Significance of Umbilical Vein Varix in Monochorionic Twins?
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Fetal Intra-Abdominal Umbilical Vein Varix in Monochorionic Twins: Is it Significant?
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Hamizah Ismail, Yao-Lung Chang, Shuenn-Dyh Chang, Zalina Nusee
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Fetal Intra-Abdominal Umbilical Vein Varix in Monochorionic Twins: Is it Significant?
Year: 2012
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Fetal intra-abdominal umbilical vein (FIUV) varix is a vascular anomaly characterized by an enlarged umbilical vein, which can be detected through advanced ultrasound techniques. This condition has been linked to various fetal complications, including intrauterine growth restriction (IUGR), structural anomalies, and even stillbirth. While numerous cases of FIUV varix have been reported in singleton pregnancies, its occurrence and implications in multiple pregnancies, specifically monochorionic twins, remain less documented. This case study presents a 30-year-old Taiwanese female with monochorionic twins, highlighting the significance of FIUV varix and its evolution into twin–twin transfusion syndrome (TTTS).
Significance of FIUV Varix in Monochorionic Twins
In this case, the patient’s pregnancy was monitored through serial ultrasounds, revealing one fetus with selective intrauterine growth restriction (sIUGR) and another appropriate for gestational age (AGA), the latter being diagnosed with an FIUV varix. Despite the FIUV varix being stable and without thrombosis on follow-up scans, the pregnancy progressed to TTTS, necessitating repeated amnioreductions. The outcomes at birth were favorable, with both twins surviving the neonatal period despite complications. The resolution of the FIUV varix shortly after delivery suggests that the complication may not have adversely affected the fetal prognosis in this instance, raising questions about the role of FIUV varix in the context of multiple pregnancies.
Conclusion
The case presented underlines the need for heightened awareness regarding FIUV varix in monochorionic twin pregnancies and supports the notion that close monitoring can lead to favorable outcomes. Although FIUV varix is commonly associated with adverse fetal development, this case suggests that the presence of the condition in a structurally normal environment may not always predict negative outcomes. Further research and prospective studies are required to better understand the implications of FIUV varix in twin pregnancies and to establish appropriate management protocols, considering both the risks and potential protective mechanisms observed during such complex deliveries.
FAQ section (important questions/answers):
What is fetal intra-abdominal umbilical vein (FIUV) varix?
FIUV varix is an abnormal dilation of the umbilical vein, defined as a diameter over 9 mm. It is associated with risks, including intrauterine growth restriction (IUGR), fetal anomalies, and potentially intrauterine fetal death.
What complications did the fetus with FIUV varix experience?
In the reported case, the AGA fetus with FIUV varix experienced no immediate complications. However, the pregnancy progressed to twin-twin transfusion syndrome (TTTS), necessitating amnioreductions due to growth discrepancies between the twins.
How was the FIUV varix managed in this case?
The FIUV varix was monitored through serial ultrasounds. Despite the diagnosis, no thrombosis was found. The pregnancy involved close surveillance due to the progression to TTTS, ultimately leading to a cesarean section delivery at 31 weeks.
What were the outcomes for the twins at birth?
Both twins survived the neonatal period despite being born premature. The AGA twin exhibited respiratory distress and coagulopathy due to the FIUV varix, while the sIUGR twin presented with hypoglycemia and hypoalbuminemia.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Significance of Umbilical Vein Varix in Monochorionic Twins?”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Blood:
Blood is a crucial component of the circulatory system, responsible for transporting oxygen, nutrients, and waste products throughout the body. In the context of pregnancy, maternal and fetal blood types and Rh factors are vital for assessing compatibility and preventing complications during gestation and delivery.
2) Table:
In medical literature, a table presents organized data and outcomes succinctly, allowing for quick reference and comparison. In the provided case report, the table summarizes neonatal outcomes of the twins, demonstrating differences in health status, weight, and challenges faced post-delivery, thus aiding in clinical assessments.
3) Activity:
Activity refers to the physiological movements and responses of both the mother and fetus during pregnancy. Monitoring fetal activity is essential for assessing fetal well-being; decreased movement can indicate distress or complications, prompting further evaluation or intervention to ensure a healthy pregnancy outcome.
4) Pulse:
Pulse is the rhythmic expansion and contraction of arteries as blood is pumped by the heart. In obstetric care, monitoring the fetal heart rate and maternal pulse helps assess cardiovascular health. Abnormalities in these rates can signal distress and necessitate intervention during pregnancy or delivery.
5) Birth:
Birth is the process by which a fetus is delivered from the uterus, marking the transition from intrauterine to extrauterine life. Management during birth is critical, especially for high-risk pregnancies like monochorionic twins, where complications may arise, necessitating careful monitoring and timely interventions.
6) Evolution:
Evolution in this context refers to the gradual changes observed in a pregnancy over time, influenced by various factors such as fetal growth, complications, or maternal health. Understanding the evolution of fetal conditions allows healthcare providers to make informed decisions regarding management and delivery.
7) Marriage:
Marriage can have implications for genetic and health assessments in pregnancy. It may affect the likelihood of inherited conditions, and understanding the couple's background aids in prenatal counseling, especially in cases involving potential complications or genetic anomalies.
8) Labour (Labor):
Labour is the process of childbirth involving contractions that lead to delivery. In the case described, the management of labour is critical, particularly when complications arise. Close monitoring of the fetal condition during labour ensures timely interventions to safeguard the health of both mother and infants.
9) Death:
Death, particularly intrauterine or neonatal, is a grave concern in high-risk pregnancies such as those with fetal anomalies or complications like varix. Understanding the risk factors is crucial for clinicians to implement preventive measures and interventions to enhance survival and health outcomes for neonates.
10) Study (Studying):
Study refers to systematic research conducted to gather data, investigate phenomena, and draw conclusions. In this medical context, studies on conditions like umbilical vein varix enhance understanding of their incidence, complications, and management strategies, ultimately improving clinical practices and patient outcomes.
11) Wall:
The uterine wall is the muscular layer that supports the fetus during pregnancy. Abnormalities or complications affecting the uterine wall can impact fetal positioning, amniotic fluid levels, and the overall health of the pregnancy, necessitating close monitoring in cases like twin-twin transfusion syndrome.
12) Post:
Post refers to the period after a significant event, such as delivery. Post-delivery care is essential for monitoring the health of both mother and newborns, addressing immediate needs, complications from prematurity, and ensuring proper support for recovery and early infant care.
13) Ter:
Ther, as part of 'treatment' or 'therapy,' refers to the medical interventions implemented to address complications during pregnancy or post-delivery. Understanding appropriate therapeutic measures for conditions like umbilical vein varix aids healthcare providers in optimizing outcomes and managing associated risks.
14) Life:
Life in the context of this case highlights the transition from fetal development to neonatal existence. It emphasizes the importance of monitoring health conditions that may threaten life during pregnancy, underlining the need for interventions to ensure the survival and well-being of newborns.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Significance of Umbilical Vein Varix in Monochorionic Twins?’. Further sources in the context of Science might help you critically compare this page with similair documents:
Adverse effect, Clinical significance, Premature birth, Case report, Fetal weight, Birth weight, Multiple pregnancies, Thrombosis, Doppler ultrasound, Ultrasound, Congenital Anomalies, Prematurity, Gestational age, Apgar score, Intrauterine growth restriction, Prospective studies, Fetal distress, Caesarean section, Colour Doppler, Tertiary care centre, Chromosomal anomalies, Karyotyping, Neonatal period, Fetal surveillance, Karyotype analysis, Amniotic fluid, Hydrops fetalis, Twin pregnancy, Fetal monitoring, Cystic mass, Singleton pregnancies, Intrauterine blood transfusion, Twin twin transfusion syndrome, Ultrasound technique, Emergency caesarean section, Fetal abnormalities, Karyotype, Selective intrauterine growth restriction, Fetal intra-abdominal umbilical vein varix, Appropriate gestational age fetus, Amnio-reductions, Serial ultrasounds, Prematurity problems, Umbilical artery, Intra-abdominal cystic mass, Fetal weight discordance, Amniotic fluid maximum vertical pocket, Vascualr anomalies, Rhesus isoimmunisation, Critical revision, Early delivery, Turbulent flow, Non-smoker, Monochorionic twin pregnancy, Appropriate gestational age, Amnioreductions, Fetal heart decelerations, Detailed ultrasound, Structural fetal anomalies, Absence of end-diastolic velocity, Turbulence Doppler flow, Problems at birth, Isolated FIUV varix, Umbilical vein varix, Monochorionic twins, Fetal survival, Article drafting, Fetal vascular anomalies, Prenatal sonographic diagnosis, Fetal venous system, Postnatal outcome, Umbilical vein, Twin–twin transfusion syndrome, Intra-abdominal umbilical vein varix, Fetal intra-abdominal umbilical vein, Non-stress cardiotocograph tests, Fetal lung maturity, Uterine wall, FIUV varix, AGA fetus, Chromosomes anomalies, Perinatal losses, Obstetrics outcome, Monochorionic pregnancy, Fetal pulmonary maturity, Doppler flow, Amniotic fluid MVP, Umbilical artery flow, Cardiovascular anomalies, Feto-placental circulation, Recipient fetuses, Donor fetuses, Fetal procedure, Hemodynamic circulation.