Mehmet Nafi SAKAR, Süleyman Cemil OĞLAK, Süreyya DEMİR, Hüseyin GÜLTEKİN, Bülent DEMİR

Isolated Single Umbilical Artery: Implications For Pregnancy

This study aimed to evaluate whether the presence of an isolated single umbilical artery (iSUA) is associated with a dverse perinatal outcomes. Fifty-one patients with iSUA and 54 controls were enrolled in the case-control study. Demographic characteristics and perinatal outcomes were recorded. All patients had normal umbilical artery (UMA) Doppler findings, and their de tailed ultrasound weeks were between 18 and 23 weeks. The birth weights of the babies in the iSUA group were significantly lower than the control group (2898.82±434.56 g vs 3143.70±419.09 g, p=0.004). In the iSUA group, oligohydramnios (7.8% vs 0%) , preterm premature rupture of membranes (PPROM) (3.9% vs 0%), preterm delivery (9.8% vs 3.7%), small for gestational age (SGA) (11.8% vs 3.7%) and neonatal intensive care unit (NICU) (2% vs 0%) admission rates were higher than control group, but there was no statistical significance (p>0.05). But the total adverse pregnancy outcomes were observed in 35.3% (18/51) of cases with iSUA is higher than controls 7.4% (4/54) (p=0.001). In our study, iSUA is found to be associated with low newborn weight. In the iSUA group, oligohydramnios, PPROM, preterm delivery, SGA, and NICU admission rates were high, but there was no statistical significance. But the total adverse pregnancy outcomes were higher in the iSUA group. These results indicate that close follow-up is essential to prevent and manage adverse perinatal outcomes in iSUA patients.

PDF

___

1. Moore KL (1988) The cardiovascular system. In: Moore KL (ed) The Developing Human, 4th edn.Philadelphia, PA: W.B. Saunders Co., pp 286-333.

2. Gornall AS, Kurinczuk JJ, Konje JC. Antenatal detection of a single umbilical artery: does it matter? Prenat Diagn 2003; 23: 117-123.

3. Bombrys AE, Neiger R, Hawkins S, Sonek J, Croom C, McKenna D, et al. Pregnancy outcome in isolate single umbilical artery. Am J Perinatol 2008; 25: 239-242.

4. Wiegand S, McKenna DS, Croom C, Ventolini G, Sonek JD, Neiger R. Serial sonographic growth assessment in pregnancies complicated by an isolated single umbilical artery. Am J Perinatol 2008; 25: 149-152.

5. Battarbee AN, Palatnik A, Ernst LM, Grobman WA. Placental abnormalities associated with isolated single umbilical artery in-small-for-gestational-age births. Placenta 2017; 59: 9-12.

6. Feldstein VA, Harris RD, Machin GA (2008) Ultrasound evaluation of the placenta and umbilical cord. In: Callen PW (ed). Ultrasonography in Obstetrics and Gynecology. 5th edn. Philadelphia, PA: Saunders Elsevier pp 744.

7. Chow JS, Benson CB, Doubilet PM. Frequency and nature of structural anomalies in fetuses with single umbilical arteries. J Ultrasound Med 1998; 17: 765-768.

8. Saller DN, Keene CL, Sun CC, Schwartz S. The association of single umbilical artery with cytogenetically abnormal pregnancies. Am J Obstet Gynecol 1990; 163: 922-925.

9. Sherer DM, Khoury-Collado F, Dalloul M, Osho JA, Lamarque MD, Fomitcheva L, et al. Recurrent antepartum compression of a single artery double nuchal cord necessitating emergency cesarean delivery. Am J Perinatol 2005; 22: 437-440.

10. Kim HJ, Kim J, Chay DB, Park JH, Kim MA. Association of isolated single umbilical artery with perinatal outcomes: Systemic review and meta-analysis. Obstet Gynecol Sci 2017; 60: 266-273.

11. Chetty-John S, Zhang J, Chen Z, Albert P, Sun L, Klebanoff M, et al. Long-term physical and neurologic development in newborn infants with isolated single umbilical artery. Am J Obstet Gynecol 2010; 203: 368e1-7.

12. Horton AL, Barroilhet L,Wolfe HM. Perinatal outcomes in isolated single umbilical artery. Am J Perinatol 2010; 27: 321-324.

13. Hua M, Odibo AO, Macones GA, Roehl KA, Crane JP, Cahill AG. Single umbilical artery and its associated findings. Obstet Gynecol 2010; 115: 930-934.

14. Tulek F, Kahraman A, Taşkın S, Özkavukçu E, Söylemez F. Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population. J Turk Ger Gynecol Assoc 2015; 16: 21-24.

15. Murphy-Kaulbeck L, Dodds L, Joseph KS, Van den Hof M. Single umbilical artery risk factors and pregnancy outcomes. Obstet Gynecol 2010; 116: 843-850.

16. Lilja M. Infants with single umbilical artery studied in a national registry. General epidemiological characteristics. Paediatr Perinat Epidemiol 1991; 5: 27-36.

17. Burshtein S, Levy A, Holcberg G, Zlotnik A, Sheiner E. Is single umbilical artery an independent risk factor for perinatal mortality? Arch Gynecol Obstet 2011; 283: 191-194.

18. Dagklis T, Defigueiredo D, Staboulidou I, Casagrandi D, Nicolaides KH. Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet Gynecol 2010; 36: 291-295.

19. Xu Y, Ren L, Zhai S, Luo X, Hong T, Liu R, et al. Association Between Isolated Single Umbilical Artery and Perinatal Outcomes: A Meta-Analysis. Med Sci Monit 2016; 22: 1451- 1459.

20. Battarbee AN, Palatnik A, Ernst LM, Grobman WA. Association of Isolated Single Umbilical Artery With Small for Gestational Age and Preterm Birth. Obstet Gynecol 2015; 126: 760-764.

21. Mu S, Lin C, Chen Y, Sung T, Bai C, Jow G. The Perinatal Outcomes of Asymptomatic Isolated Single Umbilical Artery in Full-term Neonates. Pediatr Neonatol 2008; 49: 230-233.

22. Caldas LM, Liao A, Carvalho MH, Francisco RP, Zugaib M. Should fetal growth be a matter of concern in isolated single umbilical artery? Rev Assoc Med Bras (1992) 2014; 60: 125-130.

23. Blum M, Weintraub AY, Baumfeld Y, Rotem R, Pariente G. Perinatal Outcomes of Small for Gestational Age Neonates Born With an Isolated Single Umbilical Artery. Front Pediatr 2019; 7: 79.

24. Naveiro-Fuentes M, Carrillo-Badillo MP, Malde-Conde J, Gallo-Vallejo JL, PuertasPrieto A. Perinatal outcomes in singleton pregnancies with a single umbilical artery. J Matern Fetal Neonatal Med 2016; 29: 1562- 1565.

25. Ashwal E, Melamed N, Hiersch L, Edel S, Bardin R, Wiznitzer A, et al. The impact of isolated single umbilical artery on labor and delivery outcome. Prenat Diagn 2014; 34: 581- 585.

26. Ebbing C, Kessler J, Moster D, Rasmussen S. Isolated single umbilical artery and the risk of adverse perinatal outcome and third stage of labor complications: A population‐based study. Acta Obstet Gynecol Scand 2020; 99: 374-380.

27. Thummala MR, Raju TNK, Langenberg P. Isolated Single Umbilical Artery Anomaly and the Risk for Congenital Malformations: A Meta-Analysis. J Pediatr Surg 1998; 33: 580- 585.

28. Joó JG, Beke A, Papp Z, Rigó J, Papp C. Single umbilical artery in fetopathological investigations. Pathol ResPract 2008; 204: 831-836.

29. Blazer S, Sujov P, Escholi Z, Itai BH, Bronshtein M. Single umbilical artery; right or left? Does it matter? Prenatal Diagn 1997; 17: 5-8.

30. Doornebal N, de Vries TW, Bos AF, De Vries NK. Screening infants with an isolated single umbilical artery for renal anomalies: nonsense? Early Hum Dev 2007; 83: 567-570.

31. Wu MH, Chang FM, Shen MR, Yao BL, Chang CH, Yu CH, et al. Prenatal sonographic diagnosis of single umbilical artery. J Clin Ultrasound 1997; 25: 425-430.

32. Hill LM, Wibner D, Gonzales P, Chenevey P. Validity of transabdominal sonography in the detection of a two-vessel umbilical cord. Obstet Gynecol 2001; 98: 837-842.

33. Rembouskos G, Cicero S, Longo D, Sacchini C, Nicolaides KH. Single umbilical artery at 11-14 weeks' gestation: relation to chromosomal defects. Ultrasound Obstet Gynecol 2003; 22: 567-570.

34. Stout MJ, Odibo AO, Longman R, Shanks AL, Cahill AG. The incidence of isolated single umbilical artery in twins and adverse pregnancy outcomes. Prenat Diagn 2013; 33: 269-272.