Deteção pré-natal de artéria umbilical única: qual o seu significado?
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v22.i3.10284Palavras-chave:
artéria umbilical única, diagnóstico prénatal, ecografia, malformações congénitasResumo
Introdução: A presença de artéria umbilical única (AUU) é um marcador ecográfico associado a malformações, aneuploidias, parto pré-termo e restrição de crescimento intra-uterino e/ou baixo peso ao nascimento. Este estudo tem como objetivo determinar a incidência de AUU numa população selecionada e verificar qual o significado clínico deste marcador ecográfico.
Material e métodos: Análise retrospetiva, durante um período de 36 meses, dos casos de interrupção médica da gravidez, acima das 16 semanas, com diagnóstico pré-natal de AUU; casos de recém-nascidos com diagnóstico pré-natal de AUU ou após o parto, através do exame da placenta.
Resultados: Foram identificados 39 casos de AUU durante o período de estudo. A incidência de AUU nos recém-nascidos e nos casos de interrupção médica da gravidez foi de 0,32% e 12,9%, respetivamente. A taxa de deteção pré-natal foi de 77%. Este achado ecográfico ocorreu isoladamente em 27 casos de recém-nascidos (90%). Nos recém-nascidos com AUU e outras malformações associadas (13,3%), foram identificadas malformações do sistema urinário em três casos (75%) e malformação esquelética associada a malformação esofágica em um caso (25%). Ocorreu parto pré-termo em sete casos (23,3%) e peso ao nascimento abaixo do percentil 10 em quatro casos (13,3%)
Discussão e conclusão: A deteção pré-natal de AUU deve alertar o ecografista e o clínico para o fato do feto necessitar de uma avaliação ecográfica detalhada a fim de excluir outras anomalias. O crescimento fetal e o risco de parto pré-termo, são também de considerar na vigilância destas gestações.
Downloads
Referências
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.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.
