Related Experiment Video
Updated: Nov 25, 2025
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
The intra-hepatic umbilical-Porto-systemic venous shunt and fetal growth
Zvi Kivilevitch1, Eran Kassif2, Yinon Gilboa2
1Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer-Sheva, Israel.
Insights
Intra-hepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) is linked to fetal growth restriction. Monitoring fetal growth is crucial in these cases, and IHUPSVS should be investigated when growth restriction occurs without other clear causes.
Area of Science:
- Fetal Medicine
- Pediatric Cardiology
- Vascular Biology
Background:
- Fetal liver circulation is vital for fetal development.
- Intra-hepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) reduces umbilical blood flow to the liver, potentially restricting fetal growth.
Purpose of the Study:
- To evaluate the impact of IHUPSVS on fetal growth.
Main Methods:
- Retrospective cohort study of IHUPSVS cases diagnosed between 2001 and 2019.
- IHUPSVS defined as abnormal communication between portal and hepatic veins.
- Comparison of pre- and postnatal characteristics between fetuses with fetal growth restriction (FGR) and those appropriate for gestational age (AGA).
Main Results:
- Twenty-five fetuses were included; 72% exhibited fetal weight below the 10th centile.
- Fetuses with FGR had a lower median gestational age at delivery (37 vs. 38 weeks) and a higher rate of preterm delivery.
- Associated structural anomalies and genetic aberrations were noted in a small proportion of cases.
Conclusions:
- Growth restriction is common in fetuses with IHUPSVS, necessitating fetal growth monitoring.
- Investigating for IHUPSVS is recommended in cases of unexplained fetal growth restriction.
Objective:
The fetal liver circulation has an important role in fetal growth. The intra-hepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) causes a reduction of the umbilical blood flow to the liver and has been reported to have a restrictive effect on fetal growth. The aim of this study was to evaluate the effect of IHUPSVS on fetal growth.
Methods:
We conducted a retrospective cohort study of IHUPSVS diagnosed between 2001 and 2019. IHUPSVS was defined as any abnormal communication between any branch of the portal vein and hepatic vein. Pre- and postnatal characteristics were collected from medical files and compared between cases with fetal growth restriction (FGR) and those appropriate for gestational age (AGA).
Results:
Twenty-five fetuses were included in the study. Eighteen (72%) had last estimated fetal weight and birth weight below the 10th centile, four (16%) of them between the third and fifth centile, and 11 (44%) below the third centile. Median gestational age at delivery was lower for FGR than AGA fetuses (37 vs. 38 weeks, p = 0.034) and rate of preterm delivery was higher (38.9 vs. 14.3, P = 0.24). Four cases had associated structural anomalies (2 in each group), and two had minor genetic aberrations (1 in each group).
Conclusions:
Growth restriction is prevalent in fetuses with IHUPSVS, suggesting that fetal growth should be monitored. In equal measure, in cases with growth restriction, especially without other apparent cause, an intrahepatic shunt should be looked for.
Related Concept Videos
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
01:21Hepatic Portal System
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is...
01:07Development of Blood Vessels
The initial formation of this system is facilitated by the small amount of yolk present in the ovum and yolk sac. Blood vessels originate from...
01:18Veins of the Abdomen and Pelvis
The inferior vena cava is fed by numerous smaller veins. The lumbar veins, for instance, drain the posterior abdominal wall, emptying both directly into the inferior vena cava and into the...