Perinatal Outcomes in Isolated Single Umbilical Artery

ABSTRACT

We sought to determine the rate of adverse perinatal outcomes in pregnancies diagnosed with an isolated single umbilical artery (SUA). We performed a retrospective review comparing 68 pregnancies with an isolated SUA to 68 pregnancies with a three-vessel cord (3VC). Pregnancies with structural or karyotypic anomalies were excluded. Gestational age at delivery, birth weight, SGA rate, ponderal index, and rates of admission to the neonatal intensive care unit were compared between groups. Student t test and chi-square analysis were performed. Neonates with isolated SUA had a significantly smaller birth weight than those with a 3VC (3279 ± 404 g versus 3423 ± 374 g, p = 0.0168). There was no significant difference in rates of SGA (17.6% versus 8.8%, p = 0.06). Ponderal index was significantly less in those with SUA compared with 3VC (24.2 ± 1.1 g/cm³ versus 26.1 ± 1.3 g/cm³, p = 0.001). SUA neonates had a significantly longer length of neonatal intensive care unit stay than 3VC neonates (1.25 ± 2.2 days versus 0.48 ± 1.25 days, p < 0.023). Fetuses with a prenatal diagnosis of isolated umbilical artery have a significantly lower ponderal index compared with fetuses with a 3VC. Pregnancies with isolated SUA should undergo serial assessments for fetal growth.

KEYWORDS

Fetal growth - ponderal index - pregnancy - single umbilical artery

REFERENCES

• 1 Volpe G, Volpe P, Boscia F M, Volpe N, Buonadonna A L, Gentile M. [“Isolated” single umbilical artery: incidence, cytogenetic abnormalities, malformation and perinatal outcome].  Minerva Ginecol. 2005;  57 189-198
• 2 Gornall A S, Kurinczuk J J, Konje J C. Antenatal detection of a single umbilical artery: does it matter?.  Prenat Diagn. 2003;  23 117-123
• 3 Chow J S, Benson C B, Doubilet P M. Frequency and nature of structural anomalies in fetuses with single umbilical arteries.  J Ultrasound Med. 1998;  17 765-768
• 4 Granese R, Coco C, Jeanty P. The value of single umbilical artery in the prediction of fetal aneuploidy: findings in 12,672 pregnant women.  Ultrasound Q. 2007;  23 117-121
• 5 Mu S C, Lin C H, Chen Y L, Sung T C, Bai C H, Jow G M. The perinatal outcomes of asymptomatic isolated single umbilical artery in full-term neonates.  Pediatr Neonatol. 2008;  49 230-233
• 6 Bombrys A E, Neiger R, Hawkins S et al.. Pregnancy outcome in isolated single umbilical artery.  Am J Perinatol. 2008;  25 239-242
• 7 Parilla B V, Tamura R K, MacGregor S N, Geibel L J, Sabbagha R E. The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound.  Obstet Gynecol. 1995;  85 570-572
• 8 Predanic M, Perni S C, Friedman A, Chervenak F A, Chasen S T. Fetal growth assessment and neonatal birth weight in fetuses with an isolated single umbilical artery.  Obstet Gynecol. 2005;  105(5 Pt 1) 1093-1097
• 9 Lubchenco L O, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks.  Pediatrics. 1966;  37 403-408
• 10 Wiegand S, McKenna D S, Croom C, Ventolini G, Sonek J D, Neiger R. Serial sonographic growth assessment in pregnancies complicated by an isolated single umbilical artery.  Am J Perinatol. 2008;  25 149-152
• 11 Catanzarite V A, Hendricks S K, Maida C, Westbrook C, Cousins L, Schrimmer D. Prenatal diagnosis of the two-vessel cord: implications for patient counselling and obstetric management.  Ultrasound Obstet Gynecol. 1995;  5 98-105
• 12 Lehingue Y, Remontet L, Munoz F, Mamelle N. Birth ponderal index and body mass index reference curves in a large population.  Am J Hum Biol. 1998;  10 327-340
• 13 O'Brien P M, Wheeler T, Barker D J. Fetal programming: influences on development and disease in later life. Proceedings of the 36th Royal College of Obstetricians and Gynaecologists Study Group London; RCOG 1999
• 14 Hales C N, Barker D J. The thrifty phenotype hypothesis.  Br Med Bull. 2001;  60 5-20
• 15 Yajnik C S, Fall C H, Vaidya U et al.. Fetal growth and glucose and insulin metabolism in four-year-old Indian children.  Diabet Med. 1995;  12 330-336
• 16 Albertsson-Wikland K, Wennergren G, Wennergren M, Vilbergsson G, Rosberg S. Longitudinal follow-up of growth in children born small for gestational age.  Acta Paediatr. 1993;  82 438-443
• 17 Widdowson E M, Crabb D E, Milner R D. Cellular development of some human organs before birth.  Arch Dis Child. 1972;  47 652-655
• 18 Jaquet D, Gaboriau A, Czernichow P, Levy-Marchal C. Insulin resistance early in adulthood in subjects born with intrauterine growth retardation.  J Clin Endocrinol Metab. 2000;  85 1401-1406
• 19 Ibáñez L, Ong K, Dunger D B, de Zegher F. Early development of adiposity and insulin resistance after catch-up weight gain in small-for-gestational-age children.  J Clin Endocrinol Metab. 2006;  91 2153-2158
• 20 Hediger M L, Overpeck M D, Kuczmarski R J, McGlynn A, Maurer K R, Davis W W. Muscularity and fatness of infants and young children born small- or large-for-gestational-age.  Pediatrics. 1998;  102 E60