From the Guidelines
The management plan for a 32-week pregnant patient with a persistent right paraumbilical vein (PRUV) on perinatal ultrasound should focus on routine prenatal care with additional monitoring, as PRUV is generally considered a benign anatomical variant. The patient should continue with routine prenatal care, with the addition of a detailed fetal anatomy ultrasound if not already performed to rule out associated anomalies. While PRUV itself doesn't typically require specific treatment, a fetal echocardiogram may be recommended to evaluate for potential cardiac defects, which are occasionally associated with this finding, as seen in guidelines for fetal growth restriction management 1. Serial growth ultrasounds every 3-4 weeks until delivery are advisable to monitor fetal growth and development, in line with recommendations for monitoring fetal growth restriction 1. The patient should be reassured that PRUV represents an embryological variation where the right umbilical vein persists instead of the normal left umbilical vein, and in isolation, it rarely impacts pregnancy outcomes or requires special delivery considerations. However, consultation with maternal-fetal medicine is appropriate to ensure comprehensive evaluation and to address any parental concerns, especially considering the gestational age and potential for fetal growth restriction, which may require more intensive monitoring and possibly earlier delivery as suggested by guidelines 1. After delivery, no specific follow-up for the PRUV itself is needed for the infant unless other anomalies were detected prenatally. Key considerations in the management plan include:
- Routine prenatal care with additional monitoring for fetal growth and potential cardiac defects
- Detailed fetal anatomy ultrasound and fetal echocardiogram as necessary
- Serial growth ultrasounds every 3-4 weeks until delivery
- Consultation with maternal-fetal medicine for comprehensive evaluation and parental counseling
- Awareness of guidelines for fetal growth restriction management and potential implications for delivery timing 1.
From the Research
Relevance of Persistent Right Paraumbilical Vein on Perinatal Ultrasound
The presence of a persistent right paraumbilical vein (PRUV) on perinatal ultrasound in a 32-week pregnant patient is a significant finding that requires further evaluation.
Incidence and Clinical Significance
- The incidence of PRUV varies from 0.11% to 0.5% in different studies 2, 3, 4, 5, 6.
- PRUV can be an isolated finding, but it may also be accompanied by other fetal malformations, such as omphalocele, tetralogy of Fallot, and single umbilical artery 3, 4, 5.
- The presence of PRUV increases the risk of fetal anomalies, particularly cardiovascular anomalies 5.
Management Plan
- A thorough fetal morphology scan should be performed to exclude any other malformations, especially those of the cardiovascular system 3, 4, 5, 6.
- Fetal echocardiography is recommended to evaluate the fetal heart and rule out any cardiac anomalies 4, 5, 6.
- Invasive diagnostic tests, such as chromosomal examination, may be recommended if concomitant anomalies are present 4, 5.
- Detailed prenatal ultrasonography and echocardiography should be performed to rule out anomalies in other systems 5.