Prenatal ultrasound analysis of single umbilical artery and combined malformations

doi:10.16150/j.1671-2870.2023.01.005

Abstract

Abstract:

Objective: To analyze the incidence of single umbilical artery (SUA) diagnosed by prenatal ultrasound and the types of combined fetal structural malformations. Methods: A retrospective analysis was performed on 141 577 singleton pregnancies who underwent continuous prenatal ultrasonography in Children’s Hospital of Soochow University from January 1, 2013 to January 31, 2022. Based on postpartum umbilical cord data or pathological examination，the incidence of SUA in singleton pregnancies was calculated and the combined malformations were analyzed. Results: The incidence of SUA was 0.55% (778/141 577) in singleton pregnancy, with isolated single umbilical artery (iSUA) accounting for 60.93% (474/778) and non-isolated single umbilical artery (niSUA) accounting for 39.07% (304/778). The absence rate of the left and right umbilical arteries was 51.7% (402/778) and 48.3% (376/778), respectively. The SUA with absence of right umbilical artery had a higher incidence of malformation comorbidities than those with absence of left umbilical artery [44.95% (169/376) vs. 33.58% (135/402)] (P=0.023 1). The frequency of malformations was 477 in 304 SUA fetuses, and cardiovascular malformation was the most commonly seen, accounting for 36.27% (173/477). Chromosomal examination was performed in 487 fetuses,with a chromosomal abnormalities rate of 8.83%(43/487). Incidence of chromosomal abnormalities in niSUA fetuses (13.79%,28/203) was significantly higher than that in iSUA fetuses (5.28%,15/284) (P=0.001 1). The incidence of chromosomal abnormalities rose along with the increase in the number of malformations in fetuses with four or more malformations, reaching 37.5% (3/8). Trisomy 18 syndrome was the most common abnormal chromosome karyotype (30.23%, 13/43). Conclusions: The incidence of SUA in singleton pregnancies is 0.55%, and iSUA accounts for 39.07%. Among SUA combined fetal malformations, cardiovascular malformations are the most common, with a proportion of 37.5%. When ultrasound indicates the presence of four or more malformations in fetuses, 40% of them may accompany with chromosome karyotype abnormalities.

Key words: Ultrasonography, Single umbilical artery, Abnormalitiy, Chromosomal abnormality

CLC Number:

R714.53

YAN Bing, CHEN Ping, CAO Yunyun, XU Qiuqin. Prenatal ultrasound analysis of single umbilical artery and combined malformations[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(01): 31-36.

Figures/Tables 6

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References 17

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SUA	n（%）	iSUA	niSUA				χ²	P
SUA	n（%）	iSUA	Combined with single malformation	Combined with 2 malformations	Combined with 3 malformations	Combined with 4 or more malformations	χ²	P
Left	402 (51.7)	267（56.33）	77（41.62）	35（49.30）	17（50.00）	6（42.86）	13.03	0.0231
Right	376 (48.3)	207（43.67）	108（58.38）	36（50.70）	17（50.00）	8（57.14）
Total	778（100）	474（60.93）	185（23.78）	71（9.12）	34（4.37）	14（1.80）

SUA	n（%）	Cardiovascular system	Central nervous system	Genitourinary system	Digestive system	Skeletal system	Facial system	Miscellaneous
Total	477（100）	173（36.27）	57（11.95）	93（19.50）	41（8.60）	48（10.06）	16（3.35）	49（10.27）
Left	220（46.12）	76（43.93）	27（47.37）	44（47.31）	14（34.15）	24（50）	10（62.50）	25（51.02）
Right	257（53.88）	97（56.07）	30（52.63）	49（52.69）	27（65.85）	24（50）	6（37.50）	24（48.98）
χ²	15.204	5.337	0.456	0.804	5.323	0.057	0.767	0.019
P	0.000	0.025	0.582	0.379	0.024	0.882	0.454	1.000

Classification	Karyotype	Total cases[n（%）]	iSUA[n（%）]	niSUA[n（%）]
Chromosome numerical abnormality	47，XN，+18	13（30.23）	2（13.33）	11（39.29）
	47，XN，+21	1（2.33）	1（6.67）	0
	47，XXX	1（2.33）	1（6.67）	0
	69,XXX	1（2.33）	0	1（3.57）
	mos47,XN,+9[16]	1（2.33）	0	1（3.57）
	47，XN,+22[14]	1（2.33）	0	1（3.57）
Chromosomal structural abnormality	Chromosome deletion	11（25.58）	3（20.00）	8（28.57）
	Chromosome duplication	5（11.63）	2（13.33）	3（10.71）
	Chromosomal translocation	4（9.30）	3（20.00）	1（3.57）
	Chromosome interbrachial inversion	2（4.65）	2（13.33）	0
	Chromosomal polymorphism change	3（6.98）	1（6.67）	2（7.14）
Total		43（8.83）	15（5.28）	28（13.79）

Chromosome	n（%）	iSUA	niSUA				χ²	P
Chromosome	n（%）	iSUA	Combined with single malformation	Combined with 2 malformations	Combined with 3 malformations	Combined with 4 or more malformations	χ²	P
Normality	444（91.17）	269（94.72）	115（89.84）	40（88.89）	15（68.18）	5（62.50）	27.62	<0.001
Abnormality	43（8.83）	15（5.28）	13（10.16）	5（11.11）	7（31.82）	3（37.50）