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Single Umbilical Artery
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
About 20%–30% of fetuses with a single umbilical artery have associated abnormalities. The commonly reported defects are cardiovascular abnormalities (especially ventricular septal defects and cono-truncal defects), abdominal wall defects, and urinary tract abnormalities. In addition, there is a higher incidence of marginal and velamentous insertion of the umbilical cord. There is also an increased risk of intrauterine or neonatal death, but most of these deaths occur in those with associated congenital abnormalities. Most (but not all) studies report higher risks—less so in apparently isolated single umbilical artery cases. Adverse outcomes relate to intrauterine growth restriction (IUGR) and pre-term birth, leading to a perinatal mortality rate which is 5–10 times higher. Reference ranges for umbilical artery Doppler do not apply to cases with a single umbilical artery, where the resistance is typically lower. Elevated umbilical artery pulsatility index (PI) in cases of a single umbilical artery is obviously abnormal, but a normal PI is not reassuring.
Placenta, Umbilical Cord, and Amniotic Membranes
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Prenatal ultrasound diagnosis has been reported in two cases: both of them died.98 Our group, by applying color Doppler for blood flow analysis, has diagnosed single umbilical artery in a diabetic mother. Her child was normal and alive99 (Plate 2* and Figure 37). A single umbilical artery can be associated with placental anomalies also.92
Examination abnormalities
Published in Christopher Flannigan, A Practical Guide to Managing Paediatric Problems on the Postnatal Wards, 2017
When applying the cord clamp in delivery, all infants should have their umbilical cords examined to ensure that there are three vessels present, i.e. two umbilical arteries and one vein. In about 1% of cases only two vessels will be found and there will be a single umbilical artery.16 The presence of a single umbilical artery may be associated with a higher incidence of other congenital abnormalities and genetic syndromes, although there is still some debate over this.
TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery
Published in Fetal and Pediatric Pathology, 2018
Gabriele Tonni, Gianpaolo Grisolia, Paolo Zampriolo, Federico Prefumo, Anna Fichera, Paola Bonasoni, Mathilde Lefebvre, Suonavy Khung-Savatovsky, Fabien Guimiot, Jonathan Rosenblatt, Edward Araujo Júnior
Cord of twin B was 10 cm long, thin (0.12 cm in diameter), hypercoiled, and inserted on the chorial plate side by side with the insertion of twin A cord, suggesting that the umbilical cord of the acardiac mass (twin B) was almost connected directly on the cord of twin A. Vascular anastomoses could not be truly assessed because of the maceration and the small size of the acardiac mass’s umbilical cord vessels. Even if no entanglement of the cords was noticed at gross examination, the umbilical cord of the acardiac mass likely caused a stricture that resulted in the groove and edema on twin A’s cord (Fig. 13). The placental parenchyma was homogeneous with only twin A’s territory. No area of involuted placenta that may have belonged to the acardiac mass was found. These finding, associated with the peculiar cord insertions, confirmed the TRAP sequence. A single umbilical artery was detected at histology for twin B (Fig. 14).
Value of Placental Examination in the Diagnostic Evaluation of Stillbirth
Published in Fetal and Pediatric Pathology, 2022
Funicular abnormalities, isolated or associated with placental lesions, were observed in 26/147 cases (18%) of our series and mainly corresponded to overcoiling and insertion abnormalities of the UC (velamentous insertion, trifurcation). A proportion of 15% is reported in the literature [9,10]. A single umbilical artery was observed in 3.4% of our cases. Pinar et al., [13] who studied a large series of stillbirths (518 cases) found a single umbilical artery in about 8% of cases. The clinical significance of this abnormality, which is usually associated with polymalformative syndromes, remains uncertain. It does not appear to be associated with an increased risk of IUGR, perinatal death or aneuploidy if it is isolated on prenatal screening [22].
Prenatal diagnosis and outcome of unilateral multicystic kidney
Published in Journal of Obstetrics and Gynaecology, 2021
Gurcan Turkyilmaz, Bilal Cetin, Emircan Erturk, Tugba Sivrikoz, Ibrahim Kalelioglu, Recep Has, Atıl Yuksel, Tayfun Oktar, Orhan Ziylan
An extrarenal anomaly was detected in 20 (13.8%) cases. Seven (4.8%) cases had isolated single umbilical artery (SUA). In 2 (1.3%) cases, left diaphragmatic hernia with SUA was showed. Open spina bifida in 3 (2%), isolated borderline ventriculomegaly in 3 (2%), tetralogy of Fallot in 2 (1.3%), double outlet right ventricle in 1(0.6%) and extremity contractures in 2 (1.3%) cases were identified. Extrarenal anomalies identified in the prenatal period were shown in Table 2.