Prenatally Diagnosed Single Umbilical Artery (SUA) – Retrospective Analysis of 1169 Fetuses

Abstract

Purpose The incidence of a fetal single umbilical artery (SUA) is about 0.5 % and has been associated with an increased risk of congenital malformations, fetal aneuploidy and intrauterine growth restriction (IUGR).

Materials and Methods A retrospective analysis of 1169 women with singleton pregnancies diagnosed with fetal SUA between 1997 and 2014 in a specialized practice for prenatal diagnostics has been performed. Data was obtained on maternal and fetal findings as well as pregnancy outcome.

Results 989 (84.6 %) fetuses showed an isolated SUA (iSUA) while 180 (15.4 %) presented with SUA and additional structural and/or chromosomal abnormalities. Structural malformations were distributed as follows: 9.0 % cardiovascular, 3.5 % urogenital, 2.9 % musculoskeletal, 3.0 % gastrointestinal and 2.1 % cerebral. 2.1 % of the fetuses had chromosomal aberrations. 50.8 % (49.2 %) of the fetuses were female (male) and right vs. left SUA was found in 64.2 % (35.8 %) of the cases. Fetuses with SUA and additional abnormalities showed lower rates of live births (85.0 % vs. 98.5 %, p < 0.001), a lower median birth weight (2825 g vs. 3220 g, p < 0.001), higher rates of preterm delivery before week 34 + 0 (13.7 % vs. 3.8 %, p < 0.001) and weighed less than the 5th growth percentile in 21.6 % vs. 9.3 % (p < 0.001) of the fetuses with iSUA. In 5.1 % (60) of the children, chromosomal or structural abnormalities were detected post-partum.

Conclusion Once fetal SUA is diagnosed, intense sonoanatomy of the fetus is required and, if associated malformations are found, genetic testing must be offered. In iSUA intermittent biometry is recommended for the early detection of IUGR but additional genetic testing is not necessarily recommended.

Zusammenfassung

Ziel Die Inzidenz der fetalen singulären Nabelschnurarterie (SUA) beträgt etwa 0,5 % und wird mit einem erhöhten Risiko an angeborenen Fehlbildungen, fetaler Aneuploidie und intrauteriner Wachstumsretardierung (IUGR) assoziiert.

Material und Methoden 1169 Frauen mit Einlingsgravidität und pränatal diagnostizierter SUA, die sich 1997 – 2014 in unserem pränataldiagnostischen Zentrum vorstellten, wurden einer retrospektiven Datenanalyse hinsichtlich fetaler Auffälligkeiten, Schwangerschaftsverlauf sowie perinatalem Outcome unterzogen.

Ergebnisse 989 (84,6 %) Feten zeigten eine isolierte SUA (iSUA), während 180 (15,4 %) zusätzliche strukturelle und/oder chromosomale Anomalien aufwiesen. Strukturelle Fehlbildungen waren wie folgt verteilt: 9,0 % cardiovaskulär, 3,5 % urogenital, 2,9 % musculoskelettal, 3,0 % gastrointestinal und 2,1 % cerebral. 2,1 % der Feten zeigten chromosomale Auffälligkeiten. 50,8 % (49,2 %) der Feten waren weiblich (männlich) und eine SUA Persistenz zeigte sich in 64,2 % (35,8 %) rechts (links). Feten zusätzlichen Anomalien zeichneten sich gegenüber Feten mit einer iSUA durch eine niedrigere Rate an Lebendgeburten (85,0 % vs. 98,5 %, p < 0,001), niedrigerem medianen Geburtsgewicht (2825 g vs. 3220 g, P < 0,001) und höheren Raten an Frühgeburten vor der 34 + 0 Woche aus (13,7 % vs. 3,8 %, p < 0,001). Zudem fanden sich in dieser Gruppe 21,6 % Kinder mit IUGR vs. 9,3 % bei den iSUA Feten (p < 0,001). In 5,1 % (60) der Kinder wurden Auffälligkeiten erst post partum entdeckt.

Schlussfolgerung Bei pränatal diagnostizierter SUA wird eine intensive Sonoanatomie des Fetus gefordert und im Falle assoziierter Fehlbildungen muss eine genetische Testung angeboten werden. Bei iSUA sprechen wir uns aufgrund unserer Daten für eine intermittierende Biometrie zur Früherkennung einer IUGR, nicht aber für eine zwingende weitere diagnostische Abklärung aus.

Key words

single umbilical artery - prenatal ultrasonography - congenital malformation - intrauterine growth restriction - chromosomal aberration

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