Association Between Isolated Single Umbilical Artery and Perinatal Outcomes: A Meta-Analysis

Abstract

BackgroundTo evaluate the association between the isolated single umbilical artery (iSUA) and perinatal outcomes, including pregnancy outcomes and perinatal complications.Material/MethodsWe performed a meta-analysis of 15 eligible studies regarding the relationship between the iSUA and perinatal outcomes, including gestational age at delivery, nuchal cord, placental weight, small for gestational age (SGA), oligohydramnios, polyhydramnios, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preeclampsia, and perinatal mortality. The overall odds ratios (OR) or standardized mean difference (SMD) were calculated.ResultsThe occurrence of nuchal cord was not found to be different between an iSUA and a three-vessel cord (TVC) fetus. For perinatal complications, the SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality showed dramatic difference between women with an iSUA and women with a TVC fetus, which implied that the presence of iSUA significantly increased the risk of perinatal complications. For other perinatal complications, such as PIH and preeclampsia, no significant association was detected.ConclusionsOur meta-analysis suggests that the presence of iSUA would increase the risk of perinatal complications such as SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality. Therefore, pregnant women with an iSUA fetus have poorer perinatal outcomes and more attention should be given to the management of their pregnancy compared to women with a TVC fetus.

An epigenetic association of malformations, adverse reproductive outcomes, and fetal origins hypothesis related effects

“…Contradictory results, even for SUA meta-analyses [73,82,83], are hardly surprising: Rates and findings vary with ascertainment, type and degree of investigation, and populations. Heifetz, in his landmark study [84], noted that Bthe incidence of SUA in autopsy series is about twice the incidence in prospective series.…”

Single umbilical artery and reproduction losses in Slovak population: relation to karyotype and fetal anomalies

“…The presence o f isolated SUA would increase the risk of perinatal complications such as small for gestational age, oligohydramnios, polyhydramnios and perinatal mortality (30,31,32,33). Newborns with SUA are at an increases risk for urogenital anomalies, longterm respiratory morbidity compared to newborns without SUA (34).…”

Incidental Fetal Ultrasound Findings: Interpretation and Management

“…There has been controversy over whether isolated single umbilical artery is associated with poorer outcomes. Two recent meta‐analyses found single umbilical artery carries significant increased risk for preterm birth, small for gestational age, gestational hypertension, neonatal intensive care unit admission, and perinatal mortality …”

“…Fetal echogenic bowel is associated with Down syndrome with more frequency than other soft markers; the likelihood ratio is 5.5 to 6.7 . The estimated incidence of aneuploidy with fetal echogenic bowel ranges from 3.3% to 16% with an increase in the presence of additional markers . Fetal echogenic bowel is also associated with intrauterine growth restriction (IUGR, 9.9%‐23%); cystic fibrosis (2.3%‐7.6%); congenital infections, particularly cytomegalovirus (1%‐10%); intrauterine fetal demise (IUFD, 7.3%‐10%); gastrointestinal abnormalities such as obstruction or perforations (3%‐12%); and intra‐amniotic bleeding .…”