic circulation systems

Origin and flow-mediated remodeling of the murine and human extraembryonic circulation systems

The Value of Antenatal Ultrasound in Diagnosing Anatomical and Morphological Abnormalities of the Fetal Umbilical Vein

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

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