PRUV: Key Considerations for Expecting Mothers After 28 Weeks

At 28 weeks, PRUV was only discovered, and genetic testing was not performed earlier. How can we further confirm the fetal condition?

The patient is a 33-year-old woman who had a delayed labor resulting in a cesarean section for her first pregnancy.
During her second pregnancy at 20 weeks, maternal serum screening indicated a risk of less than 1 in 400.
A high-level ultrasound at 24 weeks revealed only a calcification point in the fetal heart.
The physician explained that this is a common finding in Taiwan, so no out-of-pocket genetic testing was performed.
At 28 weeks, she switched to a closer hospital, where a second physician identified a persistent right umbilical vein (PRUV) in the fetus.
The doctor merely stated that "good fortune will prevail."
After researching, she found another case by Dr.
Chen Ming on this platform (#139028), which mentioned that although there is PRUV, both NIPS (Non-Invasive Prenatal Screening) and fetal echocardiography showed no abnormalities, concluding with "safe." However, she still has several questions:
1.
Should NIPS, fetal echocardiography, and high-level ultrasound be redone? If further testing reveals abnormalities, would it be too late to consider termination of pregnancy after the legal limit of 28 weeks?
2.
Is it advisable to store umbilical cord blood for potential future treatment of congenital anomalies?

Qídǎo zhōng de fùqīn, 30~39 year old female. Ask Date: 2019/01/05

Dr. Wu Wanru reply Rare Disease

Currently, what you are seeing are normal variations commonly found on ultrasound, with little correlation to rare diseases.
However, there is always a possibility of unexpected findings (although the probability is extremely low).
If you are very concerned about this possibility, I recommend undergoing diagnostic testing (what you mentioned are screening tests, which may not be very meaningful to pursue further).
Even if there is premature rupture of membranes at 28 weeks, medical facilities with pediatric hospitals can manage it properly.
Additionally, if a significant rare disease is unexpectedly discovered, there are no restrictions on the gestational age for termination.
Currently, the open treatment options for umbilical cord blood mainly focus on hematological diseases, regenerative medicine, and tumors.
There is no guarantee that all anomalies can be treated, but medical advancements are ongoing.
If you do not have financial burdens, you may consider preserving the umbilical cord blood to increase future treatment opportunities.

Reply Date: 2019/01/05

More Info

Understanding Persistent Right Umbilical Vein (PRUV) is crucial for expecting mothers, especially when they are approaching the later stages of pregnancy. In your case, you are 33 years old and have already experienced a cesarean delivery due to prolonged labor with your first child. Now, during your second pregnancy, you have encountered some findings that raise questions about the health of your fetus, particularly the discovery of PRUV at 28 weeks.

Key Considerations Regarding PRUV
1. What is PRUV?
PRUV, or Persistent Right Umbilical Vein, is a condition where the right umbilical vein remains dominant instead of the left, which is the typical anatomical configuration. While PRUV can be associated with certain congenital anomalies, it is often considered a benign variant when isolated and without other concerning findings.

2. Need for Further Testing:
Given that your previous non-invasive prenatal screening (NIPS) and high-level ultrasound did not show any abnormalities, the necessity for repeating these tests may not be critical unless there are new symptoms or concerns. However, if you are feeling anxious about the potential implications of PRUV, discussing the option of further diagnostic testing with your healthcare provider could provide peace of mind. It’s important to note that even if further testing reveals abnormalities, the legal restrictions regarding termination of pregnancy typically do not apply if a serious anomaly is detected after 28 weeks. This is a complex area that varies by jurisdiction, so consulting with a legal expert or your healthcare provider about local laws is advisable.

3. Umbilical Cord Blood Banking:
The decision to bank umbilical cord blood is a personal one and can be beneficial for various medical conditions, particularly blood disorders and some cancers. While it does not guarantee treatment for all congenital anomalies, it can provide options for future therapies as medical science advances. If you have the financial means and are considering the potential future health needs of your child, cord blood banking could be a prudent choice.

Addressing Your Concerns
- Reassurance About PRUV:
Many cases of PRUV are found incidentally during routine ultrasounds and do not lead to adverse outcomes. The fact that your previous screenings were normal is a positive indicator. The medical community often views isolated PRUV without additional anomalies as a benign finding.

- Monitoring and Follow-Up:
Continuous monitoring through regular prenatal visits is essential. Your healthcare provider will likely recommend follow-up ultrasounds to assess fetal growth and development, ensuring that any potential issues are caught early.

- Emotional Support:
It's natural to feel anxious about findings like PRUV, especially with your previous experience. Seeking support from healthcare professionals, family, or support groups can help you navigate these feelings.

Conclusion
In summary, while PRUV can be concerning, it is often a benign finding, especially when no other abnormalities are detected. Further testing may not be necessary unless new concerns arise. The legal implications regarding termination after 28 weeks should be clarified with a healthcare provider familiar with local laws. Lastly, considering cord blood banking could provide future health options, although it is not a cure-all for congenital issues. Regular monitoring and open communication with your healthcare team will be key in ensuring a healthy pregnancy and addressing any concerns that may arise.

Similar Q&A

Understanding Partial Placenta Previa: Risks and Outcomes for Expecting Mothers

Hello Dr. Zheng, my wife is currently pregnant with our first child and is about 20.5 weeks along. During the recent ultrasound examination, the doctor mentioned that there is a partial placenta previa, where part of the placenta is covering the cervix. However, he said that many...

Dr. Li Guanghan reply Obstetrics and Gynecology
Hello: Placenta previa is generally diagnosed after 28 weeks of gestation. You may have a low-lying placenta, which requires monitoring after 28 weeks of pregnancy. If it is confirmed as placenta previa, you should avoid actions that increase abdominal pressure, such as squatting...

Understanding Placenta Previa: Should We Opt for Early Delivery?

My wife has been diagnosed with placenta previa by her obstetrician, who has recommended a cesarean section. We are currently at 36 weeks, but the fetus weighs only 2300g. The doctor advised that we should definitely have the cesarean at 38 weeks to avoid the risk of significant ...

Dr. Li Guanghan reply Obstetrics and Gynecology
Placenta previa occurs when the placenta implants in an abnormal position, leading to reduced nutrient supply to the fetus. By 36 weeks, a fetus may weigh approximately 2300 grams, which is about 400 grams less than expected. If the due date is accurate, this condition is classif...

Managing Preterm Birth Risks in High-Risk Pregnancies

Hello, Director Cao: I am a 40-year-old pregnant woman. I had a uterine fibroid removed last year and after six months of recovery, I became pregnant. I am currently in my 15th week, and this is my first pregnancy. Early in the pregnancy, my doctor diagnosed me with adenomyosis; ...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, having preterm risk factors does not necessarily mean that you will have a preterm birth. Generally, it is advisable to rest more, have regular check-ups, and seek medical attention if you experience any discomfort. Whether to request leave for bed rest should depend on yo...

Understanding Fetal Growth Abnormalities: What to Expect After Early Delivery

Hello doctor, my wife is currently 28 weeks pregnant, but the fetal head circumference and abdominal circumference are at 24 weeks, and the limbs are stagnating at 21 weeks. All prenatal check-up reports indicate normal genetics. Previously, it was noted that there was poor place...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, it is recommended to visit a medical center for further evaluation and consult with the physicians there. Wishing you good health.