Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Prenat Diagn. 2021 Mar;41(4):457-464. doi: 10.1002/pd.5882. Epub 2020 Dec 31.
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.
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).
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).
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.
胎儿肝脏循环在胎儿生长中起着重要作用。肝内脐-门-体静脉分流（IHUPSVS）导致脐血流向肝脏减少，并已被报道对胎儿生长具有限制作用。本研究旨在评估 IHUPSVS 对胎儿生长的影响。
我们进行了一项回顾性队列研究，纳入了 2001 年至 2019 年期间诊断为 IHUPSVS 的病例。IHUPSVS 定义为门静脉任何分支与肝静脉之间的任何异常交通。从病历中收集产前和产后特征，并将其与胎儿生长受限（FGR）和适合胎龄（AGA）的病例进行比较。
本研究纳入了 25 例胎儿。18 例（72%）的最后估计胎儿体重和出生体重低于第 10 百分位，其中 4 例（16%）在第 3 至第 5 百分位之间，11 例（44%）低于第 3 百分位。FGR 胎儿的分娩时胎龄中位数低于 AGA 胎儿（37 周与 38 周，p=0.034），早产率更高（38.9%与 14.3%，P=0.24）。4 例存在相关结构异常（每组 2 例），2 例存在微小遗传异常（每组 1 例）。
IHUPSVS 胎儿生长受限常见，提示应监测胎儿生长。同样，在存在生长受限的病例中，尤其是在没有其他明显原因的情况下，应寻找肝内分流。
