Investigation of 10-year one-center single umbilical artery cases and their effects on perinatal outcomes

This study aimed to evaluate the perinatal outcomes of isolated single umbilical artery (iSUA) and incidence of fetuses diagnosed with Single Umbilical Artery (SUA) in the second trimester.

We retrospectively analyzed the data of 40,800 pregnant women who had undergone detailed ultrasonography between September 2011 and September 2021 in the perinatology clinic of tertiary university hospital. Those diagnosed with SUA accompanied by structural and genetic anomalies and maternal diseases among the 402 cases and multiple pregnancies were excluded from the study. The remaining 307 iSUA cases were compared with 650 randomly selected cases Double Umbilical Artery (DUA) by need for cesarean section due to fetal distress or suspicious Non-Stress Test (NST), delivery frequency before 37 and 34 weeks, birth weight, fetal gender, oligohydramnios, small for gestational age (SGA; <10% percentile birth weight)), intrauterine fetal death (IUFD), Apgar scores, and admission to a neonatal intensive care unit (NICU) for antenatal and perinatal outcomes.

A total of 402 (0.9%) cases were diagnosed with SUA. Thirty-nine (9.7%) cases had structural anomalies, and 13 (3.2%) had genetic anomalies. While the most frequently detected chromosomal disorder was trisomy 18, central nervous system (CNS) and cardiovascular system (CVS) anomalies were the most prevalent accompanying structural anomalies. Comparing 307 cases with iSUA with 650 cases with DUA, we detected that the group with iSUA yielded significantly lower Apgar scores at 1 st and 5th minutes, lower birth weight, SGA prevalence, higher cesarean section need due to fetal distress and unreliable non-stress test, higher IUFD, and higher preterm birth.

Overall, we believe that the patients need to be recruited for a detailed ultrasonographic examination, as well as CNS and CVS examinations, following the diagnosis of SUA and that interventional diagnostic tests need to be applied to those with structural anomalies. Although genetic diagnostic tests are not required among iSUA cases, we found that cases with iSUA had higher IUFD in the second trimester, premature birth, low birth weight, and need for cesarean section.