{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:37:18Z","timestamp":1779201438229,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Portosystemic shunts in growth\u2010restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5\u2010year period in a large tertiary referral center. Our routine evaluation of growth\u2010restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical\u2013portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f\u2010TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed\u2010rank test for paired non\u2010parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21\u201330)\u2009weeks. The estimated fetal weight was at the 1\n                      <jats:sup>st<\/jats:sup>\n                      percentile in\u00a010\/12 fetuses. The median amniotic fluid index was 5 (range, 2\u20135)\u2009cm at the initial appointment and improved significantly to 13 (range, 11\u201320)\u2009cm following the shunt diagnosis (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). Among fetuses with f\u2010TAPSE data available, the f\u2010TAPSE increased significantly from 4.0 (range, 3.0\u20135.0)\u2009mm before the diagnosis of CIPSS to 8.0 (range, 5.0\u20139.4)\u2009mm following the diagnosis (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.043). The median gestational age at delivery was 36.3 (range, 30.8\u201338.4)\u2009weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow\u2010up revealed spontaneous shunt resolution within 30\u2009months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The development of CIPSS in growth\u2010restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f\u2010TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. \u00a9 2025 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.29163","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T11:17:33Z","timestamp":1737458253000},"page":"311-316","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intrahepatic portosystemic shunt: salvage mechanism for oligohydramnios complicating fetal growth restriction"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5266-7769","authenticated-orcid":false,"given":"Y.","family":"Gilboa","sequence":"first","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5588-1410","authenticated-orcid":false,"given":"L.","family":"Drukker","sequence":"additional","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Bar","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Obstetrics and Gynecology Edith Wolfson Medical Center  Holon Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Berbing\u2010Goldstein","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Recanati Genetic Institute, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5953-1496","authenticated-orcid":false,"given":"Y.","family":"Geron","sequence":"additional","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Mozer Glassberg","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Institute of Gastroenterology, Nutrition and Liver Diseases Schneider Children's Medical Center of Israel  Petach Tikva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3101-2827","authenticated-orcid":false,"given":"E.","family":"Hadar","sequence":"additional","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1937-1800","authenticated-orcid":false,"given":"R.","family":"Charach","sequence":"additional","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4545-7234","authenticated-orcid":false,"given":"R.","family":"Bardin","sequence":"additional","affiliation":[{"name":"Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center Beilinson Hospital  Petach Tikva Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-019-05834-w"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-018-1619-8"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003450"},{"key":"e_1_2_6_5_1","first-page":"243","article-title":"Presentation of Congenital Portosystemic Shunts in Children","volume":"9","author":"Bahadori 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