A novel systematic approach to the evaluation of the fetal venous system

Sonographic evaluation of the fetal venous system in normal and abnormal conditions has drawn increasing interest in recent years. Whereas the assessment of the fetal heart and the related arteries is standardized using well-defined planes, the fetal venous system is still lacking a systematic approach. In this article we present a novel sonographic algorithm for a systematic examination of the fetal venous system using six planes of transverse and oblique views of the fetal abdomen and chest. These planes, using two-dimensional and color Doppler, enable a targeted demonstration of the typical veins to include the umbilical vein, ductus venosus, portal veins, hepatic veins, inferior vena cava, azygos vein, pulmonary veins, coronary sinus, superior vena cava and brachiocephalic vein. We postulate that integrating such a sequential stepwise algorithm for the evaluation of the venous system into targeted fetal cardiac imaging may improve the detection of isolated and combined anomalies of the fetal systemic and pulmonary veins.