Antenatal detection of a single umbilical artery: does it matter?

Abstract

The presence of a single umbilical artery is recognised as a soft marker for congenital anomalies, aneuploidy, earlier delivery and low birthweight. Most of the available data are derived from case series or highly selected populations and are therefore likely to be unrepresentative. In this retrospective case-comparison study, we firstly aimed to determine the incidence of a single umbilical artery in an unselected population and secondly to examine the clinical significance of this soft marker. Over a 40-month period, 107 cases were identified from a cohort of 35 066 births giving an incidence of 3.1 per 1000 total births and late pregnancy losses. The antenatal detection rate was only 30%. Compared to fetuses with normal cord vasculature, fetuses with a single umbilical artery were more likely to be delivered at an earlier gestation and to weigh less, were 1.7 times more likely to be delivered by a Caesarean section and 19% of the cases had a congenital anomaly. The perinatal mortality was 49.0 per 1000 total births, which was 6 times higher than the background hospital rate. The presence of a single umbilical artery is associated with a poorer perinatal outcome compared to that in fetuses with three vessels in the cord. Unfortunately, the antenatal detection rate is poor. Recognising the importance of this soft marker in counselling and management of pregnancies should provide the stimulus to improve detection rates.

Congenital Malformations Associated With a Single Umbilical Artery in Twin Pregnancies

“…We suggest that amniocentesis should only be considered in the presence of fetal anomalies. This finding, and advice, is consistent with previous studies (Gornall et al, 2003;Voskamp et al, 2013).…”

Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population

“…The most commonly suggested theories on the development of a single umbilical artery are primary agenesis or secondary thrombotic atrophy of one of the umbilical arteries (16). A single umbilical artery could be associated with some adverse perinatal outcomes such as growth restriction or higher fetal distress rates during the course of labor when it was described as an isolated finding.…”

Incidencia Y Asociaciones De Arteria Umbilical Única en Recién Nacidos: Maternidad Del Hospital Clínico De La Universidad De Chile, 1998-2010

“…La prevalencia de AUU encontrada en nuestra muestra (0,3 %) es muy superior a la encontrada por nosotros en una comunicación anterior (7) para el período 1978-98 (0,1%), pero muy inferior a la comunicada por otros autores que dan entre 0,6% y 1,2% (11,12,13). Hua y cols (14), en una casuís-tica de 72.373 embarazos da una prevalencia de 0,61% y Horton y cols de 1,3% (6).…”