Laterality of Single Umbilical Arteries and Associated Fetal Anomalies [05OP

Abstract

INTRODUCTION: Studies have suggested that single umbilical artery (SUA) is associated with adverse obstetric outcomes including growth abnormalities and congenital anomalies. The objective of this study was to determine if laterality of a single umbilical artery (SUA) is associated with specific sonographic findings or other abnormalities. METHODS: In this retrospective cohort study, medical records of patients who received an ultrasound at the Johns Hopkins Hospital with identified laterality of the SUA from 1990 to 2017 were reviewed after IRB approval. The primary outcome was the association of isolated left or right SUA with other congenital anomalies. Secondary outcomes included laterality association with intrauterine growth restriction (IUGR) and chromosomal abnormalities. Rates of sonographic abnormalities between fetuses with a right versus left SUA were compared. Multivariate marginal logistic and Poisson regression models were used to investigate the relationship between SUA and IUGR, adjusting for possible confounders. Further analyses were done using propensity score matching. RESULTS: Left SUA fetuses had a higher percentage of other fetal abnormalities (51.1% vs. 37.0%; P=0.04). In a multivariate marginal logistic regression analysis, a sonographic left SUA was significantly associated with cardiovascular (aOR 0.43, 95% CI 0.23-0.79; P=0.03) and gastrointestinal (aOR 0.43, 95% CI 0.23-0.79; P=0.03) abnormalities. No other ultrasonographic, doppler, or chromosomal abnormalities were significantly associated with a laterality of the umbilical artery. CONCLUSION: Our study identified a significant association between a left SUA and concomitant fetal cardiac and gastrointestinal abnormalities. Laterality of the SUA may be useful in identifying concomitant fetal anomalies, but requires further prospective validation.