Value of Foetal Umbilical Vein Standardised Blood Flow Volume in Predicting Weight Gain in the Third Trimester: a Prospective Case-cohort Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Aug 1

PMID 39086624

Authors

Qian Fang

Yihao Shi

Chao Zhang

Ying Cai

Cuili Yuan

Jiaxiang Yang

Guannan He

Affiliations

Soon will be listed here.

Abstract

Objective: This study aims to establish a prediction model of foetal umbilical vein standardised blood flow volume (sQuv) on estimated foetal weight (EFW) in the third trimester.

Methods: A case-cohort study involving 200 eligible normal foetuses was conducted at the Ultrasound Department of Longquanyi District of Maternity and Child Healthcare Hospital between June 1, 2020 and December 31, 2021. Ultrasound measurements were taken at two separate intervals to assess EFW and the rate of EFW (rEFW) [first: between 28 w and 33 w6d of gestational age (GA); second: after 4-6 weeks]. Umbilical vein blood flow volume (Quv) and sQuv (normalised with EFW) were calculated only during the initial measurement. Using general linear regression, a prediction model for EFW based on GA and sQuv was developed, with the gestational week employed as a calibration scalar and validated using linear regression cross-validation.

Results: In the third trimester, EFW exhibited significant correlations with GA, abdominal circumference (AC), head circumference (HC) and Quv (all > 0.6, < 0.001). Furthermore, the rEFW showed significant correlations with Quv and sQuv (all > 0.6, < 0.001). A linear regression equation was established using a general linear regression model: rEFW = 0.32689 × sQuv. Additionally, a foetal weight prediction model (EFW = -2,554.6770 + 0.9655 × sQuv + 129.6916 × GA) was established using sQuv. The above two formulas were cross-validated by intra-group linear regression and proved to be of good efficacy.

Conclusions: In the third trimester, EFW displayed significant correlations with GA, AC, HC and Quv. Additionally, the rEFW exhibited significant correlations with Quv and sQuv. The sQuv during the third trimester has predictive value for foetal weight, serving as an early warning indicator.

References

Tutus S, Asal N, Uysal G, Sahin H . Is there a relationship between high birth weight and umbilical vein diameter?. J Matern Fetal Neonatal Med. 2020; 34(21):3609-3613. DOI: 10.1080/14767058.2020.1814247. View

Yagel S, Kivilevitch Z, Cohen S, Valsky D, Messing B, Shen O . The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. Ultrasound Obstet Gynecol. 2010; 36(1):93-111. DOI: 10.1002/uog.7622. View

Rubin J, Fowlkes J, Pinter S, Treadwell M, Kripfgans O . Umbilical Vein Pulse Wave Spectral Analysis: A Possible Method for Placental Assessment Through Evaluation of Maternal and Fetal Flow Components. J Ultrasound Med. 2021; 41(10):2445-2457. PMC: 10204125. DOI: 10.1002/jum.15927. View

Sirico A, Rizzo G, Maria Maruotti G, Aiello E, Morlando M, Arduini D . Does fetal macrosomia affect umbilical artery Doppler velocity waveforms in pregnancies complicated by gestational diabetes?. J Matern Fetal Neonatal Med. 2015; 29(20):3266-70. DOI: 10.3109/14767058.2015.1121479. View

Sinkovskaya E, Klassen A, Abuhamad A . A novel systematic approach to the evaluation of the fetal venous system. Semin Fetal Neonatal Med. 2013; 18(5):269-78. DOI: 10.1016/j.siny.2013.05.009. View

Fatihoglu E, Aydin S . Diagnosing Small for Gestational Age during second trimester routine screening: Early sonographic clues. Taiwan J Obstet Gynecol. 2020; 59(2):287-292. DOI: 10.1016/j.tjog.2020.01.019. View

Rigano S, Bozzo M, Ferrazzi E, Bellotti M, Battaglia F, Galan H . Early and persistent reduction in umbilical vein blood flow in the growth-restricted fetus: a longitudinal study. Am J Obstet Gynecol. 2001; 185(4):834-8. DOI: 10.1067/mob.2001.117356. View

Wang L, Zhou Q, Zhou C, Wang J, Shi C, Long B . Z-Score Reference Ranges for Umbilical Vein Diameter and Blood Flow Volume in Normal Fetuses. J Ultrasound Med. 2021; 41(4):907-916. DOI: 10.1002/jum.15774. View

Nguyen M, Ouzounian J . Evaluation and Management of Fetal Macrosomia. Obstet Gynecol Clin North Am. 2021; 48(2):387-399. DOI: 10.1016/j.ogc.2021.02.008. View

10.

Franks P, Hanson R, Knowler W, Sievers M, Bennett P, Looker H . Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010; 362(6):485-93. PMC: 2958822. DOI: 10.1056/NEJMoa0904130. View

11.

Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R . Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019; 54(3):308-318. DOI: 10.1002/uog.20279. View

12.

Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Parra G, Sanz M . Added value of umbilical vein flow as a predictor of perinatal outcome in term small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2013; 42(2):189-95. DOI: 10.1002/uog.12380. View

13.

Cromi A, Ghezzi F, Di Naro E, Siesto G, Bergamini V, Raio L . Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol. 2007; 30(6):861-6. DOI: 10.1002/uog.5183. View

14.

DeVore G, Epstein A . Computing Z-Score Equations for Clinical Use to Measure Fetal Umbilical Vein Size and Flow Using Six Independent Variables of Age and Size. J Ultrasound Med. 2021; 41(8):1949-1960. DOI: 10.1002/jum.15872. View

15.

Rizzo G, Mappa I, Bitsadze V, Khizroeva J, Makatsarya A, DAntonio F . The added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: A prospective cohort study. Acta Obstet Gynecol Scand. 2020; 100(5):900-907. DOI: 10.1111/aogs.14047. View

16.

Hadlock F, Harrist R . In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991; 181(1):129-33. DOI: 10.1148/radiology.181.1.1887021. View

17.

Lund A, Ebbing C, Rasmussen S, Qvigstad E, Kiserud T, Kessler J . Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight. PLoS One. 2021; 16(8):e0256171. PMC: 8367003. DOI: 10.1371/journal.pone.0256171. View

18.

Hamidi O, Driver C, Steller J, Peek E, Monasta L, Stampalija T . Umbilical Venous Volume Flow in Late-Onset Fetal Growth Restriction. J Ultrasound Med. 2022; 42(1):173-183. DOI: 10.1002/jum.15993. View

19.

Choi E, Lee H, Lee S, Jung Y, Kim H, Lee S . Ultrasonographic assessment of abnormal fetal growth related to uteroplacental-fetal biometrics and Doppler (U-AID) indices: Protocol for multicenter retrospective cohort study trial. PLoS One. 2024; 19(2):e0298060. PMC: 10868764. DOI: 10.1371/journal.pone.0298060. View

20.

Cristian A, Tarry-Adkins J, Aiken C . The Uterine Environment and Childhood Obesity Risk: Mechanisms and Predictions. Curr Nutr Rep. 2023; 12(3):416-425. PMC: 10444661. DOI: 10.1007/s13668-023-00482-z. View