Case Study | Successful birthing post umbilical vein varix detection in the fetus

A second time pregnant woman was diagnosed with isolated umbilical vein varix at 31 weeks of gestation. Isolated Umbilical vein varix is a rare anomaly diagnosed on ultrasonography which has been reported to be associated with fetal anomalies and intrauterine fetal death but inconsistently. Since the cause of this variation is unknown, the consulting Obstetrician and Gynaecologist, Dr. Deepika Aggarwal recommended the patient to get a thorough evaluation done for associated fetal anomalies. She also recommended a close follow up with regular doppler as intrauterine demise is known to be caused in cases of umbilical vein varix.

The couple had a non-consanguineous marriage and had conceived the baby spontaneously. She had a history of caesarean delivery 7 years ago for placental abruption with gestational hypertension. In this pregnancy, she had a normal detailed anomaly scan, screen negative for quadruple marker and had normal fetal echocardiography. She was on regular aspirin from second trimester onwards as she had a history of high BP and placental abruption in the previous pregnancy.

At 31 weeks of gestation, the ultrasound scan showed a well-defined cystic lesion in the upper abdomen which was seen to communicate with the umbilical vein suggestive of intraabdominal umbilical vein varix. Doppler colour flow imaging of both uterine arteries, umbilical artery, middle cerebral artery and ductus venosus were within normal limits. Amniotic fluid index was also within normal limits.

The patient was counselled in length about the uncertainty of this finding and the associated risk of still birth and fetal anomalies. Regular follow up scans were done to monitor the size of the umbilical vein and rule out complications like turbulence, thrombosis and rupture. Weekly follow up dopplers thereafter showed no change in the size or appearance of umbilical vein. A satisfactory interval fetal growth was also appreciated.

At 37 weeks 3 days gestation, an elective caesarean section was performed in view of poor Bishop’s score (also known as Pelvic Score, the most commonly used method to rate the readiness of the cervix for induction of labour). The woman delivered a healthy appropriately grown male baby of 2.8kg and the baby also showed no clinical signs of abnormalities.