Umbilical venous flow in normal and complicated pregnancy

Gill, R.W.; Kossoff, G.; Warren, Peter S.; Garrett, William J.

doi:10.1016/0301-5629(84)90169-8

Cited by 141 publications

(81 citation statements)

References 21 publications

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“…And this postulation lends further credence to the notion that in the growthrestricted fetus, the decrease of UVVF does not happen later in pregnancy -the decrease of UVVF actually happens before the growth restriction is found. And, it would be compatible with previous studies reporting that reduction in UV blood could be detected weeks before IUGR was detectable by conventional fetal biometry (Gill et al, 1984) and that in singletons the reduction of the UV velocity in the IUGR fetus was observed in early pregnancy (Rigano et al, 2001), suggesting that the reduced…”

Section: Discussionsupporting

confidence: 91%

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Chang¹,

Chang

Chao

et al. 2011

Twin Res Hum Genet

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This study was conducted to investigate the relationship among umbilical venous volume flow, birthweight and placental share in monochorionic twins with or without selective growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 51 monochorionic twin pregnancies were divided into two groups as with (group 1) and without (group 2) selective intrauterine growth restriction. Umbilical venous volume flow was calculated by multiplying the umbilical vein cross-sectional area by half of the maximal velocity around mid-trimester. The placentas were cut along the vascular equator into two individual placental masses. The discordance of birthweight was calculated as [(birthweight of larger twin—birthweight of smaller twin)/birthweight of larger twin 100%]. The discordances of umbilical venous volume flow and placental share were calculated in a similar fashion. The median umbilical venous volume flow discordances (68.4% and 15.3% in groups 1 and 2 monochorionic twins, respectively) were similar and correlated well with the placental share discordances (66.6% and 18.5% in groups 1 and 2 monochorionic twins, respectively) but not with the birthweight discordance (28.6% and 6.4% in groups 1 and 2 monochorionic twins, respectively) in both groups. We concluded that the umbilical venous volume flow discordance reflects the placental share discordance rather than the birthweight discordance in monochorionic twin pregnancies.

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Section: Discussionsupporting

confidence: 91%

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Chang¹,

Chang

Chao

et al. 2011

Twin Res Hum Genet

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“…Although single components of the venous liver circulation such as umbilical blood flow (12)(13)(14) and shunting through the ductus venosus (DV) (15,16) have been investigated earlier, little is known about the distributions of umbilical and portal blood flows in the human fetus.…”

mentioning

confidence: 99%

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

et al. 2008

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Recent data suggest that umbilical venous perfusion of the fetal liver has an important influence on fetal growth and postnatal liver function, and that maternal factors in late pregnancy modify this circulation. In a longitudinal study of 160 low-risk pregnancies, we determined how umbilical and portal venous blood flows to the fetal liver changed during gestation, and examined the hypothesis that maternal body mass index and pregnancy weight gain influenced fetal liver blood flows. We measured blood flows in the umbilical and portal veins, left portal branch, and ductus venosus using ultrasound. Normalizing for estimated fetal weight, fetal liver total venous blood flow fell from 84 to 57 mL ⅐ min Ϫ1 ⅐ kg Ϫ1 during 21-39 wk of gestation; toward term the portal contribution increased (from 14 to 20%) and the umbilical contribution fell, whereas distribution between the left and right liver lobes was stable, 60%/ 40%. Greater flow of nutrient-rich umbilical venous blood to the liver was associated with higher birth weight and neonatal ponderal index. Maternal body mass index was not related to fetal liver blood flows, but low pregnancy weight gain strongly influenced flow distribution between the right and left liver lobes, sparing the left lobe and increasing the difference between lobes by 16%. T he developmental origins of health and disease hypothesis established a link between an adverse intrauterine environment and cardiovascular disease in adult life (1,2). There is strong evidence from epidemiologic studies and animal experiments that an adverse intrauterine environment is associated with raised levels of cardiovascular risk factors controlled by the liver (3). The role of the fetal liver for intrauterine growth and development has therefore come into focus of research.In fetal sheep, experimental reduction in umbilical venous liver perfusion results in decreased synthesis of insulin-like growth factors by the fetal liver, decreasing the cellular proliferation rate in peripheral tissues and impairing fetal growth (4,5). In human fetuses, venous liver blood flow was shown to be modulated by maternal diet and body composition (6).The fetal liver receives venous blood from the umbilical and portal veins (PVs). The umbilical vein (UV) directs nutrient-rich placental blood predominantly to the left liver lobe, whereas nutrient-depleted blood from the PV is directed to the right liver lobe (7). This selective perfusion pattern is thought to be the main reason for differences in micro architecture (8), hematopoiesis (9) and gene and enzyme expression (10,11).Although single components of the venous liver circulation such as umbilical blood flow (12-14) and shunting through the ductus venosus (DV) (15,16) have been investigated earlier, little is known about the distributions of umbilical and portal blood flows in the human fetus.The aim of the present study was to study simultaneously the umbilical and portal venous circulations and the blood flow distribution to the liver lobes in the second half of ...

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“…These results have proved to be reasonably reproducible even with the re®ned equipment of today 3 . In the growth restricted fetus the blood¯ow (and normalised blood¯ow) tends to be lower than in normally grown fetuses 2,4,5 . The generally low pressure and low velocity system of the umbilical vein is susceptible to external forces.…”

Section: Introductionmentioning

confidence: 87%

“…Combining ultrasound imaging and Doppler technique, Gill 1 measured this¯ow in the human fetus in utero for the ®rst time in 1979. He found that the average umbilical¯ow increased from 100 mL minute 1 at 26 weeks of gestation to 300 mL minute -1 at term and the corresponding normalised¯ow was 145 and below 100 mL minute -1 kg -1 , respectively 2 . These results have proved to be reasonably reproducible even with the re®ned equipment of today 3 .…”

Section: Introductionmentioning

confidence: 99%

The development of high venous velocity at the fetal umbilical ring during gestational weeks 11–19

Skulstad

Rasmussen

Iversen

et al. 2001

BJOG

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Objective To determine the occurrence of high venous velocities at the umbilical ring in the normal early second trimester, based on the assumption that a narrow umbilical ring may cause obstruction and increased venous blood velocity at the abdominal wall.Design Cross-sectional study. Setting Hospital antenatal clinic.Population One hundred and one low risk singleton pregnancies speci®cally recruited for the study.Methods Ultrasound was used at 11±19 weeks to determine the diameter and velocity in the umbilical vein at the fetal end of the cord and at the inlet through the abdominal wall. Outcome measures 10th, 50th and 90th centiles were estimated for the time-averaged maximum velocity in the cord and at the abdominal inlet. The increase of velocity as the blood entered the abdominal wall was calculated in percent of the velocity in the cord.Results During weeks 11-12 there was hardly any difference between blood velocity in the umbilical vein at the umbilical ring and that in the cord. From week 13 onwards it was increasingly common to ®nd blood acceleration at the umbilical ring of 50±500%. Velocity increment .50% was found in 0/12 fetuses (0%) at 11±12 weeks, 5/20 (25%) at 13±14 weeks, and in 21/28 (75%) at 17±19 weeks. Conclusions Blood velocity is higher in the umbilical vein at the abdominal wall than the cord, particularly after 13 weeks of gestation. If acceleration of blood velocity at the umbilical ring is a sign of a narrow inlet, it seems that a progressive tightening occurs during the second trimester.

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Umbilical venous flow in normal and complicated pregnancy

Cited by 141 publications

References 21 publications

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

The development of high venous velocity at the fetal umbilical ring during gestational weeks 11–19

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