Single Umbilical Artery

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Single Umbilical Artery

• Resmy Palliyil Gopi

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Umbilical cord

• 2 umbilical arteries
• 1 umbilical vein
• Rudimentary allantois
• Remnant of omphalomesenteric duct
• Whartons jelly

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Incidence

• Most common congenital malformation of the
  umbilical cord
• 5-10 in 1000 births (35-70 in 1000 twin births)
• Left artery tends to be absent more often than
  the right
• More common in Caucasian women

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Conditions associated with single umbilical artery

• Advanced maternal age
• Multiparity
• Maternal diabetes
• Hypertension / toxemia
• Ante partum hemorrhage
• Poly/oligo hydramnios

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Pathogenesis

• Primary agenesis
• Secondary atrophy or atresia of a previously
  normal umbilical artery
• Persistence of the original allantoic artery of
  the body stalk

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Classification of SUA
Type of patent vessels Consists of Frequency
I two One UA (allantoic) and left UV Common
II two One UA (vitelline) and left UV Rare
III three One UA and both UV Very rare
IV two One UA and right UV Very rare
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Associated prenatal complications

• Isolated (1/2 to 2/3rd)
• Associated congenital malformations (30)
• Fetal structural abnormalities
• Chromosomal abnormalities (trisomy 18/13)
• Genetic syndromes (VATER, sirenomelia sequence)
• IUGR
• Prematurity
• Still birth and spontaneous abortions
• Placental abnormalities

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Diagnosis

• prenatal
• Ultrasound (only two vessels are seen and artery
  is abnormally large)
• Color Doppler
• postnatal
• Examination of the cord

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Color Doppler
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Management considerations

• Detailed ultrasonographic examination
• Fetal echocardiography
• Fetal genetic testing
• Enhanced fetal surveillance
• Serial ultrasound to assess fetal growth
• Biophysical profile, NST
• Physical evaluation of the neonate
• Neonatal renal ultrasonography

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• Prognosis
• - depends on the associated anomalies
• Recurrence risk
• - Unknown

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Abnormalities of the umbilical cord

• Abnormalities of the cord length and diameter
• Short cords and long cords

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Abnormalities of the umbilical cord

• Distortional abnormalities
• loops, knots (true or false), torsions and twists

True knot
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False knot
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Twist
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Other abnormalities of the umbilical cord

• Neoplasms of the umbilical cord
• Thrombosis, hemangioma, hematoma, teratoma
• edema

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Velamentous insertion of the umbilical cord
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