20.08.

2017 Single umbilical artery

J Pharm Bioallied Sci. 2015 Apr; 7(Suppl 1): S83S84. PMCID: PMC4439720
doi: 10.4103/0975-7406.155815

Single umbilical artery

Shanthi Ramesh, Sangeetha Hariprasath, Gunasekaran Anandan, P. John Solomon, and V. Vijayakumar
Department of Pediatrics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
Address for correspondence: Dr. Shanthi Ramesh, E-mail: drshanthiramesh@gmail.com

Received 2014 Oct 31; Revised 2014 Oct 31; Accepted 2014 Nov 9.

Copyright : Journal of Pharmacy and Bioallied Sciences

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from
the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus
to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting
in single umbilical artery.

KEY WORDS: Congenital anomalies, single umbilical artery, two vessel umbilical cord

Case Report
We are presenting a newborn baby born with an isolated single umbilical artery (SUA). Second trimester
ultrasound done at 27 weeks showed a SUA and there were no other associated anomalies in the fetus as
well as in the placenta. The mother was counseled and closely followed up. The mother had pregnancy
induced hypertension and anemia complicating pregnancy. Baby was delivered by emergency cesarean
section at 36 weeks of gestation. The indication for C-section was premature rupture of membranes and
fetal distress. Baby cried immediately after birth. This was a preterm female baby with a birth weight of
2.2 kg. On examination, the baby was normal, and there were no dysmorphic features or obvious
congenital anomalies. The ultrasound abdomen done on day 3 of life showed no anomalies. Both the
kidneys were normal. Echocardiography was done as part of routine screening in such babies. There was a
small patent foramen ovale. The mother was reassured. The karyotype was done and it was reported
normal. The baby is now 1-month old and was brought for review. She is feeding well and gaining weight.
Her present weight is 2.6 kg [Figures 1 and 2].

Discussion
The incidence of SUA varies from 0.2% to 0.87%.[1] It is more common in multiple pregnancies. Prenatal
ultrasound evaluation for SUA should be done during the second and third trimester of pregnancy.[2] In
this case, the second trimester ultrasound which was done at 27 weeks showed a SUA with no other
associated anomalies. Isolated SUA is a risk factor for adverse pregnancy outcome. There is an increased
risk of intrauterine and intrapartum deaths among fetuses with SUA.[3] There is also an increased risk of
intrauterine growth restriction, prematurity and mortality among neonates with SUA when compared with
those with a three-vessel cord.[3,4] This baby was also born premature with a low birth weight.

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Neonates with SUA are at a higher risk of congenital anomalies and chromosomal abnormalities. The most
common congenital anomalies associated with SUA are renal, followed by cardiovascular and
musculoskeletal.[3] Screening renal ultrasonography done in our baby was reported to be normal.

Neonates with SUA have a 15 times higher risk of chromosomal abnormalities.[3] However, SUA can also
be an isolated finding. Fortunately, this newborn had no congenital anomalies.

A significant proportion of infants with isolated SUA may have occult renal malformations like vesico-
ureteric reflux (VUR) grade 2 or more.[5] Hence, these infants need to be followed up regularly, and we
need to maintain a low threshold for diagnosing and managing urinary tract infections (UTIs). Once the
UTI is treated a micturating cystourethrogram needs to be done to rule out VUR. We are planning to
follow up this baby based on the above recommendations.

Footnotes
Source of Support: Nil

Conflict of Interest: None declared.

References
1. Vasanthalakshmi GN, Pushpalatha T, Mehta P, Devi SA. Single umbilical artery and pregnancy
outcomes: Cause for concern. J S Asian Fed Obstet Gynaecol. 2012;4:1035.

2. Chow JS, Benson CB, Doubilet PM. Frequency and nature of structural anomalies in fetuses with single
umbilical arteries. J Ultrasound Med. 1998;17:7658. [PubMed: 9849950]

3. Murphy-Kaulbeck L, Dodds L, Joseph KS, Van den Hof M. Single umbilical artery risk factors and
pregnancy outcomes. Obstet Gynecol. 2010;116:84350. [PubMed: 20859147]

4. Leung AK, Robson WL. Single umbilical artery. A report of 159 cases. Am J Dis Child. 1989;143:108
11. [PubMed: 2910035]

5. Srinivasan R, Arora RS. Do well infants born with an isolated single umbilical artery need
investigation? Arch Dis Child. 2005;90:1001. [PMCID: PMC1720078] [PubMed: 15613529]

Figures and Tables

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20.08.2017 Single umbilical artery

Figure 1

Cut section-umbilical cord of the baby

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Figure 2

Two vessel cord of the baby-macroscopic and microscopic view

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