1. PERINATAL OUTCOMES IN CASES WITH SINGLE UMBILICAL ARTERY
İlknur Demir Karakılıç, İlker Ali Çerçi, Selçuk Özden
Sakarya University School of Medicine,
Department of Obstetrics and Gynecology

2. SINGLE UMBILICAL ARTERY
The umbilical cord contains two arteries and one vein
Single umbilical artery (SUA) refers to a variation of umbilical cord anatomy in which there is one umbilical artery
Single umbilical artery may be an isolated finding or associated with aneuploidy or other congenital anomalies
Single umbilical artery prevalence is 0.48% on prenatal sonography performed at weeks of gestation in general population
The frequency of aneuploidy isn't increased in cases with isolated single umbilical artery
Abnormal karyotype is reported in 45% of cases with non-isolated single umbilical artery

3. SINGLE UMBILICAL ARTERY
Two umbilical arteries are most accurately visualized with color Doppler imaging of the fetal bladder
Umbilical arteries are seen on both sides of the fetal bladder
Imaging of a cross section of the umbilical cord is less reliable

4. SINGLE UMBILICAL ARTERY
Approximately one third of infants with SUA have additional structural anomalies including cardiovascular, gastrointestinal (esophageal and anal atresias) and renal malformations
Fetal growth restriction (FGR), preterm birth and perinatal mortality are increased in cases of SUA, especially with coexisting structural lesions

5. METHOD
We retrospectively reviewed records of 4047 patients presented to perinatology outpatient clinic between June, 2015 and February, 2017
The cases with single umbilical artery were identified
Perinatal outcomes were extracted from hospital database
In survivors, information about current status was obtained by telephone interview

6. CASES WITH ISOLATED SINGLE UMBILICAL ARTERY
In survivors, information about current status was obtained by telephone interview Single umbilical artery was detected in 23 (0.5%) of 4047 cases
No additional pathology was detected in 9 (39.1%) of 23 cases
No perinatal complication was detected in cases with isolated single umbilical artery
Mean birth weight was 3061 g
One fetus with birth weight <2500 g (gestational week 37, birth weight 2200 g)

7. CASES WITH NON-ISOLATED SINGLE UMBILICAL ARTERY
An additional pathology was detected in 14 cases (60.9%)
Invasive prenatal testing was performed in this cases (60.9%) with non-isolated single umbilical artery
Abnormal karyotype was detected in 4 cases (28.6%; 3 cases with trisomy 18 and one case with trisomy 13)

8. SUA ULTRASONOGRAPHIC FINDINGS

9. CASES WITH NON-ISOLATED SINGLE UMBILICAL ARTERY
Two cases associated with cardiac and renal anomaly died at postpartum period
One pregnancy (7.1%) was terminated due to single umbilical artery accompanying to caudal regression syndrome
One pregnancy (7.1%) was terminated due to cardiac anomaly and hydrops fetalis
Cleft palate with hydrocephaly in one case (7.1%)
ASD in another case (7.1%)
Choroid plexus cysts and hyperechoic bowel was observed in 4 cases (28.6%) no perinatal complication

10. CONCLUSION
The type and frequency of adverse outcomes in fetuses with SUA depend largely on whether it is isolated or nonisolated
Isolated SUA has not been directly linked to adverse perinatal outcomes
Adverse perinatal outcomes may be seen in cases with additional pathologies

11. THANK YOU FOR YOUR PATIENCE…