Frequency and nature of structural anomalies in fetuses with single umbilical arteries.

Abstract

Published studies differ concerning the rate of anomalies occurring in the presence of a single umbilical artery and the significance of the single umbilical artery as an isolated sonographic finding. We assessed the frequency, nature, and sonographic detection of structural anomalies in fetuses with a single umbilical artery. We identified all cases in which prenatal sonography diagnosed a single umbilical artery. Cases were excluded if postnatal physical or pathologic examination demonstrated a three‐vessel cord, yielding a study population of 167 cases. For each case, we recorded the gestational age at diagnosis of single umbilical artery and the findings of the sonographic fetal anatomic survey. We recorded postnatal clinical and pathologic information when available. Gestational age at time of diagnosis ranged from 16.8 to 41.1 weeks (mean, 29.2 +/‐ 6.5 weeks). Twenty of the 167 fetuses (12%) were twins, and the remainder were singletons. Among 118 cases with postnatal information, 37 (31%) had structural abnormalities, often involving multiple organs. The most common organ systems involved were the heart (19 cases) and the gastrointestinal (14 cases) and central nervous systems (nine cases). Five of the anomalous fetuses had abnormal karyotypes. The sonographic survey was abnormal in 31 of the 37 anomalous fetuses (84%). Among 85 cases with apparently isolated single umbilical artery at sonography and known fetal outcome, six (7%) proved to be anomalous at birth. We had two sonographic false‐positive results (mild hydronephrosis, suspected skeletal dysplasia). In summary, approximately one third of fetuses with single umbilical artery have structural anomalies, most often cardiac. Even when the single umbilical artery is an apparently isolated sonographic finding, the likelihood that the neonate will prove to have structural anomalies is considerable (7% in our series).

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects

“…Copel et al (20) advocate that sensitivity of four-chamber view is higher, whereas other authors consider this approach as low sensitive (4-40%) (14)(15)(16)(17)(18)(19)(20)(21). Usually FE studies report that fourchamber view has low sensitivity, obstetric ultrasound studies report high sensitivity.…”

Sonographic findings of the umbilical cord: implications for the risk of fetal chromosomal anomalies

“…Associated malformations (Table 1) are observed in 7.4-46% of fetuses with SUA 7. Chow et al found that 31% of fetuses with SUA also had other structural anomalies 8 . In a meta-analysis of 37 studies related to SUA, the mean incidence of congenital structural anomalies was 27% in live newborns, but increased to 66.3% in specimens obtained from early abortions, fetal deaths and autopsies 9 .…”

Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population

“…Some studies have also indicated that risks of some adverse pregnancy outcomes such as intrauterine growth restriction, low birth weight, preterm delivery, and hypertensive disorders in pregnancy could be increased in cases with a single umbilical artery (3,4). A single umbilical artery is known to be associated with fetal chromosomal and structural abnormalities particularly neural tube, musculoskeletal, genitourinary, and cardiac anomalies (5,6). The prognoses of fetuses with a single umbilical artery largely depend on the severity of the coexisting anomaly.…”