{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:03:05Z","timestamp":1784516585043,"version":"3.55.0"},"reference-count":23,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objective: To evaluate whether fetal intrahepatic umbilical\u2013portal anastomosis type is associated with late-onset fetal growth restriction (FGR) and adverse neonatal outcomes. Methods: This prospective, single-center case\u2013control study included 160 singleton pregnancies in the third trimester: 80 with late-onset FGR defined according to Delphi consensus criteria and 80 appropriate-for-gestational-age (AGA) controls. Umbilical\u2013portal anastomosis was assessed by ultrasound and classified as T-shaped, X-shaped, or H-shaped. Maternal, sonographic, obstetric, and neonatal data were recorded. Multivariable logistic regression evaluated associations with FGR, and Firth\u2019s penalized regression assessed composite adverse perinatal outcome (CAPO) within the FGR group. Results: X-shaped anastomosis predominated in FGR (55.0%; T-shaped, 26.3%; H-shaped, 18.8%), whereas T-shaped was most common in controls (61.3%; X-shaped, 23.8%; H-shaped, 15.0%). FGR cases showed higher umbilical artery pulsatility index, lower middle cerebral artery pulsatility index and cerebroplacental ratio, earlier delivery, lower birth weight, and higher rates of NICU (neonatal intensive care unit) admission, transient tachypnea of the newborn, and CAPO (35% vs. 15%). Both X-shaped and H-shaped types were independently associated with FGR, with a stronger effect for X-shaped (adjusted odds ratio [aOR], 5.27 vs. 2.85). Predicted probabilities increased stepwise from T-shaped to H-shaped to X-shaped (30.3%, 55.3%, and 69.6%). Within the FGR group, only X-shaped anastomosis was independently associated with CAPO, whereas Doppler indices were not discriminatory. Conclusions: X-shaped fetal intrahepatic umbilical\u2013portal anastomosis was independently associated with both late-onset FGR and adverse neonatal outcome. Intrahepatic vascular configuration may provide additional value beyond conventional fetal biometry and arterial Doppler in risk stratification.<\/jats:p>","DOI":"10.3390\/diagnostics16142253","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T02:32:08Z","timestamp":1784514728000},"page":"2253","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Fetal Intrahepatic Umbilical\u2013Portal Anastomosis Type with Late-Onset Fetal Growth Restriction and Neonatal Outcomes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1881-1170","authenticated-orcid":false,"given":"Kubilay","family":"\u00c7anga","sequence":"first","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6570-1006","authenticated-orcid":false,"given":"Recep Taha","family":"A\u011fao\u011flu","sequence":"additional","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zg\u00fcr Volkan","family":"Akbulut","sequence":"additional","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-2920","authenticated-orcid":false,"given":"Mustafa","family":"Ba\u011fc\u0131","sequence":"additional","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Sakarya Training and Research Hospital, Ministry of Health, Sakarya 54100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9313-5250","authenticated-orcid":false,"given":"Emel","family":"\u00d6zalp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Alp","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16310, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y\u00fcksel","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3182-4312","authenticated-orcid":false,"given":"Kadriye","family":"Yakut Y\u00fccel","sequence":"additional","affiliation":[{"name":"Division of Perinatology, Department of Obstetrics and Gynecology, Etlik City Hospital, Ministry of Health, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s00404-017-4341-9","article-title":"Fetal growth restriction: Current knowledge","volume":"295","author":"Nardozza","year":"2017","journal-title":"Arch. 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