Skip to main content

Advertisement

SpringerLink
Log in

Is single umbilical artery an independent risk factor for perinatal mortality?

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To evaluate perinatal outcome of fetuses with isolated single umbilical artery (SUA), and specifically to examine whether an isolated SUA is an independent risk factor for perinatal mortality.

Methods

A population-based study was conducted, comparing pregnancies of women with and without SUA. Deliveries occurred between the years 1988–2006, in a tertiary medical center. Multiple gestations, chromosomal abnormalities and malformations were excluded from the analysis. Stratified analysis was performed using multiple logistic regression models to evaluate the association between SUA and perinatal mortality, while controlling for confounders.

Results

Out of 194,809 deliveries, 243 (0.1%) were of fetuses with isolated SUA. Fetuses with SUA were smaller (2,844 ± 733 vs. 3,197 ± 530 g, P < 0.001), and were delivered at an earlier gestational age (38.3 ± 3.0 vs. 39.3 ± 2.1 weeks, P < 0.001), when compared with fetuses with normal umbilical vessels. Mothers to fetuses with isolated SUA tended to have a history of infertility treatments (4.5 vs. 1.7%; P = 0.001) when compared with the comparison group. Fetuses with SUA had more complications, including fetal growth restriction (FGR 9.5 vs. 1.9%, P < 0.001), polyhydramnios (11.5 vs. 3.7%; P < 0.001) and oligohydramnios (6.6 vs. 2.2%; P < 0.001). Deliveries of SUA fetuses had higher rates of placental abruption (3.3 vs. 0.7%; P < 0.001), placenta previa (1.2 vs. 0.4%; P = 0.03) and cord prolapse (2.9 vs. 0.4%; P < 0.001). Higher rates of cesarean deliveries were noted in this group (23.9 vs. 12.2%; P < 0.001). SUA newborns had higher rates of low Apgar scores (<7) in one (11.8 vs. 3.7%; P < 0.001) and 5 min (3.5 vs. 0.4%; P < 0.001). Higher rates of perinatal mortality were noted in the SUA group, as compared to fetuses with normal umbilical vessels (6.6 vs. 0.9%, OR 7.78; 95% CI 4.7–13.0; P < 0.001). Using a multiple logistic regression model, controlling for possible confounders, such as FGR, oligohydramnios, polyhydramnios, prolapse of cord, maternal hypertension and diabetes mellitus, isolated SUA remained an independent risk factor for perinatal mortality (adjusted OR = 3.91, 95% CI 2.06–7.43; P < 0.001).

Conclusion

Isolated SUA in our population was noted as an independent risk factor for perinatal mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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 6:54–57

    Article  PubMed  Google Scholar 

  2. Csécsei K, Kovács T, Hinchliffe SA, Papp Z (1993) Incidence and associations of single umbilical artery in prenatally diagnosed malformed, midtrimester fetuses: a review of 62 cases. Am J Med Genet 46(2):248–249

    Article  Google Scholar 

  3. Persutte WH, Hobbins J (1995) Single umbilical artery: a clinical enigma in modern prenatal diagnosis. Ultrasound Obstet Gynecol 6(3):216–229

    Article  CAS  PubMed  Google Scholar 

  4. Romero R, Pilu G, Jeanty P, Ghidini A, Hobbins JC (eds) (1988) Prenatal diagnosis of congenital anomalies. Appleton & Lange, Norwalk

  5. Tanimura T, Ezaki KI (1968) Single umbilical artery found in Japanese embryos. Proc Congenit Anom Res Assoc Jpn 8:27

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Catanzarite VA, Hendricks SK, Maida C, Westbrook C, Cousins L, Schrimmer D (1995) Prenatal diagnosis of the two vessel cord: implications for patient counseling and obstetric management. Ultrasound Obstet Gynecol 5:98–105

    Article  CAS  PubMed  Google Scholar 

  8. Jauniaux E, De Munter C, Pardou A, Elkhazen N, Rodesch F, Wilkin P (1989) Evaluation echographique du syndrome de l’artere ombilicale unique: une serie de 80 cas. J Gynecol Obstet Biol Reprod 18:341–348

    CAS  Google Scholar 

  9. Leung AKC, Robson WLM (1989) Single umbilical artery: a report of 159 cases. Am J Dis Child 143:108–111

    CAS  PubMed  Google Scholar 

  10. Thummala MR, Raju TN, Langenberg P (1998) Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg 33(4):580–585

    Article  CAS  PubMed  Google Scholar 

  11. Doornebal N, de Vries TW, Bos AF, de Vries NK (2007) Screening infants with an isolated single umbilical artery for renal anomalies: nonsense? Early Hum Dev 83(9):567–570

    Article  CAS  PubMed  Google Scholar 

  12. Hershkovitz R, Sheiner E, Mazor M (2006) Middle cerebral artery blood flow velocimetry among healthy fetuses with a single umbilical artery. J Ultrasound Med 25(11):1405–1408

    PubMed  Google Scholar 

  13. 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):239–242

    Article  PubMed  Google Scholar 

  14. Maternal-Placental-Fetal Unit (2007) Fetal and early neonatal physiology. In: Decherney AH, Goodwin TM, Nathan L, Laufer N (eds) Current diagnosis and treatment OBS & GYN. McGraw-Hill, New York, p 170

  15. 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):230–233

    Article  PubMed  Google Scholar 

  16. Deshpande SA, Jog S, Watson H, Gornall A (2009) Do babies with isolated single umbilical artery need routine postnatal renal ultrasonography? Arch Dis Child Fetal Neonatal Ed 94(4):F265–F267 [Epub 8 Jan 2009]

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer-Sheva, Israel

    Shimon Burshtein, Gershon Holcberg & Eyal Sheiner

  2. Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel

    Amalia Levy

  3. Department of Anesthesiology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel

    Alexander Zlotnik

Authors
  1. Shimon Burshtein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amalia Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gershon Holcberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Zlotnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eyal Sheiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eyal Sheiner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burshtein, S., Levy, A., Holcberg, G. et al. Is single umbilical artery an independent risk factor for perinatal mortality?. Arch Gynecol Obstet 283, 191–194 (2011). https://doi.org/10.1007/s00404-009-1326-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1326-3

Keywords

Search

Navigation