Prenatal Diagnosis of Umbilical Artery Aneurysm with Good Fetal Outcome and Review of Literature

Abstract

Umbilical artery aneurysm is a rare condition. Till date, 14 cases are reported and only 4 had good fetal outcome. Umbilical artery aneurysm is associated with high risk of fetal aneuploidy and fetal demise. Though umbilical cord anomalies are rare, they are associated with significant fetal morbidity and mortality. We report a case of umbilical artery aneurysm which was detected at 33 weeks of gestation on ultrasonography as an anechoic cyst close to cord insertion with turbulent blood flow in it. The patient was hospitalized and with intensive fetal surveillance and early delivery, a live born fetus was achieved. Baby's karyotype was normal. Pathologic examination confirmed umbilical artery aneurysm close to cord insertion.

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…Echogenic structures within the aneurysm are likely to represent mural thrombus. 197,[201][202][203][204] Prenatal diagnosis as early as 22-23 weeks' gestation has been reported by a number of authors, possibly reflecting mid-trimester formation of the umbilical artery aneurysm. 198,200,205 Interestingly, according to Hill et al in the majority of cases, which described the precise anatomical location of the umbilical artery aneurysm (7/9), these were located at the placental insertion site.…”

Umbilical Cord Masses: Differential Diagnosis. A Case of Umbilical Artery Aneurysm

“…Reviewing the literature, 16 cases of umbilical artery aneurysm have been reported, of which only 5 cases were live births with normal karyotype. 2 Even though our case was a term newborn with normal karyotype, a high association of trisomy 18 with fetal death (due to thrombosis or rupture of the aneurysm) even in patients prenatally diagnosed with close ultrasound monitoring has been observed in patients with umbilical artery aneurysm. 2, 3…”

“…Umbilical artery aneurysm is rare and it is often associated with single umbilical artery, chromosomal, and other fetal structural anomalies and high fetal mortality. 1-3…”

Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord

“…They usually occur together with SUA [10] and are detected in areas near the placental insertion site that are less protected by Wharton's jelly, usually during the second or third trimester of gestation. They are associated with delayed intrauterine growth, SUA, aneuploidy like trisomy 18, cardiac abnormalities and foetal demise [13]. When aneurysm is detected a detailed ultrasaound examination with fetal echocardiography and karyotype should be considered, as well as early delivery [13].…”

“…They are associated with delayed intrauterine growth, SUA, aneuploidy like trisomy 18, cardiac abnormalities and foetal demise [13]. When aneurysm is detected a detailed ultrasaound examination with fetal echocardiography and karyotype should be considered, as well as early delivery [13].…”