Single umbilical artery
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At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosuresAt the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures- Single umbilical artery (SUA)
- Solitary umbilical artery
- Two vessel umbilical cord
- Two vessel cord (TVC)
- 2 vessel cord
- Two vessel cord (2VC)
Single umbilical artery is a congenital absence of either the right or left umbilical artery. In the usual situation, there are paired umbilical arteries. For unknown reasons, the absence of the left umbilical artery is much more common (~70%).
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Epidemiology
The estimated prevalence is ~0.4-1% of pregnancies 5,6,10. There may be an increased incidence of twin pregnancies and maternal diabetes.
Associations
When found in isolation, it is usually not of clinical significance but there is an increased incidence of intrauterine growth restriction (IUGR) 6 (~15%).
Recognized associations are thought to be present in ~35% (range 25-43%) of cases:
twin reversed arterial perfusion sequence
increased incidence of intrauterine growth restriction (IUGR)
When found with other fetal anomalies, it can also be associated with:
-
trisomy 18 (50%)
trisomy 13 (25%)
trisomy 21 (13%)
-
renal agenesis: occurs usually on the side where the artery is absent 10
Some suggest that complex congenital and chromosomal abnormalities are found almost exclusively when the left umbilical artery is absent 9
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Pathology
The occurrence of a single umbilical artery is thought to be due to secondary atresia or atrophy rather than primary agenesis of the artery. The remaining single artery is often quite large and approaches the size of the umbilical vein (which is usually larger than the artery).
In ~65% (range 57-75%) of cases, a single umbilical artery is present in isolation 1,2.
Radiographic features
Ultrasound
This is the imaging investigation of choice and a single umbilical artery is often detected incidentally on ultrasound. High-resolution ultrasound has a sensitivity and specificity approaching 100% 1. Sonographic features include:
two vessels within the umbilical cord (one artery and one vein) instead of the usual three (best seen in cross-section)
the single artery is often larger in caliber than normal and approaches the diameter of the accompanying vein
examination of the fetal pelvis will demonstrate only one umbilical artery lateral to the bladder in its course toward the umbilical cord
References
- 1. Pierce BT, Dance VD, Wagner RK et-al. Perinatal outcome following fetal single umbilical artery diagnosis. J Matern Fetal Med. 2001;10 (1): 59-63. J Matern Fetal Med (link) - Pubmed citation
- 2. Geipel A, Germer U, Welp T et-al. Prenatal diagnosis of single umbilical artery: determination of the absent side, associated anomalies, Doppler findings and perinatal outcome. Ultrasound Obstet Gynecol. 2000;15 (2): 114-7. doi:10.1046/j.1469-0705.2000.00055.x - Pubmed citation
- 3. Parilla BV, Tamura RK, Macgregor SN et-al. The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound. Obstet Gynecol. 1995;85 (4): 570-2. doi:10.1016/0029-7844(94)00451-I - Pubmed citation
- 4. Chetty-john S, Zhang J, Chen Z et-al. Long-term physical and neurologic development in newborn infants with isolated single umbilical artery. 2010;doi:10.1016/j.ajog.2010.06.031 - Pubmed citation
- 5. Murphy-kaulbeck L, Dodds L, Joseph KS et-al. Single umbilical artery risk factors and pregnancy outcomes. Obstet Gynecol. 2010;116 (4): 843-50. doi:10.1097/AOG.0b013e3181f0bc08 - Pubmed citation
- 6. Hua M, Odibo A, Macones G, Roehl K, Crane J, Cahill A. Single Umbilical Artery and Its Associated Findings. Obstet Gynecol. 2010;115(5):930-4. doi:10.1097/AOG.0b013e3181da50ed - Pubmed
- 7. Eberhard Merz. Ultrasound in Obstetrics and Gynecology. (2005) ISBN: 9781588901477 - Google Books
- 8. Vlietinck RF, Thiery M, Orye E et-al. Significance of the single umbilical artery. A clinical, radiological, chromosomal, and dermatoglyphic study. Arch. Dis. Child. 1972;47 (254): 639-42. doi:10.1136/adc.47.254.639 - Free text at pubmed - Pubmed citation
- 9. Abuhamad AZ, Shaffer W, Mari G et-al. Single umbilical artery: does it matter which artery is missing? Am. J. Obstet. Gynecol. 1995;173 (3 Pt 1): 728-32. Am. J. Obstet. Gynecol. (link) - Pubmed citation
- 10. Michael Entezami. Ultrasound Diagnosis of Fetal Anomalies. (2004) ISBN: 9781588902122 - Google Books
- 11. Lubusky M, Dhaifalah I, Prochazka M et al. Single Umbilical Artery and Its Siding in the Second Trimester of Pregnancy: Relation to Chromosomal Defects. Prenat Diagn. 2007;27(4):327-31. doi:10.1002/pd.1672 - Pubmed
Incoming Links
- Fetal MRI
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- 13 pairs of ribs and absent radius
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