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

Tai, Christiana; Conner, Tracy Marrs; Pevyandi, Shabnam; Moon-Grady, Anita J.

doi:10.1002/jum.15542

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…As SUA has a high association with foetal cardiovascular anomalies, whether foetal echocardiography is needed during pregnancy still needs to be evaluated. Several studies [ 28 – 30 ] have previously shown that if the detailed ultrasonographic anatomic survey of the foetuses with SUA is negative, foetal echocardiography is unnecessary unless the routine anatomic scan does not include an appropriate heart examination [ 31 ]. However, foetal echocardiography is commonly recommended for foetuses with SUA and extracardiac abnormalities or maternal risk factors for congenital heart disease [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of single umbilical artery and risk of foetal congenital malformations by prenatal ultrasound: a retrospective study

Yu,

Wu,

Kong

et al. 2024

BMC Pregnancy Childbirth

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Background Single umbilical artery (SUA) is strongly associated with foetal structural abnormalities; however, the exact pattern of this association has not been described. We aimed to investigate the occurrence of malformations in singleton pregnancies with SUA in China and to study the association between the absent side of the umbilical artery and foetal malformations. Methods This was a retrospective study of singleton pregnancies for which routine first-trimester anatomical screening was performed at 11+ 0-13+ 6 gestational weeks and, if the pregnancy continued, a second-trimester scan was performed at 20+ 0-24+ 0 weeks. Data were extracted from records at the referral centre, the Obstetrics and Gynecology Hospital of Fudan University, between January 2011 and April 2019 (n = 47,894). Using logistic regression, the odds ratios (OR) with 95% confidence intervals (CIs) were calculated for malformations associated with SUA. Results The incidence of SUA in our study was 2.0% (970/47,894). Of all foetuses with SUA, 387 (39.9%) had structural malformations. The malformation type varied, with cardiovascular complications being the most common. A robust association was observed between SUA and oesophageal stenosis or atresia (OR: 25.33), followed by cardiovascular (OR: 9.98–24.02), scoliosis (OR: 18.62), genitourinary (OR: 2.45–15.66), and brain malformations (OR: 4.73–9.12). The absence of the left umbilical artery (n = 445, 45.9%) was consistent with that of the right umbilical artery (n = 431, 44.4%). Furthermore, a significantly higher rate of an absent right than the left umbilical artery (p<0.01) was observed in SUA with foetal abnormalities than in SUA with no malformations. Conclusions Overall, we observed a higher risk of various specific malformations in foetuses with SUA, and a strong association between SUA and oesophageal stenosis or atresia. The absence of the right umbilical artery was most common in foetuses with SUA and structural malformations. This study provides a reference for ultrasonographers in conducting foetal structural screening for pregnant women with SUA.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of single umbilical artery and risk of foetal congenital malformations by prenatal ultrasound: a retrospective study

Yu,

Wu,

Kong

et al. 2024

BMC Pregnancy Childbirth

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“…Another study showed that the most common congenital anomalies were cardiovascular, genitourinary, and gastrointestinal anomalies, followed by CNS anomalies (8). Until now, the prognosis of cardiac and renal abnormalities, the most commonly concurrent types of anomalies with SUA, is widely known to be favorable (26,27). In our study, 74.0% of neonates with SUA had one or more concurrent congenital anomalies, and cardiac anomalies (63.5%) were most commonly associated with SUA, followed by genitourinary (19.2%), gastrointestinal (11.5%), skeletal (11.5%), CNS (4.8%), and facial (4.8%) anomalies.…”

Section: Discussionmentioning

confidence: 99%

Analysis of single umbilical artery with concurrent congenital anomaly: Is it a risk factor for poor prognosis? A cross-sectional study

Lee,

Choi

2024

IJRM

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Background: A single umbilical artery (SUA) may coexist with a single anomaly or multiple congenital anomalies. Although anomalies associated with SUA can primarily cause high perinatal mortality, their clinical significance has not been evaluated. Objective: We investigated the relationship between the clinical features and the type or number of concurrent anomalies in neonates with SUA. Materials and Methods: In this cross-sectional study, 104 neonates with SUA were enrolled from January 2000- to December 2020 at Dongsan hospital, Daegu, South Korea. Data on the maternal history and the neonates demographic characteristics, clinical course, chromosomal analysis, and congenital anomalies, were collected. Results: Among the neonates with SUA included, 77 (74.0%) had one or more congenital anomalies; 66 (63.5%) were cardiac, 20 (19.2%) were genitourinary, 12 (11.5%) were gastrointestinal, 5 (4.8%) were central nervous system, 12 (11.5%) were skeletal, and 5 (4.8%) were facial anomalies. The number of concurrent anomalies ranged from 0–4. Neonates with SUA and concurrent gastrointestinal anomaly had a high incidence of initial positive ventilation, intubation, and inotropic drug use and lower Apgar score at 1 min and 5 min. 7 (6.7%) neonates with SUA died. Low birth weight (odds ratio = 6.16, p = 0.05), maternal multiparity (2.41, p = 0.13), gastrointestinal anomaly (5.06, p = 0.11), and initial cardiac resuscitation (7.77, p = 0.11) were risk factors for mortality in neonates with SUA. Conclusion: Neonates with SUA and concurrent gastrointestinal anomaly, low birth weight, maternal multiparity, and initial cardiac resuscitation had poor outcomes. Key words: Single umbilical artery, Congenital abnormalities, Perinatal mortality.

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“…In six of the studies included in this review, echocardiography is not recommended in fetuses diagnosed with a single umbilical artery that is not associated with extracardiac abnormalities or chromosomal abnormalities, as described by Tonismae et al (Tonismae et al, 2021) who reported a sensitivity of 100%, a specificity of 77%, and a positive predictive value of 73% of anatomical ultrasound for the detection of congenital heart disease in fetuses with SUA. Compared with the fetal echocardiogram, the negative predictive value of ultrasound is 100%, so an echocardiogram is not required in fetuses with SUA and normal anatomical ultrasound (DeFigueiredo et al, 2010; Prefumo et al, 2010; Tai et al, 2021; Tonismae et al, 2021; Wang et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of heart disease in fetuses with SAU is between 9% and 32% (Araujo Júnior et al, 2015; Friebe‐Hoffmann et al, 2019; Li et al, 2020; Tai et al, 2021; Tonismae et al, 2021), a study conducted in Norway reported an increased risk of different congenital heart diseases between 2 and 7.6 times in fetuses with SAU (Ebbing et al, 2020). Chen et al found no increased risk of congenital heart disease in fetuses with SAU without other associated risk factors for heart disease (Chen et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…The sensitivity and specificity of anatomical ultrasound for detecting congenital heart disease in these fetuses are 100% and 77%, respectively, with a positive predictive value of 73%. Compared with fetal echocardiography, the negative predictive value of ultrasound is 100%, so an echocardiogram is not required in fetuses with SUA and routine anatomical ultrasound (Tai et al, 2021; Tonismae et al, 2021; Wang et al, 2019). The concordance in diagnosing heart disease in fetuses with SUA between maternal‐fetal medicine specialists and pediatric cardiologists is 94%, and diagnostic failures are equal in the two groups (Tasha et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Incidence of congenital heart disease in fetuses diagnosed with single isolated umbilical artery. Systematic review and meta‐analysis

Solano M.,

García‐Perdomo

2023

Birth Defects Research

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ObjectiveTo estimate the proportion of heart disease in fetuses with a prenatal diagnosis of a single isolated umbilical artery.MethodsWe performed a search strategy in MEDLINE (OVID), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to the present. We assessed the risk of bias and performed a meta‐analysis. We completed the subgroup analysis according to the region.ResultsWe found 1384 studies by the search strategy. After carefully reviewing the full‐text, 15 studies were included. A total of 2008 fetuses with a single isolated umbilical artery were included, and 177 had cardiac malformations. There was an overall incidence of 9% 95%CI (0.05–0.14) I2 90%. The incidence by country of origin was between 5% and 19%. The most common heart disease reported was a ventricular septal defect. Seven studies were found describing 25 cases. We described other malformations, such as tetralogy of Fallot, coarctation of the aorta, and hypoplastic left ventricle, among others.ConclusionThe incidence of congenital heart disease in fetuses with a single isolated umbilical artery was high. In addition, half of these correspond to significant heart disease. Based on the above, we suggest that fetuses with a single isolated umbilical artery should have a complete anatomic evaluation emphasizing cardiac evaluation.

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

Cited by 6 publications

References 5 publications

Diagnosis of single umbilical artery and risk of foetal congenital malformations by prenatal ultrasound: a retrospective study

Diagnosis of single umbilical artery and risk of foetal congenital malformations by prenatal ultrasound: a retrospective study

Analysis of single umbilical artery with concurrent congenital anomaly: Is it a risk factor for poor prognosis? A cross-sectional study

Incidence of congenital heart disease in fetuses diagnosed with single isolated umbilical artery. Systematic review and meta‐analysis

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