Single Umbilical Artery Is Associated With an Increased Incidence of Structural and Chromosomal Anomalies and Growth Restriction

Rinehart, Brian K.; Terrone, Dom A.; Taylor, Christopher W.; Isler, Christy; Larmon, J.Elaine; Roberts, William S.

doi:10.1055/s-2000-10002

Cited by 54 publications

(47 citation statements)

References 10 publications

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“…The literature includes conflicting recommendations regarding management when SUA is recognized prenatally. 1,3,4,[11][12][13][14][15][16] There is general agreement that targeted ultrasound, if not already done, is indicated due to the high incidence of associated anomalies, 1,3,4,13,15,16 but many believe that if no other anomalies are detected on ultrasound, further testing is unnecessary.…”

Section: Resultsmentioning

confidence: 99%

Single umbilical artery: What does it mean for the fetus? A case-control analysis of pathologically ascertained cases

Prucka

Clemens

Craven

et al. 2004

Genetics in Medicine

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Purpose: To ascertain the frequency of chromosomal and other anomalies in fetuses with single umbilical artery.Methods: Placentas with single umbilical artery were identified from hospital pathology laboratory records. For each identified case, the next consecutive placenta with two umbilical arteries served as a control. Pathology records, maternal histories, and prenatal ultrasounds when available were reviewed for congenital anomalies, pregnancy complications, and maternal characteristics. When indicated, placental specimens, amniocytes, or neonatal bloods were karyotyped. Results: Single umbilical artery existed in 2.0% (97/4846) of pathological specimens.Fetuses with single umbilical artery had significantly more chromosomal (10.3% vs. 1.0%) and other congenital anomalies (27% vs. 8%). Conclusions: The high incidence of major chromosomal and congenital anomalies justifies detailed fetal ultrasonography, echocardiography, and amniocentesis for karyotype when single umbilical artery is discovered during routine ultrasound. Genet Med 2004:6(1):54 -57. Key Words: single umbilical artery, chromosome anomalies, detailed ultrasound, karyotype, fetal echocardiographyThe umbilical cord forms between 13 and 38 days after conception and normally serves as the conduit for two umbilical arteries and one umbilical vein. 1,2 In some cases only a single umbilical artery (SUA) is present. Some report that this umbilical abnormality can be observed as early as 13 weeks. However, it is typically diagnosed in the third trimester. 1,3 There are three theories to explain how a SUA may form during development. 1,4 The first is that a primary agenesis of one umbilical artery results in a SUA. Another theory attributes the phenomenon to a secondary atrophy or atresia of a previously normal umbilical artery. A third theory describes a persistence of the original allantoic artery of the body stalk as an explanation for SUA. Embryological considerations, as well as the detection of occluded remnants of a second umbilical artery in some SUA fetuses, suggest that the second theory is the most likely explanation. 1,4,5 In a review of eight studies of SUA in the literature, Persutte and Hobbins 1 reported an incidence of SUA in 1.5% in spontaneous abortuses, 7% of pregnancies that were terminated because of a serious malformation, 0.2% to 1.6% of euploid fetuses who underwent prenatal ultrasound examination, 9% to 11% of aneuploid fetuses, and 0.5% to 2.5% of uncomplicated neonates. The reported incidence of SUA varies depending on the method used to identify its occurrence, being highest in abortuses and autopsies and relatively low on ultrasound and in term neonates. 1,6 -8 Although there has been no evidence supporting any genetic etiology or familial tendency of this condition, it is known that SUA occurs more frequently in twin births (4.6%) versus singletons (1%). 4,9 The risk for congenital anomalies in infants with SUA also depends on the method of ascertainment, being highest at autopsy, but cases diagnosed at ultrasound or at t...

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Section: Resultsmentioning

confidence: 99%

Single umbilical artery: What does it mean for the fetus? A case-control analysis of pathologically ascertained cases

Prucka

Clemens

Craven

et al. 2004

Genetics in Medicine

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“…Eleven series are based on cases diagnosed prenatally and significant differences in birth weight were demonstrated in four out of six studies that included control groups. 6,7,11,[13][14][15]18,[20][21][22][23] On the other hand, all post-natal studies have shown that birth weight is significantly lower in ISUA pregnancies compared to control pregnancies. 5,9,10,12 This is possibly related to the fact that these are the studies with greater sample size.…”

Section: Introductionmentioning

confidence: 98%

Should fetal growth be a matter of concern in isolated single umbilical artery?

Caldas¹,

Liao²,

Carvalho³

et al. 2014

Rev. Assoc. Med. Bras.

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Should fetal growth be a matter of concern in iSolated Single umbilical artery? rev aSSoc med braS 2014; 60(2):125-130 125original articleShould fetal growth be a matter of concern in isolated single umbilical artery? Conflict of interest: noneObjective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500 g), very low birth weight (< 1.500 g) and fetal growth restriction below the 5 th and 10 th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840±701g) and control (n=730, 2.983 ± 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5 th centile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5 th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies.

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“…In our patient twin-to-twin transfusion was not detected by ultrasonography and Doppler examinations. As a result, SUA via growth restriction was considered as the cause of the intrauterine loss [10]. Fetuses with sonographically diagnosed SUA were observed to have a high prevalence of structural anomalies and chromosomal abnormalities [10] but isolated SUA was not associated with aneuploidy [1,11].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, SUA via growth restriction was considered as the cause of the intrauterine loss [10]. Fetuses with sonographically diagnosed SUA were observed to have a high prevalence of structural anomalies and chromosomal abnormalities [10] but isolated SUA was not associated with aneuploidy [1,11]. If SUA occurs together with IUGR or other associated defects, because of the high risk of aneuploidy, parents should also be counselled for amniocentesis [12].…”

Section: Discussionmentioning

confidence: 99%

Brain Damage to the Survivor within 30 min of Co-Twin Demise in Monochorionic Twins

Karsidag¹,

Kars²,

Dansuk³

et al. 2005

Fetal Diagn Ther

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Single fetal death in a twin pregnancy in the late second or early third trimester is associated with significant morbidity and mortality rate in the surviving co-twin, especially in monochorionic twin pregnancies. The common causes are twin-to-twin transfusion syndrome, chromosomal abnormalities, and congenital anomalies of the fetus or anomalies of the umbilical cord-placenta. Here we report a case of monochorionic twin pregnancy in which one fetus had a single umbilical artery (SUA) while the co-twin had two umbilical arteries. The twin with SUA died in utero at the 30th week of gestation and the other fetus was delivered by cesarean section immediately due to fetal distress diagnosed by cardiotocography. Disseminated intravascular coagulation and multicystic encephalomalacia have been observed in the surviving neonate. This case and review of the literature suggest that neurologic complication rates are also increased in monochorionic twin pregnancies with single fetal demise despite the immediate delivery as in our case.

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Single Umbilical Artery Is Associated With an Increased Incidence of Structural and Chromosomal Anomalies and Growth Restriction

Cited by 54 publications

References 10 publications

Single umbilical artery: What does it mean for the fetus? A case-control analysis of pathologically ascertained cases

Single umbilical artery: What does it mean for the fetus? A case-control analysis of pathologically ascertained cases

Should fetal growth be a matter of concern in isolated single umbilical artery?

Brain Damage to the Survivor within 30 min of Co-Twin Demise in Monochorionic Twins

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