Management of fetal umbilical vein varix: a survey-based analysis of current clinical practice

OBJECTIVE: To evaluate current diagnostic criteria, risk stratification, and management practices for fetal intra-abdominal umbilical vein varix (FIUVV) among maternal-fetal medicine and obstetric ultrasound specialists in Israel. METHODS: A national web-based survey was distributed to specialists, collecting data on diagnostic parameters, classification of severity, surveillance protocols, and delivery timing recommendations. Responses were analyzed descriptively. RESULTS: 45 specialists (85% response) from 18 centers participated. Diagnosis was most commonly based on FIUVV diameter, with 9 mm the most frequent cutoff, though substantial variation in criteria existed. Severity assessment relied mainly on vessel diameter, flow abnormalities, and thrombus presence. Most respondents recommended detailed anatomical survey and fetal echocardiography. Surveillance and delivery timing recommendations were tailored to risk level, with earlier induction and increased surveillance favored in high-risk cases. However, considerable variability existed among respondents regarding both the frequency of monitoring and the timing of delivery. CONCLUSIONS: Considerable heterogeneity exists in FIUVV diagnosis and management in Israel. Consensus definitions and standardized protocols are needed to improve clinical care and enable comparative research.