SINGLE UMBILICAL ARTERY IS ASSOCIATED WITH AN INCREASED INCIDENCE OF STRUCTURAL AND CHROMOSOMAL ANOMALIES AND GROWTH RESTRICTION

ABSTRACT

The objective to characterize neonatal outcome associated with ultrasonographic identification of a single umbilical artery. Pregnancies diagnosed with single umbilical artery antenatally were identified. All prenatal/antenatal and pediatric records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome. Twenty-seven pregnancies complicated by fetal single umbilical artery were identified. Of the 27 pregnancies, 5 (18.5%) underwent pregnancy termination and 1 (3.7%) experienced fetal demise. Of the 21 liveborn infants, 4 (19%) died within the first year of life. Sixty-seven percent of fetuses had an associated structural anomaly. Sixteen of the 27 pregnancies underwent amniocentesis and 7 of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect in addition to the single umbilical artery. Of the six fetuses without any associated structural or chromosomal anomalies, three (50%) demonstrated growth restriction. Single umbilical artery is relatively rare finding. When a single umbilical artery is identified, a vigilant search for associated anomalies should be undertaken. Pregnancies identified as having fetuses with associated structural anomalies should be offered amniocentesis. Pregnancies with isolated single umbilical artery should be carefully monitored for evidence of fetal growth restriction.

KEYWORD

Single umbilical artery - chromosomal anomalies - growth restriction

REFERENCES

• 1 Heifetz S. Single umbilical artery: a statistical analysis of 237 autopsy cases and review of the literature.  Perspect Pediatr Pathol . 1984;  8 345-378
• 2 Kleigman R M, Behrman R E. The umbilicus. In: Behrman RE, Kleigman RM, eds. Nelson Textbook of Pediatrics Philadelphia: WB Saunders 1992: 488-489
• 3 Altshuler G, Tsang R C, Ermocilla R. Single umbilical artery: correlation of clinical status and umbilical cord histology.  Am J Dis Child . 1975;  129 697-700
• 4 Bryan E M, Kohler H G. The missing umbilical artery: I. Prospective study based on a maternity unit.  Arch Dis Child . 1974;  49 844-852
• 5 Konstantinova B. Malformations of the umbilical cord.  Acta Genet Med Gemellol . 1977;  26 259-266
• 6 Jassani M N, Brennan J N, Merkatz I R. Prenatal diagnosis of single umbilical artery by ultrasound.  J Clin Ultrasound . 1980;  8 447-448
• 7 Leung A K, Robson W L. Single umbilical artery: a report of 159 cases.  Am J Dis Child . 1989;  143 108-111
• 8 Shalev E. Placenta and umbilical cord. In: Chervanek FA, Isaacson GC, Campbell S, eds. Ultrasound in Obstetrics and Gynecology Boston: Little Brown 1993: 1089-1091
• 9 Wu M H, Chang F M, Shen M R, Yao B L, Chang C H, Yu C H, Hsu C C, Huang K E. Prenatal sonographic diagnosis of single umbilical artery.  J Clin Ultrasound . 1997;  25 425-430
• 10 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
• 11 Blazer S, Sujov P, Escholi Z, Itai B H, Bronshtein M. Single umbilical artery: right or left?.  <~>Does it matter? Prenat Diagn . 1997;  17 5-8
• 12 Jeanty P. Fetal and funicular vascular anomalies: identification with prenatal US.  Radiology . 1989;  173 367-370
• 13 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
• 14 Saller Jr D N, Keene C L, Sun C C, Schwartz S. The association of single umbilical artery with cytogenetically abnormal pregnancies.  Am J Obstet Gynecol. 1990;  163 922-925
• 15 Persutte W H, Hobbins J. Single umbilical artery: a clinical enigma in modern prenatal diagnosis.  Ultrasound Obstet Gynecol . 1995;  6 216-229