Umbilical venous volume flow in the normally developing and growth‐restricted human fetus

Recent data suggest that umbilical venous perfusion of the fetal liver has an important influence on fetal growth and postnatal liver function, and that maternal factors in late pregnancy modify this circulation. In a longitudinal study of 160 low-risk pregnancies, we determined how umbilical and portal venous blood flows to the fetal liver changed during gestation, and examined the hypothesis that maternal body mass index and pregnancy weight gain influenced fetal liver blood flows. We measured blood flows in the umbilical and portal veins, left portal branch, and ductus venosus using ultrasound. Normalizing for estimated fetal weight, fetal liver total venous blood flow fell from 84 to 57 mL ⅐ min Ϫ1 ⅐ kg Ϫ1 during 21-39 wk of gestation; toward term the portal contribution increased (from 14 to 20%) and the umbilical contribution fell, whereas distribution between the left and right liver lobes was stable, 60%/ 40%. Greater flow of nutrient-rich umbilical venous blood to the liver was associated with higher birth weight and neonatal ponderal index. Maternal body mass index was not related to fetal liver blood flows, but low pregnancy weight gain strongly influenced flow distribution between the right and left liver lobes, sparing the left lobe and increasing the difference between lobes by 16%. T he developmental origins of health and disease hypothesis established a link between an adverse intrauterine environment and cardiovascular disease in adult life (1,2). There is strong evidence from epidemiologic studies and animal experiments that an adverse intrauterine environment is associated with raised levels of cardiovascular risk factors controlled by the liver (3). The role of the fetal liver for intrauterine growth and development has therefore come into focus of research.In fetal sheep, experimental reduction in umbilical venous liver perfusion results in decreased synthesis of insulin-like growth factors by the fetal liver, decreasing the cellular proliferation rate in peripheral tissues and impairing fetal growth (4,5). In human fetuses, venous liver blood flow was shown to be modulated by maternal diet and body composition (6).The fetal liver receives venous blood from the umbilical and portal veins (PVs). The umbilical vein (UV) directs nutrient-rich placental blood predominantly to the left liver lobe, whereas nutrient-depleted blood from the PV is directed to the right liver lobe (7). This selective perfusion pattern is thought to be the main reason for differences in micro architecture (8), hematopoiesis (9) and gene and enzyme expression (10,11).Although single components of the venous liver circulation such as umbilical blood flow (12-14) and shunting through the ductus venosus (DV) (15,16) have been investigated earlier, little is known about the distributions of umbilical and portal blood flows in the human fetus.The aim of the present study was to study simultaneously the umbilical and portal venous circulations and the blood flow distribution to the liver lobes in the second half of ...

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“…An increasing umbilical venous blood flow throughout gestation was found previously (13)(14)(15)(16)30,31). We found a similar development (Fig.…”

Section: Discussionsupporting

confidence: 75%

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

et al. 2008

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“…In our cases, the mean gestational age of estimation of the UVVF in group 1 MCs was 24.6 weeks and the significant discordance of UVVF was already detected. UVVF in normally developing and growth restricted fetuses were evaluated and were reported as significantly reduced in the restricted fetuses (Boito et al, 2002). Because UVVF can be significantly different among different fetuses -even at the same gestational age (Acharya et al, 2005) -it can be difficult to compare the UVVF between IUGR and AGA fetuses in singletons.…”

Section: Figurementioning

confidence: 99%

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Chang¹,

Chang

Chao

et al. 2011

Twin Res Hum Genet

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This study was conducted to investigate the relationship among umbilical venous volume flow, birthweight and placental share in monochorionic twins with or without selective growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 51 monochorionic twin pregnancies were divided into two groups as with (group 1) and without (group 2) selective intrauterine growth restriction. Umbilical venous volume flow was calculated by multiplying the umbilical vein cross-sectional area by half of the maximal velocity around mid-trimester. The placentas were cut along the vascular equator into two individual placental masses. The discordance of birthweight was calculated as [(birthweight of larger twin—birthweight of smaller twin)/birthweight of larger twin 100%]. The discordances of umbilical venous volume flow and placental share were calculated in a similar fashion. The median umbilical venous volume flow discordances (68.4% and 15.3% in groups 1 and 2 monochorionic twins, respectively) were similar and correlated well with the placental share discordances (66.6% and 18.5% in groups 1 and 2 monochorionic twins, respectively) but not with the birthweight discordance (28.6% and 6.4% in groups 1 and 2 monochorionic twins, respectively) in both groups. We concluded that the umbilical venous volume flow discordance reflects the placental share discordance rather than the birthweight discordance in monochorionic twin pregnancies.

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“…A more detailed description of both vessel area and UV flow velocity measuring techniques for calculation of volume flow have been described in detail elsewhere 8 . In brief, UV volume flow was calculated according to the formula: UV volume flow (mL/min) = 0.06 × timeaveraged velocity (mm/s) × cross-sectional vessel area (mm 2 ).…”

Section: Recording Techniquementioning

confidence: 99%

“…The umbilical cord was scanned in such a way that the umbilical arteries were visualized as close as possible to a circular shape. Umbilical venous (UV) cross-sectional area (mm 2 ) was expressed by the mean of three tracings of the inner edge of the vessel 8 . The software program used to obtain these tracings was developed in our Department using Labview and Imaq Vision software (National Instruments, Austin, TX, USA).…”

Section: Recording Techniquementioning

confidence: 99%

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Umbilical venous volume flow and fetal behavioral states in the normally developing fetus

Boito

Ursem

Struijk

et al. 2004

Ultrasound in Obstet & Gyne

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Umbilical venous volume flow in the normally developing and growth‐restricted human fetus

Cited by 118 publications

References 25 publications

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Umbilical venous volume flow and fetal behavioral states in the normally developing fetus

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