HEALTH OF WOMAN. 2019.5(141): 54–58; doi 10.15574/HW.2019.141.54

Krasovska O. V., Lakatosh V. P., Slobodyanyk O. Y., Guzhevska I. V., Tkalich V. O. 
Bogomolets National Medical University, Kiev
Perinatal center, Kiev

The single umbilical artery (SUA) is considered an independent risk factor for perinatal complications. The influence of some endocrine, gynecological and general factors on the occurrence of SUA, the detection of SUA at different stages of pregnancy, and the effect of SUA on the fetal and placental state are assumed. The article presents some features of ultrasound indicators at different trimesters of pregnancy with SUA compared with pregnant women with three umbilical vessels and physiological births in the future.

The objective: is to study and analyze some ultrasound indices of the fetus and placenta at different trimesters of pregnancy with SUA, to conduct a comparative characteristic of the revealed features with such indices in pregnant women with three umbilical vessels.

Materials and methods. 31 pregnant women with a single umbilical artery of the fetus (study group), 62 pregnant women with 2 umbilical cord blood arteries (control group).

Results. In our study in 6 patients (19.4%) of pregnant women with SUA during ultrasound scanning at 12–13 weeks of pregnancy reverse flow in the venous duct was found.

According to doplerometry, the flow rate in the fetal aorta in pregnant women with SUA is definitely less than that of the control group, although it does not exceed the normal values. There is a tendency to a greater importance of the cerebroortal index among pregnant women with SUA.

Conclusions. In the 12-13 week period, reverse flow in the venous duct can be considered an SUA marker. According to the data of doplerometry in pregnant women with SUA fetuses, there are slight negative changes in the direction of increasing peripheral vascular resistance (according to the blood flow velocity in the fetal aorta) and the tendency to centralize the blood circulation (according to the cerebroortical index).

Key words: single umbilical artery, venous duct, doplerometry, cerebroortal index.

REFERENCES

Kogan YaE. 2016. Patologiya pupovinyi i ee rol v perinatalnyih oslozhneniyah. Prakticheskaya meditsina 1: 22–25.

Marzoeva OV, Leonova EI, Bartagova MN. 2014. Prognosticheskaya znachimost otsenki krovotoka v venoznom protoke u plodov na sroke 10–14 nedel dlya ranney diagnostiki vrozhdennyih porokov serdtsa. Tez. dokl. Konf. «Markery hromosomnoy patologii i prediktory VPS u ploda pri skriningovom ultrazvukovom issledovanii v I trimestre beremennosti»: 245.

Markin LB, Shakhova OV. 2007. Ultrazvukove doslidzhennia pupovyny. Reproduktyvnoe zdorove zhenshchynу 4: 60–64.

Mitkov VV, Medvedev MV. 1996. Klinicheskoe rukovodstvo po ultrazvukovoy diagnostike. M, Vidar 2: 394.

Saveleva GM, Kulakov VI, Strizhakov AN i dr. 2000. Akusherstvo: Uchebnik. Pod red. Savelevoy GM. M, Meditsina: 816.

Schegolev AI, Dubova EA, Gus AI i dr. 2011. Edinstvennaya arteriya pupochnogo kanatika (klinicheskoe nablyudenie i obzor literaturyi). Meditsinskaya vizualizatsiya 1: 75–82.

Yudina EV. 2003. Ultrazvukovyie prenatalnyie markeryi hromosomnyih anomaliy vo vtorom trimestre beremennosti. Diss. d-ra med. nauk: 247.

Yudina EV. 2002. Ehograficheskie markeryi hromosomnyih anomaliy ploda: edinstvennaya arteriya pupovinyi. Prenatalnaya diagnostika 1;3: 240.

Arcos-Machancoses JV, Marín-Reina P, Romaguera-Salort E. 2015. Postnatal development of fetuses with a single umbilical artery: differences between malformed and non-malformed infants. World J Pediatr VII (1);61:66. https://doi.org/10.1007/s12519-014-0471-3; PMid:24668234

Bornemeir S, Carpinito L, Winter T. 1996. Sonographic evaluation of the two vessel umbilical cord: a comparison between umbilical arteries adjacent to the bladder and cross-sections of the umbilical cord. J.Diagn.Med. 12:260–265. https://doi.org/10.1177/875647939601200603

Budorick N, Kelly T, Dunn J et al. 2001. The single umbilical artery in a high-risk patient population: what sould be offered? J.Ultrasound Med. 20:619–627. https://doi.org/10.7863/jum.2001.20.6.619; PMid:11400936

Catanzarite VA, Hendrics SK, Maida C. 1995. Prenatal diagnosis of the two-vessel: implications for patient counseling and obstetric management. Ultrasound Obstet.Gynecol. 5; 2:98–105. https://doi.org/10.1046/j.1469-0705.1995.05020098.x; PMid:7632225

Dagklis T, Defiguei F, Redo D. 2010. Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet.Gynecol. 36: 291–295. https://doi.org/10.1002/uog.7717; PMid:20549772

Dogan S. 2014. Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices. J.Obstet.Gynecol. 34 (7):576–579. https://doi.org/10.3109/01443615.2014.919578; PMid:24867412

Fujkura T. 2003. Fused umbilical arteries near placental cord insertion. Am.J.Obstet.Gynecol. 188:765–767. https://doi.org/10.1067/mob.2003.165; PMid:12634654

Goldkrand J, Lenz S, Turner A et al. 1999. Doppler velocimetry in the fetus with a single umbilical artery. J.Report Med. 44 (4): 346–350.

Hill LM, Wibner D, Gonzales P, Chenevey P. 2001. Validity of transabdominal sonography in detection o two-vessel umbilical cord. Obstet. Gynecol. 98: 837–842. https://doi.org/10.1016/S0029-7844(01)01572-1

Hitschold T, Müntefering HSingle umbilical artery. 2001. Effect on fetal growth and doppler flow velocity wave form. Ultraschall Med. 22 (1):17–22. https://doi.org/10.1055/s-2001-11247; PMid:11253550

Hua Meilin, Odibo Anthony O, Macones George A, Roehl Kimberly A, Crane James P, Cahill Alison G. 2010. Umbilical Artery and Its Associated Findings. Obstetrics & Gynecology 115 (5):930–934. https://doi.org/10.1097/AOG.0b013e3181da50ed; PMid:20410765

Jones TB, Sorokin Y, Bhatia R еt al. 2000. Single umbilical artery: accurate diagnosis? Am.J.Obstet.Gynecol. 169: 538–540. https://doi.org/10.1016/0002-9378(93)90615-P

Lacro R, Jones K, Benirschke K. 1987. The umbilical cord twist: origin, direction, and relevance. Am. J. Obstet.Gynecol. 157:833–838. https://doi.org/10.1016/S0002-9378(87)80067-4

Martínez-Frías ML, Bermejo-Sánchez E, Rodríguez-Pinilla E, Prieto-Merino D. 2006.  Characteristics of neonates with and without a single umbilical artery. Analysis of two consecutive series of neonates with and without congenital defects Periférico del ECEMC. An Pediatr (Barc). 65 (6):541–550. https://doi.org/10.1157/13095846

Murphy A, Weerakkody Y. 2016. Single umbilical artery. Radiology 34 (7): 476–479.

Murphy-Kaulbeck L. 2010. Single umbilical artery risk factors and pregnancy outcomes. Obstet. Gynecol. 12:35–40. https://doi.org/10.1097/AOG.0b013e3181f0bc08; PMid:20859147

Nicolaides PJ, Sebore NJ, Snijders JM. 1999. The 11-week scan. The diagnosis of fetal abnormalities. Parthenon Publishing group: 196.

Persutte W, Lenke R. 1994. Tranaverse umbilical arterial diameter: technique for the prenatal diagnosis of single umbilical artery. J. Ultrasound Med. 13:763–766. https://doi.org/10.7863/jum.1994.13.10.763; PMid:7823338

Raio L, Ghezzi F, Naro E еt al. 1999. Prenatal assessment of Warton`s jelly in umbilical cords with single artery. Ultrasound Obstet.Gynecol. 14: 42–46. https://doi.org/10.1046/j.1469-0705.1999.14010042.x; PMid:10461337

Raio L, Mueller M, Schumacher A еt al. 1998. Vascular diameter and resistance indices in normal fetuses with a single umbilical artery. Ultraschall. Med. 19:187–191. https://doi.org/10.1055/s-2007-1000487; PMid:9816624

Rembouskos G, Cicero S, Longo D, Sacchini C, Nicolaides KH. 2003. Single umbilical artery at 11–14 weeks’ gestation: relation to chromosomal defects. Ultrasound Obstet Gynecol.  22 (6): 567–570. https://doi.org/10.1002/uog.901; PMid:14689527

Saller DN Jr, Canick JA, Palomaki GE, Knight GJ, Haddow JE. 1994. Second-trimester maternal serum alpha-fetoprotein, unconjugated estriol, and hCG levels in pregnancies with ventral wall defects. Obstet Gynecol. 84 (5): 852–855.

Sepulveda W, Dezerega V, Carstens E. 2001. Fused umbilical arteries: prenatal sonographic diagnosis and clinical significance. J. Ultrasound Med. 20:59–62. https://doi.org/10.1002/uog.901; PMid:14689527

Suess G, Raio L, Kuhn A, Di Naro E, Surbek D. 2009. Arterial-adaptive dilatation and Doppler velocimetry in normal fetuses with a single umbilical artery. Ultraschall Med. 30 (5):485–489. https://doi.org/10.1055/s-2008-1027705; PMid:18773382

Suzuki S, Masahiko K. 2015. Clinical Significance of Pregnancies Complicated by Velamentous Umbilical Cord Insertion Associated With Other Umbilical Cord. Placental Abnormalities. Clin Med Res. 7 (11):853–856. https://doi.org/10.14740/jocmr2310w; PMid:26491497 PMCid:PMC4596266