Significance of the Single Umbilical Artery: A Clinical, Radiological, Chromosomal, and Dermatoglyphic Study

Abstract

P. (1972). Archives of Disease in Childhood, 47, 639. Significance of the single umbilical artery: a clinical, radiological, chromosomal, and dermatoglyphic study. A single umbilical artery is present in about 1% of all singletons. It is associated with a wide range of congenital malformations. Chromosomal analysis of our surviving cases gave normal results. Dermatoglyphic patterns were normal, except that the boys showed a three-to fourfold increase in the number of the radial loops on the fingers, and a lowering of the total finger ridge count. Evidence favouring a common non-genetic cause for both a single umbilical artery and the associated malformations is discussed.Although the absence of one umbilical artery was first reported a century ago (Hyrtl, 1870), the significance of a single umbilical artery (SUA) has only been realized since a retrospective study by Benirschke and Brown (1955) showed it was associated with increased incidence of congenital anomalies. Because most of the investigations on SUA have been made by pathologists, the conclusions drawn may not be applicable to the live infant population. And because most of these studies are retrospective, they may also be biased with respect to the incidence of congenital malformations.The present report concerns a prospective study carried out in a consecutive series of 2572 singletons born in the same hospital and followed up over a period of several years by means of a planned investigative programme including intravenous pyelography (IVP), chromosome patterns, and dermatoglyphs. MethodsIn this investigation the umbilical cord was studied in various ways: gross examination of the freshly delivered umbilical cord and placenta; re-examination after fixation for one week in 10% formaldehyde, followed by the study of H. and E.-stained paraffin sections prepared from the middle portion of the cord.All children with SUA who succumbed during the perinatal period were necropsied. Follow-up study of the survivors included clinical examination, IVP, and Received 13 December 1971. investigation of the karyotype and dermatoglyphs.The mean age at the last examination was 21 months (range, 5 months to 31 years). ResultsIncidence and mortality. In 29 of the 2572 consecutive cords examined (1-1 %), one umbilical artery was lacking. The significance of SUA, and its association with such factors as birthweight, maternal pathology, and placental pathology have been discussed elsewhere (de Clercq et al., 1970).Of the 29 children with SUA, 4 were stillborn and 2 died neonatally, giving a perinatal mortality rate of 21%. Half of the stillborn fetuses (2/29: 7%) showed congenital malformations (Table I).Of the 23 children with SUA still living, 22 were given a complete clinical and neurological examination. In one case examination was refused by the parents; this child had been found to be grossly normal at birth and showed no malformations at

Do babies with isolated single umbilical artery need routine postnatal renal ultrasonography?

“…Of 252 infants with apparently isolated SUA reported in eight studies over 40 years, 38 (15.1%) were found to have renal anomalies on postnatal imaging 7 – 14. These malformations were significant and persistent in half, the most frequent being vesico-ureteric reflux (VUR) of grade 2 or greater.…”

The missing umbilical artery. II. Paediatric follow-up.

“…This remarkably high incidence has not been confirmed in subsequent studies (Van Leuwen, Behringer, and Glenn, 1967;Vlietinck et al, 1972 …”

Malformations associées à l’artère ombilicale unique

“…Le pourcentage de malformations associées à l'artère ombilicale unique varie de 7,4% [20] à 97,5% [18], avec une moyenne de 30,5% [24].…”

“…Dans les travaux réalisés sur le matériel d'autopsie, le pourcentage est nettement plus élevé [8,17,18,23] avec une moyenne de 45,5% [24].…”