Antenatal detection of single umbilical artery: what does it mean?

Authors

  • Vânia Ferreira U. diagnóstico Pré-Natal, S. Obstetrícia, Maternidade Júlio Dinis, CH Porto
  • Inês Vaz Obstetric Service of Maternidade Júlio Dinis of Centro Hospitalar do Porto
  • Ana Paula Reis Obstetric Service of Maternidade Júlio Dinis of Centro Hospitalar do Porto
  • Maria José Mendes Obstetric Service of Maternidade Júlio Dinis of Centro Hospitalar do Porto
  • Maria do Céu Rodrigues Obstetric Service of Maternidade Júlio Dinis of Centro Hospitalar do Porto

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v22.i3.10284

Keywords:

Congenital malformation, prenatal diagnosis, single umbilical artery, ultrasonography

Abstract

Introduction: The presence of a single umbilical artery (SUA) is recognised as a soft marker for congenital anomalies, aneuploidy, earlier delivery and intra-uterine growth restriction and/or low birth weight. The aim of this study was to assess the incidence of SUA in a selected population. And secondly, to examine the clinical signiÞ cance of this soft marker.

Material and methods: A retrospective analysis, over a 36-month period, of all cases of pregnancy interruption due to medical causes, up to 16 weeks of gestation, with prenatal diagnosis of SUA; cases of live born with a prenatal diagnosis of SUA or after delivery, at the routine examination of the placenta. Fetal growth and the risk of preterm labor are also to consider in the surveillance of these pregnancies.

Results: Thirty nine cases of SUA were identiÞ ed during the study period. Incidence of SUA in live born was 0.32% (n=30) and in pregnancy interruption due to medical causes was 12.9% (n=9). The antenatal detection rate was 77%. This ecographic soft marker was an isolated Þ nding in 27 live born (90%). In live born with SUA and associated malformations (13.3%), urinary abnormalities were identiÞ ed in three cases (75%), and a skeletal with esophageal malformation was identiÞ ed in one case (25%). Preterm birth occurred in seven cases (23.3%) and birth weight below 10th percentile in four cases (13.3%).

Discussion and conclusions: The presence of SUA in antenatal period should alert the sonographer and clinician for the need of a detailed examination of the fetus to exclude other anomalies. Fetal growth and the risk of preterm labor are also to consider in the surveillance of these pregnancies.

References

Peckham CH, Yerushalmy J. Aplasia of one umbilical artery:

incidence in race and certain obstetric factors. Obstet Gynecol

; 26:359-66.

Heifetz SA. Single umbilical artery: a statistical analysis of

autopsy cases and review of literature. Perspect Pediatr

Pathol 1984; 8:345-78.

Persutte WH, Hobbins J. Single umbilical artery: a clinical

enigma in modern prenatal diagnosis. Ultrasound Obstet

Gynecol 1995; 6:216-29.

Bernischke K, Kaufmann P. Pathology of the human placenta.

nd Ed. New York: Springer-Verlag, 1990.

Lubusky M, Dhaifalah I, Prochazka M, Hyjanek J, Mickova I,

Vomackova K, et al. Single umbilical artery and its siding in

the second trimester of pregnancy: relation to chromosomal

defects. Prenat Diagn 2007; 27:327-31.

Weissman A, Jakobi P, Bronshtein M, Goldstein I. Sonographic

measurements of the umbilical cord and vessels during

normal pregnancies. J Ultrasound Med 1994; 13:11-4.

Sepulveda W, Peek MJ, Hassan J. Umbilical vein to artery

ratio in fetuses with single umbilical artery. Ultrasound Obstet

Gynecol 1996; 8:23-6.

Persutte WH, Lenke RR. Transverse umbilical arterial diameter:

techniques for the prenatal diagnosis of single umbilical

artery. J Ultrasound Med 1994; 13:763-6.

Bornemeier S, Carpinito LA, Winter TC. Sonographic evaluation

of the two vessel umbilical cord: A comparison between

umbilical arteries adjacent to the bladder and cross-sections

of the umbilical cord. J Diag Med Sono 1996; 12:260-5.

Hyrtl J. Die Blutgefässe der menschlichen Nachgeburt in normalen

und abnormen Verhältnissen. Vienna: W. Braumüller;

Benirschke K, Brown WH. A vascular anomaly of the umbilical

cord; the absence of one umbilical artery in the umbilical

cords of normal and abnormal fetuses. Obstet Gynecol 1955;

:399-404.

Thummala MR, Raju TN, Langenberg P. Isolated single umbilical

artery anomaly and the risk for congenital malformations:

a meta-analysis. J Pediatr Surg 1998; 33:580-5.

Abuhamad AZ, Shaffer W, Mari G, Copel JA, Hobbins JC,

Evans AT. Umbilical artery: does it matter which side is missing?

Am J Obstet Gynecol 1995; 173:728-32.

Gornall AS, Kurinczuk JJ, Konje JC. Antenatal detection of

a single umbilical artery: does it matter? Prenat Diagn 2003;

:117-23.

Chow JS, Benson CB, Doubilet PM. Frequency and nature of

structural anomalies in fetuses with single umbilical arteries.

J Ultrasound Med 1998; 17:765-8.

Khong TY, George K. Chromosomal abnormalities associated

with a single umbilical artery. Prenat Diagn 1992; 12:965-8.

Saller DN, Keene CL, Sun CJ, Schwartz S. The association

of single umbilical artery with cytogenetically abnormal pregnancies.

Am J Obstet Gynecol 1990; 163:922-5.

Nyberg DA, Mahony BS, Luthy D, Kapur R. Single umbilical

artery: prenatal detection of concurrent anomalies. J Ultrasound

Med 1991; 10:247-53.

Parilla BV, Tamura RK, MacGregor SN, Geibel LJ, Sabbagha

RE. The clinical signiÞ cance of a single umbilical artery as an

isolated Þ nding on prenatal ultrasound. Obstet Gynecol 1995;

:570-2.

Byrne J, Blanc WA. Malformations and chromosome anomalies

in spontaneously aborted fetuses with single umbilical

artery. Am J Obstet Gynecol 1985; 151:340-2.

Jones TB, Sorokin Y, Bhatia R, Zador IE, Bottoms SF. Single

umbilical artery: accurate diagnosis? Am J Obstet Gynecol

; 169:538-40.

Froehlich LA, Fujikura T. Follow-up of infants with single umbilical

artery. Pediatrics 1973; 52:22-9.

Benirschke K, Bourne GL. The incidence and prognostic implication

of congenital absence of one umbilical artery. Am J

Obstet Gynecol 1960; 79:251-4.

Nyberg DA, Shepard T, Mack LA, Hirsh J, Luthy D, Fitzsimmons

J. SigniÞ cance of a single umbilical artery in fetuses

with central nervous system malformations. J Ultrasound

Med 1988; 7:265-73.

Jeanty P. Fetal and funicular vascular anomalies: identiÞ cation

with prenatal ultrasound. Radiology 1989; 173:367-70.

Abuhamdad AZ, Shaffer W, Mari G, Copel JA, Hobbns JC,

Evans AT. Single umbilical artery: does it matter which artery

is missing? Am J Obstet Gynecol 1995; 173:728-32.

Catanzarite VA. The clinical signiÞ cance of a single umbilical

artery as an isolated Þ nding of prenatal ultrasound. Obstet

Gynecol 1995;86:155-6.

Farrel T, Leslie J, Owen P. Accuracy and signiÞ cance of prenatal

diagnosis of single umbilical artery. Ultrasound Obstet

Gynecol 2000; 16:667-8.

Geipel A, Germer U, Welp T, Schwimger E, Gembruch U. Prenatal

diagnosis of single umbilical artery: determination of the

absent side, associated anomalies, Doppler Þ ndings and perinatal

outcome. Ultrasound Obstet Gynecol 2000; 15:114-17.

Volpe G, Volpe P, Boscia FM, Volpe N, Buonadonna AL, Gentile

M. ‘Isolated’ single umbilical artery: incidence, cytogenetic

abnormalities, malformation and perinatal outcome. Minerva

Ginecol 2005; 57:189-98.

Lacro RV, Jones KL, Benirschke K. The umbilical cord twist:

origin, direction, and relevance. Am J Obstet Gynecol 1987;

:833-8.

Raio L, Ghezzi F, Di Naro E, Franchi M, Brühwiler H, Lüscher

KP. Prenatal assessment of Wharton’s jelly in umbilical cords

with single artery. Ultrasound Obstet and Gynecol 1999;

:42-6.

Leung AK, Robson WL. Single umbilical artery: a report of

cases. Am J Dis Child 1989; 143:108-11.

Tortora M, Chevernak FA, Mayden K, Hobbins JC. Antenatal

sonographic diagnosis of single umbilical artery. Obstet

Gynecol 1984; 63:693-6.

Gosset DR, Lantz ME, Chisholm CA. Antenatal diagnosis of

single umbilical artery: is fetal echocardiography warranted.

Obstet Gynecol 2002; 100:903-8.

Published

2017-01-16

How to Cite

Ferreira, V., Vaz, I., Reis, A. P., Mendes, M. J., & Rodrigues, M. do C. (2017). Antenatal detection of single umbilical artery: what does it mean?. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 22(3), 140–144. https://doi.org/10.25753/BirthGrowthMJ.v22.i3.10284

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