ARTERIA UMBILICAL UNICA PDF
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Antenatal detection of single umbilical artery: The aim of this study was to assess the incidence of SUA in a selected population.
And secondly, to examine the clinical significance of this soft marker. A retrospective analysis, over a month period, of all cases of pregnancy interruption due to medical causes, up to 16 weeks of gestation, with prenatal diagnosis of SUA; cases of live born with a prenatal diagnosis of SUA or after delivery, at the routine examination of the placenta.
Fetal growth and the risk of preterm labor are also to consider in the surveillance of these pregnancies. Thirty nine cases of SUA were identified during the study period.
Incidence of SUA in live born was 0. In live born with SUA and associated malformations Preterm birth occurred in seven cases The presence of SUA in antenatal period should alert the sonographer and clinician for the need of a detailed examination of the fetus to exclude other anomalies.
Congenital malformation, prenatal diagnosis, single umbilical artery, ultrasonography. Single umbilical artery SUA is the most common developmental abnormality of the umbilical cord. The etiopathogenesis, although, not definitively clarified, has been attributed to primary agenesis of umbilical cord, secondary atrophy or atresia of a previously normal umbilical artery or persistence of the original allantoic artery of the body stalk. A SUA is likely due to secondary atresia or atrophy rather than primary agenesis of the artery.
The left umbilical artery is absent more often than the right. The side of absence can be determined by evaluating the umbilical arteries as they course around the fetal urinary bladder laterally. In fact, this is the best place to evaluate these vessels as they may fuse at the region of the umbilical cord insertion into the placenta.
Although the absence of one umbilical artery was first reported a century ago by Hyrtl 10the significance of a SUA has only been realized since a retrospective study by Benirschke and Brown 11 showed it was associated with increased incidence of congenital anomalies.
Virtually any organ system can be involved with an anomaly in fetuses with a single umbilical artery, however, genitourinary, cardiac and central nervous system abnormalities are the most common. Although this has not been true at all centers, a study by Abuhamad et al 26 found complex congenital and chromosomal abnormalities exclusively when the left umbilical artery was absent.
In a study by Nyberg et al 24fetuses with a known central nervous system abnormality and a single umbilical artery were found to have a significantly higher frequency of extra-CNS malformations, fetal mortality and chromosomal abnormalities than fetuses with two umbilical arteries. A SUA in the second trimester of pregnancy has a high association with Trisomy 18, 13, 21 and other chromosomal defects, but all chromosomally abnormal fetuses had associated malformations detected by ultrasound 5.
Trisomy 21 is not commonly associated with a single umbilical artery. In addition to malformations and karyotypic abnormalities, infants with a single umbilical artery have an increased incidence of prematurity, low birth weight and intrauterine growth retardation.
The remaining single artery is often quite large approaching the size of the umbilical vein. Sonography is often able to accurately diagnose this condition, especially with the use of colour Doppler flow imaging.
uunica With this study we pretend to determine the association between diagnosis of SUA and perinatal outcome malformations, prematurity, low birth weight, intrauterine growth retardation, delivery type as well as to determine the clinical significance of antenatal detection of a single umbilical artery.
For the purpose of this study were considered all cases of pregnancy interruption due to medical cases, up to 16 weeks of gestation, with prenatal diagnosis of SUA; all newborns with prenatal diagnosis of SUA and those who were identified at the routine examination of the placenta after delivery, over a 36 month period.
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Pregnancy data maternal age, parity, gestational age at diagnosis of SUA, adverse pregnancy outcomes, prenatal diagnosis of other anomalies, gestational age at deliveryperinatal outcome delivery mode, gestation weeks, birthweigth, postnatal anomalies were reviewed. A variety of methods, previously described ,25were employed by different sonographers to detect the presence of a single umbilical artery.
In some cases, a free loop of the umbilical cord was viewed in cross-section and the vessels were counted. Umbklical other cases, the uunica cord insertion at the abdominal wall or the umbilical arteries, as they traverse either side of the fetal bladder, was viewed with colour power angiography.
The methodology used was not recorded by the sonographer at the time of the examination. Fetuses were evaluated in posnatal umbklical with transfontanelar ultrasound, echocardiography, and bladder-kidney ultrasound.
During the study period there were fetuses delivered after 24 weeks gestation and 70 pregnancy interruption due to medical causes.
The incidence of SUA in live born was 0. One of the nine cases with a single umbilical artery not recognised antenatally was diagnosed by the routine examination of the placenta after delivery. It was a delivery at 31 weeks and the newborn presented unilateral renal agenesis.
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The maternal and pregnancy characteristics of live borne cases with SUA are shown in Table 1. Of the total cases with SUA detected antenatally, 12 had suspicious malformations associated.
Of these three live born, two presented associated malformations and in one case the malformation recognized antenatally was not confirmed in postnatal period. The description of cases with a SUA and other anomaly recognised antenatally are shown in Table 2.
The principal complications of uniica were: Ecocardiography and transfontanelar ultrasound in postnatal period did not revealed alterations. Bladder-kidney ultrasound revealed a horseshoe kidney in one case recognized in prenatal period and unilateral renal agenesis de novo umbipical recognised in prenatal period.
There are two main sources of data on SUA and its association with other abnormalities: The first source of data produces a higher incidence of SUA, as well as more frequent association with structural and genetic abnormalities and perinatal mortality. The second data set suggests a lower incidence and frequency of associated anomalies, as many of the most severely affected infants have aborted or been voluntarily terminated early in pregnancy.
A meta analysis of these data highlights the differences: Reports of association between SUA and other anomalies have created an imperative to identify or exclude the presence of such anomalies and detailed sonography is advised for all fetuses with SUA. In our study, we found that a SUA was present in 0. This is similar to published data. The antenatal detection rate of a SUA in this population presents a value quite acceptable, with only one-quarter of artwria not identified.
There are possible explanations for this, including technical difficulties or lack of training; failure by the sonographers to spend much time examining the cord vasculature because of a lack of understanding of the implications of the presence of a SUA and due to the fact that other anomalies are noted with ultrasonography before the presence of a SUA is confirmed and examination of the cord then becomes lower in priority.
The presence of malformations was identified in four cases of live born with SUA Four of the 30 live born with SUA were born below tenth percentile, contrastating well with the proportion of live born in global sample 3. These findings were similar to previous reports of an increased risk of prematurity as well as birth weight below the tenth percentile in live born with single umbilical artery. Our results indicate that the identification of a SUA should be regarded as a significant finding associated with other congenital anomalies and a poorer perinatal outcome.
The detection arterix, despite having an acceptable value, should be improved. Further training is required together with rising the awareness of the implications of this finding. When identified at unia routine antenatal scan, the presence of a SUA should alert the sonographer and clinician of the fact that the fetus requires a more detailed examination to exclude other anomalies.
Deteção pré-natal de artéria umbilical única: qual o seu significado?
If other anomalies are detected, umbilicao the case should be managed according to the type and severity of the abnormalities. Since the presence of a SUA with an associated anomaly carries an aneuploidy risk 5,26karyotyping should be advised if another anomaly is detected. However, advice regarding karyotyping in the presence of an isolated SUA is more difficult. Any advice should be tailored to the particular pregnancy, taking into account other factors such as age, but we would not strongly recommend karyotyping in agreement with other authors.
In light of the poorer perinatal outcome in fetuses with an apparently isolated single umbilical artery, further ultrasound scans in the third trimester to knica growth and continuous fetal-heart-rate monitoring during labour should be offered. Parents should be advised of the increased risks associated with the presence of a SUA and the need for extra surveillance, and it may also be advisable to counsel parents of the possibility of an associated abnormality that may only be detectable after delivery.
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Khong TY, George K. Chromosomal abnormalities associated with a single umbilical artery. The association of single umbilical artery with cytogenetically abnormal pregnancies.
The clinical significance of a single umbilical artery as an isolated finding on prenatal ultrasound. Byrne J, Blanc WA. Malformations and chromosome anomalies in spontaneously aborted fetuses with single umbilical artery.