Top

Archives of Gynecology and Obstetrics

Published in:

01-11-2016 | Maternal-Fetal Medicine

Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates

Authors: Gil Gutvirtz, Asnat Walfisch, Ofer Beharier, Eyal Sheiner

Published in: Archives of Gynecology and Obstetrics | Issue 5/2016

Abstract

Objective

To determine whether an isolated single umbilical artery (iSUA) is an independent risk factor for perinatal mortality in term neonates with normal estimated fetal weight (EFW) prior to delivery.

Method

A population-based study was conducted, including all deliveries occurring between 1993 and 2013, in a tertiary medical center. Pregnancies with and without iSUA were compared. Multiple gestations, chromosomal, and structural abnormalities were excluded from the cohort. Only pregnancies delivered at term with normal EFW evaluated prior to delivery were included. Stratified analysis was performed using multiple logistic regression models to evaluate the risk of adverse outcomes and perinatal mortality for iSUA fetuses.

Results

During the study period, 233,123 deliveries occurred at “Soroka” University Medical Center, out of which 786 (0.3 %) were diagnosed with iSUA. Different pregnancy complications were more common with iSUA fetuses including: placental abruption (OR = 3.4), true knot of cord (OR = 3.5) and cord prolapse (OR = 2.8). Induction of labor and cesarean delivery were also more common in these pregnancies (OR = 1.5 and OR = 1.9, respectively). iSUA neonates had lower Apgar scores at 1 and 5 min (OR = 1.8, OR = 1.9, respectively) compared to the control group and perinatal mortality rates were higher both antenatally (IUFD, OR = 8.1) and postnatally (PPD, OR = 6.1).

Conclusion

iSUA appears to be an independent predictor of adverse perinatal outcomes in term neonates.

Mailath-Pokorny M, Worda K, Schmid M, Polterauer S, Bettelheim D (2015) Isolated single umbilical artery: evaluating the risk of adverse pregnancy outcome. Eur J Obstet Gynecol Reprod Biol 184:80–83CrossRefPubMed

Murphy-Kaulbeck L, Dodds L, Joseph KS, Van den Hof M (2010) Single umbilical artery risk factors and pregnancy outcomes. Obstet Gynecol 116(4):843–850CrossRefPubMed

American Institute of Ultrasound in Medicine (2013) AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med 32(6):1083–1101CrossRef

Pierce BT, Dance VD, Wagner RK, Apodaca CC, Nielsen PE, Calhoun BC (2001) Perinatal outcome following fetal single umbilical artery diagnosis. J Matern Fetal Med 10(1):59–63CrossRefPubMed

Granese R, Coco C, Jeanty P (2007) The value of single umbilical artery in the prediction of fetal aneuploidy: findings in 12,672 pregnant women. Ultrasound Q 23(2):117–121CrossRefPubMed

Rochon M, Eddleman K (2004) Controversial ultrasound findings. Obstet Gynecol Clin North Am 31(1):61–99CrossRefPubMed

Prucka S, Clemens M, Craven C, McPherson E (2004) Single umbilical artery: what does it mean for the fetus? A case-control analysis of pathologically ascertained cases. Genet Med 6(1):54–57CrossRefPubMed

Hua M, Odibo AO, Macones GA, Roehl KA, Crane JP, Cahill AG (2010) Single umbilical artery and its associated findings. Obstet Gynecol 115(5):930–934CrossRefPubMed

Khalil MI, Sagr ER, Elrifaei RM, Abdelbasit OB, Halouly TA (2013) Outcomes of an isolated single umbilical artery in singleton pregnancy: a large study from the Middle East and Gulf region. Eur J Obstet Gynecol Reprod Biol 171(2):277–280CrossRefPubMed

10.

Parilla BV, Tamura RK, MacGregor SN, Geibel LJ, Sabbagha RE (1995) The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound. Obstet Gynecol 85(4):570–572CrossRefPubMed

11.

Predanic M, Perni SC, Friedman A, Chervenak FA, Chasen ST (2005) Fetal growth assessment and neonatal birth weight in fetuses with an isolated single umbilical artery. Obstet Gynecol 105(5 Pt 1):1093–1097CrossRefPubMed

12.

Voskamp BJ, Fleurke-Rozema H, Oude-Rengerink K, Snijders RJ, Bilardo CM, Mol BW, Pajkrt E (2013) Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. Ultrasound Obstet Gynecol 42(6):622–628CrossRefPubMed

13.

Araujo Júnior E, Palma-Dias R, Martins WP, Reidy K, da Silva Costa F (2015) Congenital heart disease and adverse perinatal outcome in fetuses with confirmed isolated single functioning umbilical artery. J Obstet Gynaecol 35(1):85–87CrossRefPubMed

14.

Ashwal E, Melamed N, Hiersch L, Edel S, Bardin R, Wiznitzer A, Yogev Y (2014) The impact of isolated single umbilical artery on labor and delivery outcome. Prenat Diagn 34(6):581–585CrossRefPubMed

15.

Burshtein S, Levy A, Holcberg G, Zlotnik A, Sheiner E (2011) Is single umbilical artery an independent risk factor for perinatal mortality? Arch Gynecol Obstet 283(2):191–194CrossRefPubMed

16.

Christensen KM, Heilbrun ME, Patel N, Woodward PJ, Kennedy A (2015) Estimated fetal weight and birth weight associated with isolated single umbilical artery: the University of Utah experience. Ultrasound Q 31(1):19–22CrossRefPubMed

17.

Mu SC, Lin CH, Chen YL, Sung TC, Bai CH, Jow GM (2008) The perinatal outcomes of asymptomatic isolated single umbilical artery in full-term neonates. Pediatr Neonatol 49(6):230–233CrossRefPubMed

18.

Naveiro-Fuentes M, Carrillo-Badillo MP, Malde-Conde J, Gallo-Vallejo JL, Puertas-Prieto A (2016) Perinatal outcomes in singleton pregnancies with a single umbilical artery. J Matern Fetal Neonatal Med 29(10):1562–1565CrossRefPubMed

19.

Doğan S, Özyüncü Ö, Atak Z, Turgal M (2014) Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices. J Obstet Gynaecol 34(7):576–579CrossRefPubMed

20.

Bombrys AE, Neiger R, Hawkins S, Sonek J, Croom C, McKenna D, Ventolini G, Habli M, How H, Sibai B (2008) Pregnancy outcome in isolated single umbilical artery. Am J Perinatol 25(4):239–242CrossRefPubMed

21.

Horton AL, Barroilhet L, Wolfe HM (2010) Perinatal outcomes in isolated single umbilical artery. Am J Perinatol 27(4):321–324CrossRefPubMed

22.

Wiegand S, McKenna DS, Croom C, Ventolini G, Sonek JD, Neiger R (2008) Serial sonographic growth assessment in pregnancies complicated by an isolated single umbilical artery. Am J Perinatol 25(3):149–152CrossRefPubMed

23.

Chetty-John S, Zhang J, Chen Z, Albert P, Sun L, Klebanoff M, Grewal U (2010) Long-term physical and neurologic development in newborn infants with isolated single umbilical artery. Am J Obstet Gynecol 203(4):368 (e1–7) CrossRefPubMedPubMedCentral

24.

Lacro RV, Jones KL, Benirschke K (1987) The umbilical cord twist: origin, direction, and relevance. Am J Obstet Gynecol 157(4 Pt 1):833–838CrossRefPubMed

25.

Raio L, Ghezzi F, Di Naro E, Franchi M, Bruhwiler H, Luscher KP (1999) Prenatal assessment of Wharton’s jelly in umbilical cords with single artery. Ultrasound Obstet Gynecol 14(1):42–46CrossRefPubMed

Title: Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates
Authors: Gil Gutvirtz
Asnat Walfisch
Ofer Beharier
Eyal Sheiner
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 5/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-016-4088-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates

Abstract

Objective

Method

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2016

Questions concerning “Polymicrobial Gardnerella biofilm resists repeated intravaginal antiseptic treatment in a subset of women with bacterial vaginosis: a preliminary report”

Pathophysiological aspects of cystocele with a 3D finite elements model

Risk factors for brachial plexus injury in a large cohort with shoulder dystocia

Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study

Morgagni hernia presenting with massive pericardial effusion and ascites: prenatal management by thoraco-amniotic shunting and fetal endoscopic tracheal occlusion (FETO) and review of the literature

Fetal colour tissue Doppler imaging (cTDI): biventricular reference ranges for the time segments of the cardiac cycle in second and third trimesters of gestation