In a remarkable case that has caught the attention of the medical community, a newborn, against the typical adversities associated with umbilical vein varices, has been reported to have an uncomplicated hospital course after an antenatal diagnosis of an extra-abdominal umbilical vein varix. This condition is a rare fetal anomaly usually found intra-abdominally and identified on ultrasound before birth. The case, detailed in BMJ Case Reports last May, provides hope and insights into the surveillance and management of such rare conditions.
The publication in question, indexed under the DOI: 10.1136/bcr-2018-227424, presented by Cassidy-Vu, Clark, and Cuka, is notable not just for its rarity but also the successful outcome in the face of possible complications.
Background on Umbilical Vein Varices
Umbilical vein varices are dilations of the umbilical vein, which typically carries oxygen-rich blood from the placenta to the fetus. While intra-abdominal umbilical vein varices are known to occur in about 4% of umbilical cord abnormalities, extra-abdominal manifestations, such as in this case, are exceptionally rare. These abnormalities are considered developmental rather than congenital malformations, and their detection is often during routine prenatal ultrasounds.
The Significance of Early Detection
Early diagnosis through antenatal testing is crucial as these varices have been linked to adverse perinatal outcomes, including fetal death, and associations with chromosomal abnormalities, as evidenced by literature reports (Al-Maghrabi et al., 2017; Lee et al., 2014; Rahemtullah et al., 2001). The case report in the BMJ emphatically underscores the importance of antenatal monitoring for early detection and the implementation of surveillance strategies once an umbilical vein varix is identified.
The Case of an Extra-Abdominal Umbilical Vein Varix
The case involves a Hispanic female with multiple prior pregnancies who delivered an infant diagnosed with an extra-abdominal umbilical vein varix. Such a condition is typically more severe given the rarity and the paucity of literature surrounding its management. The newborn was admitted to the neonatal intensive care unit (NICU) as a precautionary measure but fortunately experienced an uncomplicated hospital stay.
Management and Outcomes
While intra-abdominal umbilical vein varices management has been documented (Ozek et al., 2018), extra-abdominal cases remain medically challenging due to the lack of comprehensive guidelines. Surveillance includes frequent ultrasounds to monitor the varix’s size and blood flow patterns and to assess for potential complications, such as thrombosis or rupture. This particular case delineated by the team from Wake Forest University School of Medicine is paving the way for more structured approaches to the condition.
The medical team’s vigilance and the antenatal testing strategies played a pivotal role in this favorable outcome, as the literature suggests a close relationship between these varices and chromosomal abnormalities (Lallar & Phadke, 2017). Therefore, the necessity for rigorous prenatal care and intervention cannot be overstated.
Contemporary Literature and Research
Bouzid et al. (2016) provided retrospective insights into fetal intra-abdominal umbilical vein varix case management, emphasizing the significance of prognosis based on the antenatal diagnosis and size of the varix. Whereas, Beraud et al. (2015) remarked on the importance of both ante- and post-natal monitoring via ultrasound for determining the course of treatment and ensuring the safety of both mother and child.
Keywords
1. Umbilical Vein Varix
2. Extra-Abdominal Vein Varix
3. Fetal Ultrasound Diagnosis
4. Antenatal Testing and Surveillance
5. Neonatal Intensive Care
Implications for Medical Practice
This report encourages the medical community to consider the broader spectrum of fetal umbilical abnormalities and adapt surveillance and management protocols accordingly. Each case of umbilical vein varices can provide invaluable data to improve maternal-fetal medicine further and contribute to better pregnancy outcomes, despite the high-risk nature of such anomalies.
Moreover, it promotes a dialogue on whether routine prenatal ultrasound practices should be adjusted to screen more specifically for umbilical vein varices or if current practices are sufficient in detecting these irregularities.
Conclusion
The described case stands as a testament to the advancements in prenatal care and neonatal monitoring, but it also highlights the need for ongoing research and shared knowledge in the healthcare community regarding rare fetal conditions like extra-abdominal umbilical vein varix. The successful outcome witnessed here is a beacon of hope for many and a reminder of how progress in medical science can tangibly improve lives.
The case further exemplifies that despite predispositions to adverse outcomes associated with umbilical vein varices, individualized and meticulous antenatal and postnatal care can lead to successful and uncompromised births. Parents and practitioners alike can find solace in these findings, as they embark on the journey of pregnancy and childbirth, knowing that even rare anomalies can be managed with the right medical approach and vigilant monitoring.
References
1. Bouzid, A., Karmous, N., Trabelsi, H., Mkaouar, L., & Mourali, M. (2016). Fetal Intra-abdominal Umbilical Vein Varix: A Case Report and Literature Review. Gynecology & Obstetrics, 6, 2161–0932. https://doi.org/10.4172/2161-0932.1000379
2. Al-Maghrabi, H. A., Contreras, L. H. C., & Martinez, S. (2017). Extra abdominal Umbilical Vein Varix Causing Stillbirth: a Case Report. Annals of Pathology and Laboratory Medicine, 4, C94–C97. https://doi.org/10.21276/APALM.1265
3. Lallar, M., & Phadke, S. R. (2017). Fetal intra abdominal umbilical vein varix: Case series and review of the literature. Indian J Radiol Imaging, 27, 59. https://doi.org/10.4103/0971-3026.202964
4. Lee, S. W., Kim, M. Y., Kim, J. E., et al. (2014). Clinical characteristics and outcomes of antenatal fetal intra-abdominal umbilical vein varix detection. Obstet Gynecol Sci, 57, 181–186. https://doi.org/10.5468/ogs.2014.57.3.181
5. Ozek, M. A., Calis, P., Bayram, M., et al. (2018). Fetal intraabdominal umbilical vein varix: antenatal diagnosis and management. J Matern Fetal Neonatal Med, 31, 245–250. https://doi.org/10.1080/14767058.2016.1278208
6. Rahemtullah, A., Lieberman, E., Benson, C., et al. (2001). Outcome of pregnancy after prenatal diagnosis of umbilical vein varix. J Ultrasound Med, 20, 135–139. https://doi.org/10.7863/jum.2001.20.2.135
7. Beraud, E., Rozel, C., Milon, J., et al. (2015). Umbilical vein varix: Importance of ante- and post-natal monitoring by ultrasound. https://doi.org/10.7863/jum.2001.20.2.135