To explore the prenatal ultrasound imaging features and prognosis of five types of umbilical-portal-systemic venous shunt (UPSVS) and evaluate the clinical value of prenatal ultrasound diagnosis of UPSVS.

A retrospective analysis was conducted on 52 cases of UPSVS that was diagnosed by repeat antenatal ultrasonography at Hunan Maternal and Child Health Hospital from January 2017 to January 2021. Two-dimensional ultrasound combined with spatiotemporal image correlation (STIC) technology was used to classify UPSVS into five types: (1) umbilical-systemic shunt; (2) ductus venosus-systemic shunt; (3) portal-systemic shunt; (4) congenital hepatoportal arteriovenous fistula; and (5) isolated absence or closure of the ductus venosus. The prenatal ultrasound imaging characteristics, main clinical features, and postpartum outcomes of each type of UPSVS were investigated.

Each type of UPSVS had its unique ultrasound imaging features. The postpartum outcomes of UPSVS varied among different types, mainly in terms of delivery rate, surgical intervention rate, and shunt vessel closure rate. The types with higher delivery rates were ductus venosus-systemic shunt, intrahepatic portal-systemic shunt, and isolated absence or closure of the ductus venosus (100%, 85.0%, and 83.3% respectively), while the type with the lowest delivery rate was portal-systemic shunt (0%). The types with the highest surgical intervention rate were extrahepatic portal-systemic shunt and congenital hepatoportal arteriovenous fistula (both 50.0%). The ductus venosus-systemic shunt and intrahepatic portal-systemic shunt types had higher shunt vessel closure rates, and spontaneous closure of shunt vessels was also possible in the congenital hepatoportal arteriovenous group.

Each type of UPSVS has characteristic ultrasound imaging features. Prenatal two-dimensional ultrasound combined with STIC technology can be used for prenatal diagnosis and classification of UPSVS. Prenatal accurate diagnosis and dynamic monitoring have important value for prenatal counseling and postpartum treatment of UPSVS.