Title: Single Umbilical Artery
1Single Umbilical Artery
2Umbilical cord
- 2 umbilical arteries
- 1 umbilical vein
- Rudimentary allantois
- Remnant of omphalomesenteric duct
- Whartons jelly
3(No Transcript)
4Incidence
- 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
5Conditions associated with single umbilical artery
- Advanced maternal age
- Multiparity
- Maternal diabetes
- Hypertension / toxemia
- Ante partum hemorrhage
- Poly/oligo hydramnios
6Pathogenesis
- Primary agenesis
- Secondary atrophy or atresia of a previously
normal umbilical artery - Persistence of the original allantoic artery of
the body stalk
7Classification 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
8Associated 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
9Diagnosis
- prenatal
- Ultrasound (only two vessels are seen and artery
is abnormally large) - Color Doppler
- postnatal
- Examination of the cord
10Color Doppler
11Management 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
12- Prognosis
- - depends on the associated anomalies
- Recurrence risk
- - Unknown
13Abnormalities of the umbilical cord
- Abnormalities of the cord length and diameter
- Short cords and long cords
14Abnormalities of the umbilical cord
- Distortional abnormalities
- loops, knots (true or false), torsions and twists
True knot
15False knot
16Twist
17Other abnormalities of the umbilical cord
- Neoplasms of the umbilical cord
- Thrombosis, hemangioma, hematoma, teratoma
- edema
18Velamentous insertion of the umbilical cord
19Thank you