Association of umbilical venous with inferior vena cava blood flow velocities

The fetal cardiac and placental circulations are interconnected through the umbilical venous and arterial vasculature. We hypothesized that alterations in umbilical venous blood flow velocities are present in fetuses with abnormal umbilical arterial circulation, and further, that changes in inferior vena cava blood flow velocities occur with, and might explain, these variations in umbilical venous blood flow velocities. Umbilical venous and inferior vena cava blood flow velocities were examined in 15 normal fetuses and in 59 fetuses with abnormalities that included absent end-diastolic umbilical artery blood flow velocities (N = 21) or abnormal heart rates (N = 27). Inferior vena cava velocities were also analyzed in 11 other fetuses with anomalies or known growth or placental abnormalities who had abnormal umbilical venous blood flow velocities. In normal fetuses, variations in umbilical venous velocities occurred during fetal activity or with fetal breathing; however, no variation in velocity corresponded with heart rate. Eleven of 21 fetuses with absent end-diastolic velocities in the umbilical artery demonstrated decreases in umbilical venous velocities (“venous pulsations”) during arterial diastole. Blood flow velocities in the reverse direction, from the right atrium into the inferior vena cava with atrial contraction, were significantly greater in these fetuses than in those without umbilical venous pulsations (27.5 ± 14.9% and 7.5 ± 5.7% of total forward flow velocity, respectively;P<.001). Venous pulsations were also seen in fetuses with abnormally fast or slow heart rates; reverse flow with atrial contraction in the inferior vena cava was likewise greater than normal in these fetuses. We conclude that umbilical venous pulsations with heart rate are abnormal in human fetuses and that these pulsations are associated with and probably result from increases in inferior vena cava reverse flow velocity with atrial contraction, which signal alterations in cardiac function. Fetuses with umbilical venous pulsations should be examined carefully for further evidence of cardiovascular or circulatory abnormalities.