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Single Umbilical Artery

Single Umbilical Artery. Resmy Palliyil Gopi. Umbilical cord. 2 umbilical arteries 1 umbilical vein Rudimentary allantois Remnant of omphalomesenteric duct Whartons jelly. Incidence. Most common congenital malformation of the umbilical cord 5-10 in 1000 births (35-70 in 1000 twin births)

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Single Umbilical Artery

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  1. Single Umbilical Artery Resmy Palliyil Gopi

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

  3. 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

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

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

  6. Classification of SUA

  7. Associated prenatal complications • Isolated (1/2 to 2/3rd) • 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

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

  9. Color Doppler

  10. 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

  11. Prognosis - depends on the associated anomalies • Recurrence risk - Unknown

  12. Abnormalities of the umbilical cord • Abnormalities of the cord length and diameter • Short cords and long cords

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

  14. False knot

  15. Twist

  16. Other abnormalities of the umbilical cord • Neoplasms of the umbilical cord • Thrombosis, hemangioma, hematoma, teratoma • edema

  17. Velamentous insertion of the umbilical cord

  18. Thank you

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