1. Single Umbilical Artery Resmy Palliyil Gopi

2. Umbilical cord 2 umbilical arteries 1 umbilical vein Rudimentary allantois Remnant of omphalomesenteric duct Whartons jelly

4. Incidence Most common congenital malformation of the umbilical cord 5-10 in 1000 births (35-70 in 1000 twin births) Left artery tends to be absent more often than the right More common in Caucasian women

5. Conditions associated with single umbilical artery Advanced maternal age Multiparity Maternal diabetes Hypertension / toxemia Ante partum hemorrhage Poly/oligo hydramnios

6. Pathogenesis Primary agenesis Secondary atrophy or atresia of a previously normal umbilical artery Persistence of the original allantoic artery of the body stalk

7. Classification of SUA Typ e # of patent vessels Consists ofFrequency ItwoOne UA (allantoic) and left UV Common IItwoOne UA (vitelline) and left UV Rare IIIthreeOne UA and both UVVery rare IVtwoOne UA and right UVVery rare

8. Associated prenatal complications Isolated (1/2 to 2/3 rd ) Associated congenital malformations (30%) – Fetal structural abnormalities – Chromosomal abnormalities (trisomy 18/13) – Genetic syndromes (VATER, sirenomelia sequence) – IUGR – Prematurity – Still birth and spontaneous abortions – Placental abnormalities

9. Diagnosis prenatal – Ultrasound (only two vessels are seen and artery is abnormally large) – Color Doppler postnatal – Examination of the cord

10. Color Doppler

11. Management considerations Detailed ultrasonographic examination Fetal echocardiography Fetal genetic testing Enhanced fetal surveillance – Serial ultrasound to assess fetal growth – Biophysical profile, NST Physical evaluation of the neonate Neonatal renal ultrasonography

12. Prognosis - depends on the associated anomalies Recurrence risk - Unknown

13. Abnormalities of the umbilical cord Abnormalities of the cord length and diameter – Short cords and long cords

14. Abnormalities of the umbilical cord Distortional abnormalities – loops, knots (true or false), torsions and twists True knot

15. False knot

16. Twist

17. Other abnormalities of the umbilical cord Neoplasms of the umbilical cord – Thrombosis, hemangioma, hematoma, teratoma edema

18. Velamentous insertion of the umbilical cord

19. Thank you