Incidence Of Single Umbilical Artery Research Articles

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

BackgroundSingle 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.MethodsThis 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.ResultsThe 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.ConclusionsOverall, 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.

Perinatal Prognosis of Pregnancies with Single Umbilical Artery in a Romanian Third-Level Unit.

Objectives: Single umbilical artery (SUA) is considered the most common abnormality of the umbilical artery. The objective of the study was to evaluate the perinatal prognosis of fetuses with SUA and to describe the associated malformations. The significance of the study is represented by examining whether our findings are in correlation with data already described.Methods: We performed a prospective cohort study on singleton pregnancies complicated with SUA. The study population was composed of women with singleton pregnancies who were examined at the Department of Obstetrics and Gynecology of the Târgu Mures County Emergency Clinical Hospital between 2012 and 2021.Results: The incidence of SUA in the study population was 0.48%. C-section was performed in 40 cases with SUA and in 5258 cases with no SUA (RR:1.56, P<0.05.) From the total number of 2249 premature deliveries, 23 newborns were diagnosed with SUA (RR:2.12, P<0.05.) From the total number of 869 deliveries with low birth weight (LBW) newborns, 13 were associated with SUA (RR: 3.12, P<0.05.) There were 206 pregnancies noted with antenatal fetal demise after 24 weeks of gestation, and only 2 of them were with SUA (RR:2.01, P>0.05.) Fetal and neonatal malformations were described in 290 cases, and 28 were associated with SUA (R:21.96, P<0.05.) In 57 of 85 cases (67.05%), we found iSUA, and 28 newborns (32.95%) had minor, major, or other associated pathologies. We found two cases of trisomy 18 and one case with trisomy 13 associated with SUA. Investigating the malformations associated with SUA, the most common were cardiac and great vessels malformations (12), followed by limb malformations (8), urogenital malformations (7), digestive tract malformations (7), central nervous system malformations (4), and in one case we found cleft palate.Conclusions: Perinatal prognosis regarding SUA is significantly poorer than in cases without this pathology. One-third of fetuses with SUA were associated with fetal anomalies. The most common pathologies associated with SUA were cardiovascular, limb, urogenital, and digestive system malformations. Our data are similar to those described in other studies; therefore, we conclude, we can implement the general recommendations in our region regarding counselling patients.

Prenatal diagnosis of single umbilical artery and postpartum outcome

ObjectivesTo investigate the incidence of the single umbilical artery (SUA) malformation and postpartum outcomes in a retrospective analysis of 781 fetuses. Materials and methodsThis retrospective analysis included 781 pregnant women carrying singleton fetuses diagnosed with SUA at Gansu Provincial Maternal and Child-care Hospital between 2013 and 2019. Detailed data on maternal and fetal characteristics and postpartum outcomes were obtained. ResultsIn total, 624 (79.9 %) fetuses were diagnosed with isolated SUA and 157 (20.1 %) fetuses had SUA together with other structural and/or chromosome abnormalities. The highest incidence of malformation was found in the urinary system, followed by the cardiovascular system and digestive system. The incidence of SUA was 59.1 % on the right side and 40.9 % on the left side. Fetuses with SUA and other abnormalities tended to have a lower mean birth weight (3061 g vs 3201 g, p < 0.01), but no difference in the rate of preterm delivery was noted. ConclusionsAfter a diagnosis of SUA, structural observation of the fetus is required. The urinary, cardiovascular and digestive systems should be the focus of observation. If relevant malformations are found, then genetic testing must be performed. With isolated SUA, dynamic monitoring of biological indicators is recommended for lower birth weight, but genetic testing is not recommended.

Prenatal Diagnosis of Single Umbilical Artery: Incidence, Counselling and Management in Indian Scenario.

The objective of this study is to report the incidence of single umbilical artery (SUA) on prenatal diagnosis and formulate protocol for counselling and its management in Indian scenario. A total of 1024 cases were screened for Single umbilical artery (SUA) between 12 and 20weeks gestation during the 1year period from May 2016 to April 2017. Targeted anomaly scan was performed for all cases at 18-20weeks. Those with additional structural anomalies were subjected toinvasive genetic testing. Serial growth monitoring starting from 28weeks was done. Out of ten cases diagnosed with SUA, five had isolated SUA. Two out of five cases of isolated SUA developed FGR in third trimester. Out of the remaining, three cases with additional structural anomalies had normal foetal karyotype, whereas other two cases showed chromosomal abnormalities (12pder and trisomy 18). Targeted anomaly scan is must in all cases of SUA. Invasive genetic testing must be offered in case of associated anomalies. Serial growth monitoring in third trimester is an important part of protocol.

Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices

We aimed to evaluate perinatal outcomes and blood gas indices of isolated single umbilical artery (SUA). In this retrospective study, 134 fetuses with SUA were evaluated. A total of 77 (57.4%) fetuses with isolated SUA (iSUA) were compared with maternal age-matched 95 fetuses with double umbilical arteries (DUA), with respect to pregnancy outcome and umbilical cord blood gas indices. The incidence of SUA in our cohort was 1.04%. Patients with iSUA had lower neonatal birth weight compared with the control group (2,635 ± 972 g vs 2,991 ± 669 g; p = 0.009). Small for gestational age (SGA) frequency was higher in the group of iSUA when compared with fetuses with DUA (17.4% vs 5.4%; p = 0.03). Regarding the umbilical cord blood gas, the parameters were comparable between the two groups. SUA has a favourable obstetric outcome as long as the accompanying malformations are ruled out. Furthermore, neonatal cord blood gas parameters in fetuses with iSUA do not differ from fetuses with DUA.

The incidence of isolated single umbilical artery in twins and adverse pregnancy outcomes

The aim of this study was to estimate the incidence of single umbilical artery (SUA) in twin pregnancies and to investigate whether SUA in twin gestations is associated with adverse obstetric outcomes. We performed a retrospective cohort study of consecutive twin pregnancies over 17 years at a tertiary care hospital. Primary exposure was SUA in one or both twins documented at routine second trimester anatomic survey. Adverse obstetric outcomes included small for gestational age (SGA), placental abruption, and preterm birth, evaluated in univariable and multivariable analyses. Analysis was performed both at the pregnancy level and at the fetal level using paired analyses to account for the non-independence of twin pairs. Of the 2378 twin pregnancies without major anatomic abnormalities, 1.7% (n = 40) had SUA. Only one pregnancy (one monochorionic twin pair) was complicated by both twins having SUA. Twin fetuses with SUA are at increased risk for SGA (aOR = 2.1 (1.2-4.1), p = 0.03) after adjusting for pertinent confounding factors, similar to the findings of previous studies in singleton pregnancies. In addition, twins with SUA may be at increased risk for preterm delivery before 28 weeks compared with twin pregnancies with normal three-vessel umbilical cords (adjusted odds ratio (aOR) 3.2 (1.3-7.89.4), p = 0.01). The incidence of SUA in twin gestations in this cohort is significantly less than the recently published data. Similar to reports in singleton gestations, SUA appears to be associated with an increased risk for SGA in twins.

The Incidence of Two-Vessel Umbilical Cords and its Association With Other Fetal Anomalies:A Retrospective Study of Over 12,000 Placentas

Single umbilical artery (SUA) has an overall incidence of 1%, but rates are increased with fetal trisomy and other structural anomalies, intrauterine growth restriction, prematurity, and gestations complicated by maternal diabetes mellitus or hypertension. Owing to the increasing rates of maternal obesity and its associated complications, we sought to determine if the incidence of SUA at …

Single umbilical artery in twin pregnancies

Our purpose was to evaluate the antenatal incidence of single umbilical artery (SUA) in twin pregnancies according to chorionicity and to assess its relationship with outcome. Consecutive twin pregnancies undergoing ultrasound evaluation at our institutions were included. A targeted sonographic evaluation of the umbilical cord and vessels was performed in all cases. Chorionicity was determined according to standard ultrasound criteria. A total of 174 twin pregnancies, 100 dichorionic (DC) and 74 monochorionic (MC), were included in the study. An SUA was identified in 17 (9.8%) pregnancies, and in 18 (5.2%) fetuses. No difference was found in the incidence of SUA in DC and MC twins. Among affected pregnancies, all but one DC twin pregnancy were discordant for SUA. Structural and/or chromosomal abnormalities were present in 27.8% of fetuses with SUA. The prevalence of small-for-gestational-age fetuses and of discordant birth weight (> 20% discordance) was higher in the SUA group than in the rest of the population, although these differences were not statistically significant. Twin pairs discordant for SUA had significantly higher weight discordance than those with normal umbilical cords. The sonographic cross-sectional area of the SUA did not appear to show the typical adaptive dilatation usually seen in singleton pregnancies with SUA. The incidence of SUA in twins is higher than in singletons, with no difference between MC and DC twins. Intrapair discordance for SUA in identical twins provides evidence against an exclusively genetic origin of this anomaly. The apparent failure of compensatory dilatation of the umbilical artery in twins with SUA may explain in part the higher risk for fetal growth restriction in these cases.

Umbilical cord abnormalities in singleton pregnancies following assisted reproductive technologies (ART)

OBJECTIVE: To determine if umbilical cord abnormalities differ in singleton pregnancies following assisted reproductive technologies (ART) compared to those from spontaneous pregnancies.DESIGN: Case-Control Study.MATERIALS AND METHODS: Outcome of all pregnancies from January 2001 to December 2005 were recorded in the McGill Obstetric and Neonatal Database (MOND). Umbilical cord features were noted at the time of delivery. All cords were subjected to histological examination. Singleton pregnancies derived from ART were compared with spontaneously conceived singleton pregnancies, matched for age and parity, and also with singleton pregnancies in couples with infertility who did not undergo ART.RESULTS: Umbilical cords from 468 singleton deliveries following ART were compared with those from 936 age- and parity-matched spontaneously conceived singleton deliveries and also with those from 202 singleton pregnancies in couples with infertility who did not undergo ART. Velamentous cord insertion was increased following ART (21/468 – 4.5%) when compared with matched controls (20/936 – 2.1%) and couples with a history of infertility who did not undergo ART (6/202 – 2.9%). The incidence of a single umbilical artery was also higher following ART (5/436) compared with matched controls (1/936) and infertility controls (0/202). There was no difference in the incidence of marginal cord insertion, cord twist, true knots, stenosis, thrombosis, cord length, nuchal cords, and prolapsed cord.CONCLUSIONS: We report a higher incidence of velamentous cord insertion and single umbilical artery in singleton pregnancies following ART. These results could be due in part to the techniques associated with ART or their underlying infertility. OBJECTIVE: To determine if umbilical cord abnormalities differ in singleton pregnancies following assisted reproductive technologies (ART) compared to those from spontaneous pregnancies. DESIGN: Case-Control Study. MATERIALS AND METHODS: Outcome of all pregnancies from January 2001 to December 2005 were recorded in the McGill Obstetric and Neonatal Database (MOND). Umbilical cord features were noted at the time of delivery. All cords were subjected to histological examination. Singleton pregnancies derived from ART were compared with spontaneously conceived singleton pregnancies, matched for age and parity, and also with singleton pregnancies in couples with infertility who did not undergo ART. RESULTS: Umbilical cords from 468 singleton deliveries following ART were compared with those from 936 age- and parity-matched spontaneously conceived singleton deliveries and also with those from 202 singleton pregnancies in couples with infertility who did not undergo ART. Velamentous cord insertion was increased following ART (21/468 – 4.5%) when compared with matched controls (20/936 – 2.1%) and couples with a history of infertility who did not undergo ART (6/202 – 2.9%). The incidence of a single umbilical artery was also higher following ART (5/436) compared with matched controls (1/936) and infertility controls (0/202). There was no difference in the incidence of marginal cord insertion, cord twist, true knots, stenosis, thrombosis, cord length, nuchal cords, and prolapsed cord. CONCLUSIONS: We report a higher incidence of velamentous cord insertion and single umbilical artery in singleton pregnancies following ART. These results could be due in part to the techniques associated with ART or their underlying infertility.

Clinical significance of the umbilical cord twist

Objective The objective of this study was to determine the clinical significance of the umbilical cord twist direction. Study design Two hundred singleton third-trimester placentas with a right umbilical cord twist and 200 placentas with a left umbilical cord twist, which was determined by pathologic examination, were included. Maternal and neonatal outcomes were compared with the use of Fisher's exact and Mann Whitney U tests; a probability value of <.05 considered statistically significant. Results Placenta previa was more common in patients with a right umbilical cord twist compared with a left umbilical cord twist (6.0% vs 1.5%; P<.05). There was a trend towards an increased incidence of single umbilical artery in patients with a right umbilical cord twist (2.5% vs 0%; P = .06). The incidence of fetal demise, intrauterine growth restriction, chromosomal abnormalities, congenital anomalies, preterm delivery, infant gender, birth weight, maternal age, and parity were similar between the 2 groups. Conclusion Placenta previa is associated with a right umbilical cord twist.

The missing umbilical artery. I. Prospective study based on a maternity unit.

In a consecutive series of nearly 20,000 freshly delivered placentas, 2 vessels instead of the normal 3 were found in the umbilical cords of 143 (0·72%) infants, 83 females and 60 males. 4 infants were twins: in each instance the co-twin had 3 vessels. The incidence of single umbilical artery (SUA) in multiple pregnancies was slightly less than in singletons. 2 infants with SUA were sibs. There was an increased incidence of major malformations (17·5%), of prematurity (16·5%), and of smallness for dates (34%) among infants with SUA. 25 (17·5%) infants, of whom 19 had a major malformation, died in the perinatal period; of these, 2 had a persistent vitelline artery. (A follow-up study has been carried out on the surviving infants—results to be published.) This investigation into the incidence and significance of SUA is based on what is so far the largest prospective and unselected series collected in a single maternity unit. All placental examinations and necropsies were carried out by one pathologist, all follow-up examinations by one paediatrician.

Significance of a single umbilical artery: Report from the collaborative study of cerebral palsy

1.1. A total of 26,539 placentas of single births obtained from 12 different institutions enrolled in the collaborative study were evaluated, in which 203 (0.76 per cent) showed a single umbilical artery on gross and microscopic examination.2.2. The incidence of single umbilical artery in the white was 1.22 per cent, a higher incidence than in the Negro, which was 0.44 per cent. This racial difference was consistently present in the various institutes and in all maternal age and birth weight groups. Conversely, the incidence of associated congenital malformations was higher in the Negro (42.1 per cent) than in the white (23.0 per cent).3.3. Associated congenital malformations were classified into three Types of malformations: A (lethal or major), B (nonlethal), and C (borderline). The over-all incidence of associated malformations (Types A, B, plus C) was 28.6 per cent. When the Type C malformations were excluded, the incidence was 16.7 per cent. Type A malformations were found in 9 of the 20 stillbirths and in 4 of the 6 neonatal deaths, but only in 7 (4.0 per cent) of the 174 survivors. Skeletal system anomalies showed the highest incidence in the associated malformations.4.4. The incidence of SUA was 1.98 per cent in infants of low birth weight (2,500 grams and under). In infants weighing over 2,500 grams the incidence was 0.63 per cent.5.5. Maternal diabetes was 6.4 per cent, an incidence 5 times higher than in the control group.

INTRAVENOUS PYELOGRAPHY IN INFANTS WITH SINGLE UMBILICAL ARTERY. A PRELIMINARY REPORT.

IN 1955 Benirschke and Brown1 reported extensively on the occurrence of congenital anomalies in association with the absence of one of the two umbilical arteries. This study, together with previous and subsequent investigations, has stimulated interest in the value of this defect as a means of early recognition of neonatal malformations. Prospective studies (Table 1) have shown the incidence of single umbilical artery to vary from 0.2 to 1.3 per cent in consecutive single births and from 0 to 7 per cent in twin births.2 3 4 5 The frequency of congenital anomalies in such series has ranged from 20 to 47 per . . .