Ultrasonographic Findings and Clinical Features of 30 Cases of Intrahepatic PortalSystemic Shunts in Fetuses With Different Outcomes.

Objective: This study aimed to compare and analyze the clinical features and ultrasound findings of fetuses with intrahepatic portosystemic shunts (IHPSS).

Methods: A retrospective study of 30 fetuses with IHPSS diagnosed from 2019 to 2024 was conducted. Clinical and ultrasound features related to different outcomes were analyzed.

Results: A total of 30 fetuses were prenatally diagnosed with IHPSS. Labor induction was required in five cases (16.7%), including three with prenatal cardiac enlargement and tricuspid regurgitation (TR), 1 with associated anomalies, and 1 fetal death after umbilical blood puncture. One neonate (3.3%) died postnatally from heart failure and pulmonary hypertension, associated with cardiac enlargement, TR, and ventricular septal defect (VSD). One case underwent successful postpartum surgery for persistent shunting with hyperammonemia. Another case remained unclosed for 2 years with patent foramen ovale. Spontaneous closure within 2 years occurred in 22 cases (73.3%). Cardiac enlargement and TR correlated significantly with labor induction (p = 0.041; p = 0.022), and VSD with postnatal death (p = 0.033).

Conclusion: Most surviving fetuses achieved spontaneous closure and favorable outcomes. Cardiac enlargement, TR, and intracardiac shunts predicted poorer prognosis.