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Single umbilical artery: accurate diagnosis?
T B Jones1, Y Sorokin, R Bhatia
1Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201.
Objective:
We sought to evaluate the accuracy of ultrasonographic, obstetric, and neonatal diagnosis of a single umbilical artery.
Study Design:
We studied 17,777 consecutive singleton births from women who had undergone ultrasonographic examination at our hospital. A single umbilical artery was confirmed in 37 cases (0.2%) by two clinical methods or by pathologic assessment. Outcome of neonates with a single umbilical artery was compared with the outcome of neonates with either two or three vessel cords.
Results:
Ultrasonographic diagnosis had a 65% sensitivity and positive predictive value. Obstetricians and pediatricians failed to diagnose 24% and 16% of the cases, respectively. On average, neonates with a single umbilical artery weighed 320 gm less, were delivered 1 week earlier, and had lower Apgar scores than neonates with three vessel cords (p < 0.01 in each case.)
Conclusion:
Although early gestational age may account for some cases not diagnosed by ultrasonography, there is a little justification for missing the diagnosis after delivery. Greater emphasis on clinical examination of the umbilical cord is needed to identify neonates at risk of associated malformations.