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Introduction Fetal intra-abdominal umbilical vein varix (FIUVV) is defined as focal dilatation of umbilical vein, characterized by an increased diameter of 50% compared to adjacent umbilical vein or >9mm dilatation of the intra-abdominal segment of the umbilical vein. In normal fetuses, the diameter of the umbilical vein increases in a linear pattern from 3mm at 15weeks to 8 mm at term. Case Report We report 2 cases of umbilical vein varix with two different outcomes, approaches and management in our hospital. First case: 28 year old low risk primigravida was diagnosed with umbilical vein varix with no evidence of haemodynamic compromise. Serial USG monitoring was done. Weekly MBBP was done. Induction of labour was done at 37 weeks. She delivered normally a live term boy baby of weight 2.7kg and apgar 9/10. Postnatal USG showed proximal superior mesenteric vein varix of 8mm. Second case: 33 yrs old low risk primigravida was diagnosed with umblical vein varix at 30weeks gestation. Serial USG monitoring was done. USG showed small umbilical vein varix with turbulent flow, dilated coronary arteries and DV high velocity at 34.3 weeks gestation. She was admitted. Regular electronic fetal heart rate monitoring was done. In view of suspicious NST and prematurity, it was decided to deliver the baby by emergency LSCS. A live girl baby of birth weight 2.14 kg and APGAR 9/10. Baby suffered cardiac arrest and declared dead on first-postnatal day. Discussion In the first case, after diagnosis of FIUVV, serial scans and FHR monitoring were performed. Thrombus formation in varix and non-reassuring fetal status did not occur. However, acute accidental thrombosis is unavoidable. Hence she was planned for early delivery. However with respect to the second case, regardless of APGAR 9/10, baby later succumbed to cardiac arrest due to severe anemia, shock and PDA-severe pulmonary artery hypertension. FIUVV is uncommon, its incidence is 0.4- 1.1/1000 fetuses. It constitutes approximately 4% of umbilical cord malformations and it's generally diagnosed in the second and third trimester. When present, there is an associated high incidence of fetal anomalies which could vary from Cardiovascular, urogenital, diaphragmatic hernia, ventriculomegaly, and echogenic bowel. When chromosomal abnormalities are suspected invasive testing for karyotyping should be offered. Adverse fetal outcome including still birth, is usually associated with multiple malformations, chromosomal abnormalities, bidirectional or turbulent flow, and thrombotic varix. CONCLUSION The clinical impact of FIUVV depends on the gestational age at detection, diameter of the varix, turbulent flow, thrombosis and associated malformations. The outcome is generally favourable, unless there are associated fetal anomalies. Nevertheless, close monitoring by ultrasound for fetal growth, size of varix and dopplers for flow inside the varix, as well as carefully planning and timing the delivery is recommended to prevent complications. Though the timing of delivery is arguable , in order to obtain healthy infant early delivery is also considerable.