Singular umbilical artery
| Classification according to ICD-10 | |
|---|---|
| Q27.0 | Congenital absence or hypoplasia of the umbilical artery, singular umbilical artery |
| ICD-10 online (WHO version 2019) | |
As Single umbilical artery ( SUA ), even singular umbilical artery (SNSA) is called a variant or abnormality of the umbilical cord in the human fetus . When looking at ultrasound , only one umbilical vein and one umbilical artery can be seen in cross-section, especially with Doppler sonography , instead of the usual two umbilical arteries.
distribution
SUA occurs in an average of 1 in 100 pregnancies, making it the most common umbilical cord abnormality. The right umbilical artery is absent in around 70% of the fetuses and the left in 30%.
Before the introduction of ultrasound technology, SUA was diagnosed at most after birth when examining the placenta . Since the vast majority of expectant mothers worldwide are still not examined with the advanced technologies that are necessary to confirm the presence of SUA in utero , it can be assumed that even today most cases are only detected after birth.
Clinical manifestations
Isolated finding
The occurrence of SUA represents a risk factor for further complications, but the vast majority of babies have no problems during pregnancy or after birth. This is especially true if no other soft markers for malformations are visible in the sonography . In a study by the University of Lübeck, SUA was an isolated finding and not associated with aneuploidy in 57.8% of 102 fetuses examined ; the average of four studies was as high as 68.1%, in one study in the USA from 2010 with 643 cases at 65.9%. In the study from Lübeck, all children in this group (59) were phenotypically healthy at birth. The average gestation period was 38.4 weeks and the children were thus “born at term”. The average birth weight of the newborns in this group was 3047 grams and was therefore normal. 10.2% of these newborns were relatively small (“ Small for Gestational Age ”).
Soft marker for complications
In the study by the University of Lübeck, various congenital anomalies were found in 43 of 102 fetuses with SUA .
Damage in the chromosome set was found in 10 of the 102. All 10 cases were already diagnosed on ultrasound due to significant malformations. The authors of the study "in agreement with most of the authors" recommend primarily sonography as a diagnostic tool in order to rule out further anomalies, especially trisomy 13 and 18. They only recommend an amniotic fluid test and analysis of the karyotype if further anomalies have already been found during the sonography.
The rate of miscarriages was 25.5% of diagnosed SUAs, affecting only fetuses with other abnormalities in addition to SUA.
A single artery in the umbilical cord is considered a sonographic soft marker for:
- Edwards syndrome (trisomy 18) / 5 cases in the study at the University of Lübeck with 102 SUAs
- Patau syndrome (trisomy 13) / 2 cases in the study by the University of Lübeck with 102 SUAs
- Trisomy 9
- Pallister-Killian Syndrome
- VACTERL association
- Heart defects (in 6.25%)
- Malformations in the urogenital tract , especially the kidneys , also renal agenesis (in about 6.48% of cases)
A study by the Free University of Berlin, in which 362 fetuses with a single umbilical artery were included, showed that accompanying malformations and chromosomal anomalies in a single umbilical artery can be diagnosed prenatally with great certainty, and that if the findings in the qualified ultrasound examination are normal, the risk of overlooked malformations is low .
Investigation methods
In Germany, after a SUA is discovered on ultrasound, regular repeat examinations are recommended in order to monitor the growth of the fetus during pregnancy and to detect possible malformations. The children are also carefully examined postnatally to rule out possible abnormalities. An amniotic fluid puncture for chromosome analysis is only recommended if the pregnant woman has a great need for safety.
literature
- Christof Sohn , Wolfgang Holzgreve : Ultrasound in gynecology and obstetrics. Georg Thieme Verlag, 2003, ISBN 3-13-101972-7 , p. 335. in the Google Book Search
Individual evidence
- ^ SA Heifetz: Single umbilical artery: a statistical analysis of 237 autopsy cases and review of literature. In: Perspect Pediatr Pathol. 8: 345-378 (1984).
- ↑ a b Study by the University of Lübeck : A. Geipel, U. Germer, T. Welp, E. Schwinger, U. Gembruch: Prenatal diagnosis of single umbilical artery: determination of the absent side, associated anomalies, Doppler findings and perinatal outcome. In: Ultrasound in Obstetrics & Gynecology . 15 (2000), pp. 114-117, doi: 10.1046 / j.1469-0705.2000.00055.x
- ↑ T. Dagklis, D. Defigueiredo, I. Staboulidou, D. Casagrandi, KH Nicolaides: Isolated single umbilical artery and fetal karyotype. In: Ultrasound in Obstetrics & Gynecology. 36 (2010), pp. 291-295, doi: 10.1002 / uog.7717
- ↑ a b L. Murphy-Kaulbeck, L. Dodds, KS Joseph, M. Van den Hof: Single umbilical artery risk factors and pregnancy outcomes. In: Obstet Gynecol. 116 (2010), pp. 843-850, PMID 20859147
- ↑ : I. Weinert: The Singular Umbilical Artery - Historical Aspects, Comorbidities and Perinatal Outcome. FU Berlin, October 11, 2005, accessed on October 27, 2011 .
- ↑ F. Voigt, MW Beckmann, TW Goecke: Softmarker and Serum Biochemistry - Pregnancy Between Risk and (Un) Certainty. In: Frauenheilkunde up2date. 2 (2011), pp. 74-84, doi: 10.1055 / s-0031-1271422
