Transcript Single Umbilical Artery - Resmy Palliyil Gopi, M.D.

Single Umbilical Artery
Resmy Palliyil Gopi
Umbilical cord
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2 umbilical arteries
1 umbilical vein
Rudimentary allantois
Remnant of omphalomesenteric duct
Whartons jelly
Incidence
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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
Conditions associated with single
umbilical artery
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Advanced maternal age
Multiparity
Maternal diabetes
Hypertension / toxemia
Ante partum hemorrhage
Poly/oligo hydramnios
Pathogenesis
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Primary agenesis
Secondary atrophy or atresia of a previously
normal umbilical artery
Persistence of the original allantoic artery of
the body stalk
Classification of SUA
Typ
e
I
# of patent
vessels
two
Consists of
Frequency
II
two
III
three
One UA (vitelline) and Rare
left UV
One UA and both UV Very rare
IV
two
One UA and right UV
One UA (allantoic) and Common
left UV
Very rare
Associated prenatal complications
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Isolated (1/2 to 2/3rd)
Associated congenital malformations (30%)
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Fetal structural abnormalities
Chromosomal abnormalities (trisomy 18/13)
Genetic syndromes (VATER, sirenomelia sequence)
IUGR
Prematurity
Still birth and spontaneous abortions
Placental abnormalities
Diagnosis
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prenatal
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Ultrasound (only two vessels are seen and artery is
abnormally large)
Color Doppler
postnatal
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Examination of the cord
Color Doppler
Management considerations
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Detailed ultrasonographic examination
Fetal echocardiography
Fetal genetic testing
Enhanced fetal surveillance
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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
Abnormalities of the umbilical cord
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Abnormalities of the
cord length and
diameter
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Short cords and long
cords
Abnormalities of the umbilical cord
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Distortional abnormalities
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loops, knots (true or false), torsions
and twists
True knot
False knot
Twist
Other abnormalities of the umbilical
cord
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Neoplasms of the
umbilical cord
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Thrombosis,
hemangioma,
hematoma, teratoma
edema
Velamentous insertion of the umbilical
cord
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