Abstract
Background
The presence of a single umbilical artery (SUA) is a fetal soft marker of congenital abnormalities. Among the most common related malformations, there are cardiological, nephrourological and digestive anomalies, most of which are considered to have a vascular etiology. There is an association between increased incidence of intrauterine growth retardation and adverse perinatal indicators, but whether this association is due to related anomalies or isolated SUA (iSUA) is controvisal.
Methods
We reviewed 96 cases of iSUA and non-isolated SUA (niSUA), diagnosed in a period of two years in a referral hospital for high-risk pregnancies. Data on prenatal explorations, including fetal ultrasonography and karyotyping, were obtained. niSUA was diagnosed when no malformations were found prenatally or in postnatal evaluation.
Results
Sixty-six newborns (68.8%) had no other anomalies and 30 (31.3%) presented with a variety of malformations including heart diseases, urophaties, digestive, nervous and musculoskeletal disorders, genetic abnormalities and complex malformations. Cardiological and nephrourological abnormalities were found to be the most frequent association with a SUA (both in 23.8% of malformed SUA newborns). Intrauterine growth restriction was not higher in iSUA newborns than in a normal population. Ultrasound allowed optimal prenatal diagnosis in most cases.
Conclusions
The prognosis of the fetus with a SUA is determined by the presence of other malformations observed by an expert sonographer. If no other findings are made, only a routine physical examination should be performed in newborns, but no other complementary examinations are required.
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References
Van den Hof MC, Wilson RD. Fetal soft markers in obstetric ultrasound. J Obstet Gynaecol Can 2005;27:592–636.
Trecet J. Ultrasound screening in the second trimester. In: Diaz Recasens J, eds. Prenatal diagnosis. Madrid: Ergon Editorial, 2010: 135–225.
Lilja M. Infants with single umbilical artery studied in a national registry. General epidemiological characteristics. Paediatr Perinat Epidemiol 1991;5:27–36.
Lilja M. Infants with single umbilical artery studied in a national registry. 2: Survival and malformations in infants with single umbilical artery. Paediatr Perinat Epidemiol 1992;6:416–422.
Pavlopoulos PM, Konstantinidou AE, Agapitos E, Christodoulou CN, Davaris P. Association of single umbilical artery with congenital malformations of vascular etiology. Pediatr Dev Pathol 1998;1:487–493.
Rittler M, Mazzitelli N, Fuksman R, de Rosa LG, Grandi C. Single umbilical artery and associated malformations in over 5500 autopsies: relevance for perinatal management. Pediatr Dev Pathol 2010;13:465–470.
Lazaro J, Cid MJ, Repolles M. Actualization in prenatal diagnosis of single umbilical artery. Clin Invest Ginecol Obstet 2004;3:93–102.
Thummala MR, Raju TN, Langenberg P. Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg 1998;33:580–585.
Predanic M, Perni SC, Friedman A, Chervenak FA, Chasen ST. Fetal growth assessment and neonatal birth weight in fetuses with an isolated single umbilical artery. Obstet Gynecol 2005;105:1093–1097.
Martinez-Frias ML, Bermejo-Sanchez E, Rodriguez-Pinilla E, Prieto-Merino D. Characteristics of neonates with and without a single umbilical artery. Analysis of two consecutive series of neonates with and without congenital defects. An Pediatr 2006;65:541–550.
Benirschke K, Brown WH. A vascular anomaly of the umbilical cord; the absence of one umbilical artery in the umbilical cords of normal and abnormal fetuses. Obstet Gynecol 1955;6:399–404.
Burshtein S, Levy A, Holcberg G, Zlotnik A, Sheiner E. Is single umbilical artery an independent risk factor for perinatal mortality? Arch Gynecol Obstet 2011;283:191–194.
Lilja GM. Single umbilical artery and maternal smoking. BMJ 1991;302:569–570.
Lilja M. Infants with single umbilical artery studied in a national registry. 3: A case control study of risk factors. Paediatr Perinat Epidemiol 1994;8:325–333.
Budorick NE, Kelly TF, Dunn JA, Scioscia AL. The single umbilical artery in a high-risk patient population: what should be offered? J Ultrasound Med 2001;20:619–627.
Chow JS, Benson CB, Doubilet PM. Frequency and nature of structural anomalies in fetuses with single umbilical arteries. J Ultrasound Med 1998;17:765–768.
Hua M, Odibo AO, Macones GA, Roehl KA, Crane JP, Cahill AG. Single umbilical artery and its associated findings. Obstet Gynecol 2010;115:930–934.
Csecsei K, Kovacs T, Hinchliffe SA, Papp Z. Incidence and associations of single umbilical artery in prenatally diagnosed malformed, midtrimester fetuses: a review of 62 cases. Am J Med Genet 1992;43:524–530.
Joo JG, Beke A, Papp Z, Rigo J, Papp C. Single umbilical artery in fetopathological investigations. Pathol Res Pract 2008;204:831–836.
Granese R, Coco C, Jeanty P. The value of single umbilical artery in the prediction of fetal aneuploidy: findings in 12,672 pregnant women. Ultrasound Q 2007;23:117–121.
Nyberg DA, Shepard T, Mack LA, Hirsch J, Luthy D, Fitzsimmons J. Significance of a single umbilical artery in fetuses with central nervous system malformations. J Ultrasound Med 1988;7:265–273.
Martinez-Frias ML, Bermejo E, Rodriguez-Pinilla E, Prieto D. Does single umbilical artery (SUA) predict any type of congenital defect? Clinical-epidemiological analysis of a large consecutive series of malformed infants. Am J Med Genet A 2008;146A:15–25.
Prefumo F, Guven MA, Carvalho JS. Single umbilical artery and congenital heart disease in selected and unselected populations. Ultrasound Obstet Gynecol 2010;35:552–555.
Defigueiredo D, Dagklis T, Zidere V, Allan L, Nicolaides KH. Isolated single umbilical artery: need for specialist fetal echocardiography? Ultrasound Obstet Gynecol 2010;36:553–555.
Gossett DR, Lantz ME, Chisholm CA. Antenatal diagnosis of single umbilical artery: is fetal echocardiography warranted? Obstet Gynecol 2002;100:903–908.
Dagklis T, Defigueiredo D, Staboulidou I, Casagrandi D, Nicolaides KH. Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet Gynecol 2010;36:291–295.
Mu SC, Lin CH, Chen YL, Sung TC, Bai CH, Jow GM. The perinatal outcomes of asymptomatic isolated single umbilical artery in full-term neonates. Pediatr Neonatol 2008;49:230–233.
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Arcos-Machancoses, J.V., Marín-Reina, P., Romaguera-Salort, E. et al. Postnatal development of fetuses with a single umbilical artery: differences between malformed and non-malformed infants. World J Pediatr 11, 61–66 (2015). https://doi.org/10.1007/s12519-014-0471-3
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DOI: https://doi.org/10.1007/s12519-014-0471-3