Presence Of Single Umbilical Artery Research Articles

Роль оцінювання провізорних органів у діагностуванні патології плода

Aim - to evaluate the potential of using data on provisional organs’ changes and fetal growth restriction (FGR) for the diagnosis of fetal pathology, including severe/sublethal pathology - multiple malformations and chromosomal abnormalities (CA). Materials and methods. The results of complex prenatal examinations of 2954 high-risk pregnant women performed in 2020-2022 were analyzed. The rate of FGR, placenta, umbilical cord and amniotic fluid changes were compared depending on the presence of fetal pathology by Chi-Square (χ2) test and odds ratio (OR) calculation. Results. 853 cases of fetal pathology (28.9%) were diagnosed, including cases of 658 anatomical malformations and 195 CA. 264 observations of multiple malformations and CA were allocated to the subgroup of severe pathology. The rates of provisional organs’ changes were significantly higher in presence of fetal pathology: FGR in the control group 2.0%, in the group of fetal pathology 19.5%, in the group of severe pathology 36.7%; single umbilical artery in 1.1%, 9.3% and 14.8%, respectively, velamentous/marginal cord insertion in 1.95%, 7.4% and 8.3%, respectively. OR of fetal pathology in presence of FGR was 11.6, in presence of single umbilical artery 9.2, in presence of FGR combined with polyhydramnios 97.9; for single umbilical artery combined with polyhydramnios 30, combined with oligohydramnios, combined with FGR 13.6. OR of severe pathology in presence of FGR was 27.8, for combination of FGR and polyhydramnios 172.1; in presence of single umbilical artery 15.7, its combination with polyhydramnios 57.2, with FGR 35.5. These markers had low sensitivity, high specificity and accuracy. Conclusions. Early FGR, polyhydramnios, oligohydramnios, single umbilical artery, velamentous/marginal umbilical cord insertion, structural placenta changes are associated with the higher rate of fetal pathology. These findings must prompt women’s referral to tertiary prenatal diagnosis departments and may be an indication for prenatal invasive procedures. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Особливості перебігу вагітності за наявності єдиної пупкової артерії плода

Among the abnormalities in the number of umbilical cord vessels, the single umbilical artery (SUA) is most common. The influence of some endocrine, gynecological and general factors on the occurrence of SUA, the detection of SUA at different stages of pregnancy, as well as the effect of SUA on the course of pregnancy and the condition of the fetus are assumed. In most cases, according to different data – 57–75%, SUA is an isolated change and does not affect the course of pregnancy and childbirth, as well as the postnatal period. Other authors see a significant impact of SUA on the course of such pregnancy and childbirth. The article presents some features of the course of pregnancy with SUA compared with pregnant women with three umbilical cord vessels and physiological labor in the future. The objective: to study and analyze the peculiarities of pregnancy with SUA, to conduct a comparative description of the revealed features with such indicators among pregnant women with three umbilical cord vessels. Materials and methods. 31 pregnant with a single umbilical artery of the fetus (study group), 62 pregnant with 2 umbilical arteries of the fetus (control group). Results. In pregnant women with SUA, increased body weight, first blood group, and diseases of insulin-dependent diabetes mellitus were observed with greater frequency. In the history of pregnant women with SUA, artifactual abortions, spontaneous miscarriages, or missed pregnancies are more common than pregnant women who have two umbilical arteries of the fetus. Among pregnant women with SUA during pregnancy, the risk of miscarriage, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes and the threat of premature birth are significantly more common. Premature birth occurs in 12.9% of pregnant women with SUA. The reverse blood flow in the venous duct, detected by ultrasound at 12–13 weeks of gestation, was detected in 19.4% of pregnant women with EPA. According to Doppler, when comparing pregnant women with fetal EPA and two umbilical arteries, there are true negative changes in the direction of increased peripheral vascular resistance (according to the blood flow velocity in the aorta of the fetus) and a tendency to centralize blood circulation (according to cerebro-aortic index) in fetuses with SUA. The average Doppler indices of other vessels of the placental complex do not differ between the two studied groups of pregnant women. According to hormonal studies in pregnant women with SUA at the end of the first trimester of pregnancy in 26.8%, rates of PAPP-A were higher than the reference values (in the control group – 6.4%). Conclusions. Identified features among pregnant women with SUA, such as increased body weight, first blood group, diseases of insulin-dependent diabetes mellitus and a significant number of spontaneous miscarriages and missed abortion in history, can be cumulative risk factors for the occurrence of SUA. Among pregnant women with SUA during pregnancy, the threat of miscarriage, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes and the threat of premature birth are significantly more common. Premature birth occurs in 12.9% of pregnant women with EPA. In the period of 12-13 weeks, the reverse blood flow in the venous duct can be considered a marker of SUA. The features we found in terms of Doppler metrics indicate true negative changes in the direction of increasing peripheral vascular resistance (according to the blood flow velocity in the aorta of the fetus) in fetuses with SUA. An increase in PAPP-A can serve as a marker of the presence of SUA in the fetus in early pregnancy. Key words: single umbilical artery, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes, venous duct, dopplerometry, PAPP-A.

Single umbilical artery and reproduction losses in Slovak population: relation to karyotype and fetal anomalies.

The purpose of this study was to monitor the association between single umbilical artery (SUA), chromosomal abnormalities and associated anomalies during the routine examination of spontaneous or induced miscarriages and premature births. During 1992-2015 we morphologically and cytogenetically examined a series of 4098 samples. For 1330 cases the number of umbilical cord vessels could be reported. The presence of single umbilical artery was identified in 67 fetuses of 1330 pregnancies (5.04%); 36 of the 67 fetuses (53.7 %) had additional congenital malformations. The cultures were unsuccessful in 29 of 67 cases (43.3 %). 38 cases (56.7 %) were successfully karyotyped; 20 out of them had anormal karyotype and 18 had chromosomal anomalies including trisomy 18 (n = 4), trisomy 13 (n = 3), trisomy 21 (n = 2), trisomy 11 (n = 1), triploidy (n = 3), monosomy X (n = 3) and structural chromosomal aberrations (n = 2). Isolated SUA is not at increased risk of chromosomal abnormalities and generally does not endanger pregnancy. All chromosomally abnormal embryos and fetuses had associated congenital anomalies. The most frequently associated congenital anomalies were in the musculoskeletal system, central nervous system and genitourinary tract (Tab. 4, Ref. 44).

Anomalies associated with single umbilical artery at perinatal autopsy.

We evaluated 214 fetuses sent for autopsy with gestational ages ranging from 12 to 39 weeks. Of these, seventeen fetuses (7.9%) had single umbilical artery. Thirteen of these fetuses were aborted after antenatal detection of severe malformations and 4 died in utero. Genito-urinary system (n=6) and central nervous system (n=4) were the most common sites of involvement. Presence of single umbilical artery warrants a detailed evaluation of the fetus for other anomalies.

Antenatal detection of single umbilical artery: what does it mean?

Introduction: The presence of a single umbilical artery (SUA) is recognised as a soft marker for congenital anomalies, aneuploidy, earlier delivery and intra-uterine growth restriction and/or low birth weight. The aim of this study was to assess the incidence of SUA in a selected population. And secondly, to examine the clinical signiÞ cance of this soft marker. Material and methods: A retrospective analysis, over a 36-month period, of all cases of pregnancy interruption due to medical causes, up to 16 weeks of gestation, with prenatal diagnosis of SUA; cases of live born with a prenatal diagnosis of SUA or after delivery, at the routine examination of the placenta. Fetal growth and the risk of preterm labor are also to consider in the surveillance of these pregnancies. Results: Thirty nine cases of SUA were identiÞ ed during the study period. Incidence of SUA in live born was 0.32% (n=30) and in pregnancy interruption due to medical causes was 12.9% (n=9). The antenatal detection rate was 77%. This ecographic soft marker was an isolated Þ nding in 27 live born (90%). In live born with SUA and associated malformations (13.3%), urinary abnormalities were identiÞ ed in three cases (75%), and a skeletal with esophageal malformation was identiÞ ed in one case (25%). Preterm birth occurred in seven cases (23.3%) and birth weight below 10 th percentile in four cases (13.3%). Discussion and conclusions: The presence of SUA in antenatal period should alert the sonographer and clinician for the need of a detailed examination of the fetus to exclude other anomalies. Fetal growth and the risk of preterm labor are also to consider in the surveillance of these pregnancies.

Serial Sonographic Growth Assessment in Pregnancies Complicated by an Isolated Single Umbilical Artery

Pregnancies complicated by an isolated single umbilical artery (SUA) are thought to be at increased risk for intrauterine growth restriction (IUGR). The management of these pregnancies often includes serial sonographic assessments of fetal growth. The goal of our study was to test the validity of this assertion. We conducted a longitudinal sonographic assessment of intrauterine fetal growth in pregnancies complicated by a SUA. We included pregnancies where fetal growth was assessed three or more times, and the presence of SUA was repeatedly demonstrated. Pregnancies with fetal anomalies and multiple gestations were excluded. IUGR was defined as an estimated fetal weight (EFW) < or = 10th percentile of the normal ranges established by Hadlock. Between January 1999 and December 2005, we identified 273 pregnancies with SUA, for an overall incidence of 0.48% within the total population of patients examined at our institution. One hundred and thirty-five pregnancies did not meet our inclusion criteria. Of the 138 we analyzed, four pregnancies (2.9%) were found to have EFW < or = 10th percentile. We concluded that the occurrence of IUGR in pregnancies complicated by an isolated SUA is not increased. Serial sonographic assessments of fetal growth do not appear to be indicated in the management of such pregnancies.

Epidemiological association between isolated skin marks in newborn infants and single umbilical artery (SUA). Does it have biological plausibility?

In a previous study on single umbilical artery (SUA) and its association with congenital defects, we observed a serendipitous association between isolated skin anomalies and the presence of SUA. Although this could be a spurious association, we considered that it deserved to be studied in detail. The aim of this study was to investigate, in an epidemiological setting, whether this association has any biological meaning or if it occurs just by chance. Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), we analyzed "angiomas" (including all type of capillary skin marks, since it is not possible to distinguish it during the first 3 days of life), and nevi because they are the only defects detected in newborn infants as isolated skin defects. In the ECEMC methodology, infants with nevi or angiomas as the only congenital defect are considered as cases when they present with only one of these skin marks measuring at least 1 cm in diameter and within the first 3 days of life, or when they have three or more such marks of any size. A total sample of 1,832 consecutive newborn infants with isolated congenital skin marks was identified: 871 with nevi, 958 with angiomas, and 3 with both. Newborn infants with SUA and isolated angiomas displayed higher birth measurements, and older maternal and paternal ages than newborn infants with angiomas and three umbilical vessels. Similar results were observed when infants with angiomas and SUA were compared with control infants either with or without SUA. These associations were not observed in newborn infants with nevi with or without SUA or for control infants with or without SUA. The distribution of the angiomas by body areas, and sex preferences were also analyzed. After evaluating the limitations and advantages of the present study, the results suggest that newborn infants with angiomas (irrespective of their type), SUA, and higher centile measurements may have one of the syndromes that exhibit this type of skin mark. Although this observation requires confirmation, we do suggest close attention to newborns with these three signs.

WS17‐10Sonographic evaluation of the umbilical cord throughout gestation

Traditionally, the prenatal assessment of the umbilical cord (UC) is limited to the assessment of the number of vessels and to the evaluation of umbilical artery blood flow parameters. Morphologic aspects of the UC have usually been studied by pathologists and retrospectively correlated with the perinatal outcome. The introduction of more sophisticated imaging techniques have offered the possibility to investigate the UC characteristics during fetal life from early to late gestation. A number of investigations have demonstrated that an altered structure of the UC can be associated with pathologic conditions (i.e. preeclampsia, fetal growth restriction, diabetes, fetal demise). Nomograms of the various UC components have been generated and allow the identification of lean or large umbilical cords, entities frequently associated with fetal growth abnormalities and diabetes, respectively. Of note, lean UC in the second and third trimester differs from normal UC not only from a structural point of view but also in the umbilical vein blood flow characteristics. On the other hand a thin UC in the first trimester seems to be a marker for identifying a subset of fetuses at risk for spontaneous abortion and pre‐eclampsia. A Wharton's jelly reduction has also been invoked as a possible cause of fetal death in the presence of single umbilical artery. Prenatal morphometric and morphologic UC characteristics as well as UC arterial and venous blood flow parameters in normal and pathologic conditions will be presented and discussed.

Malformations and chromosome anomalies in spontaneously aborted fetuses with single umbilical artery

Presence of a single umbilical artery was noted 13 times among a series of 879 consecutively collected, spontaneously aborted embryos and fetuses. This rate of 1.5% is approximately twice that reported from the largest series of term births. Eight of the 13 fetuses had additional serious malformations. Of nine successfully karyotyped fetuses, six had chromosome anomalies. All six occurred in fetuses with severe malformations in addition to the single umbilical artery. The presence of single umbilical artery with other major anatomic defects may be a significant predictor of the presence of chromosome anomalies in live births. Early recognition of offspring with chromosome anomalies will be useful in counseling the family and in managing the care of the infant.