The anatomy of the umbilical, portal and hepatic venous systems in the human fetus at 14-19 weeks of gestation.
BACKGROUND
Ultrasound imaging of the fetal ductus venosus is becoming increasingly commonplace in clinical practice. The true anatomical relationships of the fetal umbilical and portal venous systems have not been clearly defined due to paucity of published data on the relevant anatomy. This has led to confusing terminology when describing the fetal umbilical, portal and hepatic circulations. The aim of the present study was to examine and document the anatomy of the umbilical, portal and hepatic venous systems and to propose a standardized nomenclature.


METHODS
This was a prospective study on 11 fetuses obtained from medical termination of pregnancies between 14 and 19 weeks of gestation. The liver was microdissected to expose the branching pattern and anatomical relations of the umbilical, portal and hepatic venous systems.


RESULTS
A wide L-shaped venous confluence at the terminal end of the umbilical vein, termed the portal sinus, was identified. The portal sinus was connected to the right and left hepatic lobes, by the right and left intrahepatic portal veins, respectively. The extrahepatic portal vein drained into the portal sinus just before the origin of the right intrahepatic portal vein. The ductus venosus, a branchless straight vessel, originated from the portal sinus and ascended steeply in the direction of the diaphragm. Numerous small vessels draining the liver converged into three main hepatic veins, which open into the subdiaphragmatic vestibulum.


CONCLUSIONS
Based on detailed sequential anatomical dissection and clear illustrations, the present study documents the anatomy of the umbilical, portal and hepatic venous systems. Taking into account the embryological origin of the vessels, a new anatomically appropriate and simplified nomenclature of these venous systems is proposed. In clinical practice, the consistent use of the suggested terminology would allow collection of comparable data between units and enable operators to be confident of which vessels they are sampling by Doppler ultrasound.
Mavrides
E
E
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Moscoso
G
G
Carvalho
J S
JS
Campbell
S
S
Thilaganathan
B
B
D004210:Dissection; D005260:Female; D005865:Gestational Age; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000196:embryology*; D006801:Humans; D011169:Portal Vein / Q000033:anatomy & histology / Q000196:embryology*; D011247:Pregnancy; D011446:Prospective Studies; D009626:Terminology as Topic; D014471:Umbilical Veins / Q000033:anatomy & histology / Q000196:embryology*