Is echocardiography necessary for all single umbilical artery fetuses? A retrospective study in a selected Chinese population

Abstract

Aim Previous evidence on the relationship between single umbilical artery (SUA) and congenital heart disease (CHD) is controversial. We thus conducted a retrospective study to explore the potential risk factors associated with CHD in SUA fetuses, and verify if all these SUA fetuses should be referred for detail fetal echocardiography. Methods We reviewed medical records of SUA fetuses referred to Xinhua Hospital for fetal echocardiography between September 2009 and February 2014. All the pregnancies were divided into two groups of CHD and non‐CHD according to the results of fetal echocardiography. The maternal and fetal characteristics were compared via χ2 test and Fishers’ test. Furthermore, Poisson regression was used to analyze the risk factors associated with CHD in SUA pregnancies. Results Nineteen CHD cases (12.5%) were detected among 152 SUA fetuses, all with abnormal cardiac views during obstetric screening ultrasound (P < 0.001). χ2 test showed that abnormal cardiac screening findings, extracardiac abnormality and infection or threatened abortion during first trimester were significantly associated with prenatal detection of CHD (P < 0.001). Multivariable Poisson regression after adjustment found that SUA fetuses with extracardiac abnormality had 4.74 (95% confidence interval: 1.89, 11.90) times higher risk of CHD. Conclusion Incidence of CHD was higher in SUA cases, and CHD fetuses could be screened efficiently by abnormal cardiac screening during obstetric screening ultrasound. SUA fetuses with extracardiac abnormality and maternal risk factors have higher risk of CHD, and should be strongly recommended for fetal echocardiography. In contrast, SUA fetuses without above situations might only need routine obstetric follow‐up.

Prenatal and neonatal outcomes of pregnancies diagnosed with fetal single umbilical artery

“…This may result from the fact that when a structural or chromosomal abnormality is detected, the patient is subject to more detailed fetal anatomic screening, which heightens the possibility of detecting SUA. Unlike previous studies which found genitourinary or gastrointestinal system anomalies as the second most common anomaly, [10,22] we found fetal central nervous system anomalies as the second most frequent group of anomalies. Similar to previous studies, in this study, cardiac anomalies were the most commonly detected abnormalities (24.3%, 20/82).…”

“…The frequency of detected karyotypic abnormalities revealed in this study is comparable with other studies, which ranged from 1.3% to 15.3%. [10,[22][23][24][25] However, the number of our patients who consented to genetic tests was relatively low, which may not reflect the true percentages of genetic abnormalities. Similar to previous studies, there were no karyotypic abnormalities in patients with iSUA.…”

Anatomical Survey Versus Fetal Echocardiograms for Diagnosis of Cardiac Defects with a Single Umbilical Artery Cases

“…6 Strengths of our study include use of data from both our single center institution as well as data from 4 other publications over the last 9 years. 5,[10][11][12] This allowed both direct comparison of our current data with those across the country and yielded summary predictive characteristics. Our high positive predictive value is likely associated with our high prevalence of cardiac abnormalities detected in our patient population (38% vs.1% reported in the general population).…”

“…4 However, recent studies have questioned the need for additional imaging in the context of isolated SUA. 5 Given the need to minimize anxiety and unnecessary interventions, it is important to understand if fetal echocardiograms are necessary in the fetus with isolated SUA.…”

Prevalence of Congenital Heart Disease in an Isolated Single Umbilical Artery Is Low at a Tertiary Referral Center

“…1 Although an SUA is thought to have a high association with fetal anomalies, including congenital heart disease (CHD), several studies in low-risk or mixed risk populations have shown that an isolated SUA (without extracardiac or genetic abnormalities) is not associated with an increased risk of CHD. [2][3][4][5] Furthermore, as major cardiac defects are detectable in standard obstetric screening with sensitivity as high as 90%, 6 the need for dedicated fetal echocardiography in an isolated SUA has been questioned.…”