Early-onset fetal growth restriction with normal Doppler findings associated with prenatal diagnosis of an intrahepatic portosystemic shunt: A case report.

Congenital portosystemic shunts are rare vascular anomalies of the fetal venous system caused by abnormal connections between the portal and systemic circulation. Although prenatal diagnosis is challenging, it is essential for appropriate counseling and management. A 34-year-old pregnant woman was referred at 26 weeks of gestation with suspected early-onset fetal growth restriction. Ultrasonography revealed severe fetal growth restriction, with all biometric parameters below the 1st percentile, while Doppler findings remained normal. Targeted evaluation demonstrated an abnormal vascular connection between the left portal vein and the left hepatic vein, consistent with an intrahepatic portosystemic shunt, without additional structural anomalies. The pregnancy was closely monitored, and a female infant weighing 1410 g was delivered at 37 weeks of gestation. The neonatal course was uneventful except for low birth weight. Intrahepatic portosystemic shunts should be considered in the differential diagnosis of unexplained early-onset fetal growth restriction, even when conventional Doppler findings are normal.