Abstract
Objective
To assess the frequency and accuracy of prenatal diagnosis of a single umbilical artery
(SUA) and to compare the fetal and neonatal outcome of isolated SUA to that of a normal
three-vessel umbilical cord in a population from the Middle East and Gulf region.
Study design
Data were collected from 37,500 singleton pregnancies that were scheduled for antenatal
care and delivered at Security Forces Hospital in Riyadh, Saudi Arabia, between May
2004 and December 2012. Comparisons between the groups were performed using a chi-square
test or a Fisher exact test for the categorical variables, and Student's t test or Wilcoxon's rank-sum test were used for continuous variables. The Kappa statistic
was used to study the agreement between the antenatal and final neonatal diagnosis
of SUA. A univariable analysis was used to calculate the unadjusted and adjusted ORs
and the 95% CIs expressing the relationship of the normal three-vessel umbilical cord,
the isolated SUA, and each outcome.
Results
A total of 35,249 cases completed the study, including 35,026 cases with normal neonatal
three-vessel umbilical cords (Group B). SUA was present in 223 (0.63%) neonates (0.45%
isolated SUA (Group A) and 0.18% non-isolated SUA). The sensitivity, specificity,
positive predictive value and negative predictive value of using prenatal ultrasound
for the diagnosis of SUA were 90.58%, 99.9%, 98.5% and 99.94%, respectively. Neonatal
anomaly was present in 2.6% of the fetuses with isolated SUA. A pregnancy with isolated
SUA was more likely to be complicated with polyhydramnios (OR 3.32; CI 1.22–9.04),
preterm delivery <34 weeks (OR 4.662; CI 2.346–9.195), birth weight <10th percentile
(OR 2.1; CI 1.44–2.93), cesarean delivery for fetal distress (OR 2.72; CI 1.53–4.81),
perinatal death (OR 3.31; CI 1.34–8.12), admission to NICU (OR 2.71; CI 1.87–3.91),
and placental abnormalities (OR 3.25; CI 2.14–4.93; p value 0.0001) compared to a pregnancy with a fetal and neonatal three-vessel cord.
Conclusion
Isolated SUA is associated with anomalies at birth and with an increased risk of adverse
pregnancy outcomes even in the absence of other anomalies. A pregnancy with this complication
should receive close fetal monitoring for growth and fetal wellbeing.
Keywords
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References
- The missing umbilical artery: a prospective study based on a maternity unit.Arch Dis Child. 1974; 49: 844-852
- Single umbilical artery: a statistical analysis of 237 autopsy cases and review of the literature.Perspect Pediatr Pathol. 1984; 8: 345-378
- Single umbilical artery: a report of 159 cases.Am J Dis Child. 1989; 143: 108-111
- Single umbilical artery: accurate diagnosis?.Am J Obstet Gynecol. 1993; 169: 538-540
- The association of single umbilical artery with cytogenetically abnormal pregnancies.Am J Obstet Gynecol. 1990; 163: 922-925
- Single umbilical artery: prenatal detection of concurrent anomalies.J Ultrasound Med. 1991; 10: 247-253
- Prenatal diagnosis of the two-vessel cord: implications for patient counseling and obstetric management.Ultrasound Obstet Gynecol. 1995; 5: 98-105
- Perinatal management and outcome of fetuses with single umbilical artery diagnosed prenatally.J Matern Fetal Investig. 1998; 8: 156-159
- The use of color Doppler imaging for prenatal diagnosis of umbilical cord anomalies: report of three cases.Am J Obstet Gynecol. 1989; 161: 1195-1197
- Single umbilical artery and its associated findings.Obstet Gynecol. 2010; 115: 930-934
- Single umbilical artery risk factors and pregnancy outcomes.Obstet Gynecol. 2010; 116: 843-850
- Validity of transabdominal sonography in the detection of a two-vessel umbilical cord.Obstet Gynecol. 2001; 98: 837-842
- Morphology of arterial anastomoses in the human placenta.Folia Morphol (Warsz). 1974; 33: 53-60
- The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound.Obstet Gynecol. 1995; 85: 570-572
- Pregnancy outcome in isolated single umbilical artery.Am J Perinatol. 2008; 25: 239-242
- Frequency and nature of structural anomalies in fetuses with single umbilical arteries.J. Ultrasound Med. 1998; 17: 765-768
- 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
- Fetal growth assessment and neonatal birth weight in fetuses with an isolated single umbilical artery.Obstet Gynecol. 2005; 105: 1093-1097
Article info
Publication history
Published online: October 07, 2013
Accepted:
September 21,
2013
Received in revised form:
August 29,
2013
Received:
June 12,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
