title: Umbilical vein insertion into the inferior vena cava: an ominous sign of chromosomal abnormalities?
abstract: This series describes the sonographic characteristics and pregnancy outcomes of fetuses with abnormal insertion of the umbilical vein (UV) into the inferior vena cava (IVC). We conducted a retrospective study that described the sonographic features of 6 patients who underwent a routine anatomic scan during early pregnancy. Six patients had a diagnosis of abnormal insertion of the UV to the IVC; in 3, the diagnosis was made at 12 weeks' gestation. Cardiac anomalies were detected in 3 patients, including ventricular septal defects, pericardial effusion, tricuspid and mitral regurgitation, and an aberrant right subclavian artery. Four had noncardiac anomalies, including cystic hygroma and skeletal, brain, and abdominal anomalies. Only 1 fetus who presented with UV insertion into the IVC as an isolated finding had a normal karyotype, resulting in term vaginal delivery. Four other patients had chromosomal abnormalities, including trisomies 13 and 21, Turner mosaicism of 45,XO/46,XY, and Robertsonian translocation, and 1 patient terminated the pregnancy without a karyotype evaluation. Abnormal insertion of the UV into the IVC with agenesis of the ductus venosus can be seen as early as the first trimester. When detected, a detailed anatomic examination should be performed, as well as a fetal karyotype evaluation. Isolated cases of insertion of the UV into the IVC at a position lower than usual may have a good prognosis.
authors.affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated With the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel. alinabrenner@yahoo.com.
authors.forename: Alina
authors.initials: A
authors.lastname: Weissmann-Brenner
authors.affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated With the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Zalel
mesh_terms: D000328:Adult; D025063:Chromosome Disorders / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014471:Umbilical Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016157:Vascular Fistula / Q000000981:diagnostic imaging*; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging*
keywords: agenesis of the ductus venosus; chromosomal abnormalities; inferior vena cava; obstetric ultrasound; umbilical vein