PRENATAL AND PERINATAL MORTALITY  

 

  • Perinatal mortality in fetuses with SUA = 8%-60% (mean = 20%) (1-4).
  • The increased perinatal mortality in infants with SUA without associated anomalies suggests that the concomitant abnormality is probably not the cause  (3,5-6).

 

Single umbilical artery has been associated with a worse pregnancy outcome than fetuses with two umbilical arteries.

·         Gornall et al (7)  compared 107 cases of SUA from an unselected cohort of more than 35,000 births as a comparison cohort, and found:

·         Perinatal mortality was 49 per 1000 total births for the SUA group, significantly higher than the 8.3 per 1000 total births rate for all deliveries at the same institution in the same time period.

·         Fetuses with SUA delivered at an earlier gestational age (36.6 versus 38 weeks) weighed less (2706 versus 3017 g), were more likely to be small-for-gestational-age (defined as birthweight < 10th percentile, 27% versus 14% of fetuses), and were 1.7 times more likely to be delivered by cesarean section.

·         These findings have been supported by some studies, whereas others have found no difference (8-14).

·         In the series described previously, the perinatal mortality rate for the isolated SUA group was 24 per 1000 total births, which represented nearly a threefold increase when compared with the general rate in that institution for the same time period, although this was not statistically significant (OR 2.9; 95% CI 0.7,12, P = .15). Some studies have reported an increased rate of IUGR in fetuses with isolated SUA, although most of the data involve small numbers (10,15,16). As an example, in a retrospective analysis of 82 fetuses with SUA, 7 (18%) of the 38 fetuses with prenatally diagnosed SUA had IUGR (10). Increased rates of intrauterine fetal demise and preterm delivery have also been reported for fetuses with isolated SUA (8, 17-21). Other studies have not supported these findings (8,9,20).

 

 

 

REFERENCES
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  2. Leung AKC, Robson WLM. Single umbilical artery. Am J Dis CHILD 1989;143:108-111.
  3. Herrmann UJ, Sidiropoulos D. Single umbilical artery: prenatal findings. Prenat Diagn 1988;8:275-280.
  4. Adler J, Lewenthal H, Ben-Adereth N. Absence of one umbilical artery and its relationship to congenital malformation. Harefuah 1963;65:286-288.
  5. Fujikura T. Single umbilical artery and congenital malformation. Am J Obstet Gynecol 1964;88:829.
  6. Froelich LA,Fujikura T. Follow-up of infants with single umbilical artery. Pediatrics 1973;52:22.
  7. Gornall AS, Kurinczuk JJ, Konje JC. Antenatal detection of a single umbilical artery: does it matter? Prenat Diagn 2003;23:117-23.  
  8. Abuhamad A, Shaffer W, Mari G, Copel JA, Hobbins JC, Evans AT. Single umbilical artery: Does is matter which artery is missing? Am J Obstet Gynecol 1995;173:728-32.  
  9. Parilla BV, Tamura RK, MacGregor SN, Geibel LJ, Sabbagha RE. The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound. Obstet Gynecol 1995;85:570-2.  
  10. Catanzarite VA, Hendricks SK, Maida C, Westbrook C, Cousins L, Schrimmer D. Prenatal diagnosis of the two-vessel cord: implications for patient counseling and obstetric management. Ultrasound Obstet Gynecol 1995;5:75-6.  
  11. ]. Reinhart BK, Terrone DA, Taylor CW, Isler CM, Larmon JE, Roberts WE. Single umbilical artery is associated with an increased incidence of structural and chromosomal anomalies and growth restriction. Am J Perinatol 2000;17:229-32.  
  12. Herrmann UJ, Sidiropoulos D. Single umbilical artery: prenatal findings. Prenat Diagn 1988;8:275-80.
  13. Bjoro K. Vascular anomalies of the umbilical cord: obstetric implications. Early Hum Dev 1983;8:119-27
  14. Pierce BT, Dance VD, Wagner RK, Apodaca CC, Nielsen PE, Calhoun BC. Perinatal outcome following fetal single umbilical artery diagnosis. J Matern Fetal Med 2001;10:59-63.
  15. Catanzarite VA, Hendricks SK, Maida C, Westbrook C, Cousins L, Schrimmer D. Prenatal diagnosis of the two-vessel cord: implications for patient counseling and obstetric management. Ultrasound Obstet Gynecol 1995;5:75-6.
  16. Sepulveda WH. Antenatal sonographic detection of single umbilical artery. J Perinat Med 1991;19:391-5.  
  17. 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;20:619-27
  18. Ulm B, Ulm MR, Deutinger J, Bernaschek G. Umbilical artery Doppler velocimetry in fetuses with a single umbilical artery. Obstet Gynecol 1997;90:205-9.  
  19. Sepulveda WH. Antenatal sonographic detection of single umbilical artery. J Perinat Med 1991;19:391-5.  
  20. Nyberg DA, Mahony BS, Luthy D, Kapur R. Single umbilical artery: prenatal detection of concurrent anomalies. J Ultrasound Med 1991;10:247-53.
  21. Parilla BV, Tamura RK, MacGregor SN, Geibel LJ, Sabbagha RE. The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound. Obstet Gynecol 1995;85:570-2.