Practice importance of the results of population studies on the single umbilical artery
DOI: 10.32364/2618-8430-2020-3-4-242-247
Yu.V. Trusov, V.A. Kramarskiy, N.I. Faizullina
Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation
This paper discusses the clinical importance of the isolated single umbilical artery (iSUA). It was demonstrated that iSUA is an independent risk factor for perinatal death. The authors report that iSUA results in higher risk of the manual removal of the placenta, atonic post-partum hemorrhage, and postpartum uterus curettage. iSUA is closely associated with esophageal and anorectal atresia or stenosis and trisomy 13 and trisomy 18. Isolated iSUA (i.e., in the lack of fetal malformations) is associated with the Battledore placenta. It is also emphasized that iSUA fetus should be monitored using an ensemble of diagnostic techniques (ultrasound, Doppler, cardiotocography) for the early recognition of placental hypoperfusion, intrauterine growth restriction, and fetal acidosis. The authors postulate that a worsening of the cerebroplacental ratio or placental perfusion indices as well as abnormal cardiotocography are the indications to C-section in iSUA. In spontaneous delivery, the continuous electronic monitoring of fetal heart beat is recommended for the prompt diagnosis of its impairment, the prevention of maternal hemorrhages, and the detection of fetal abnormalities postnatally. The management of iSUA risk factors includes smoking cessation, the control of diabetes and hypertension.
Keywords: single umbilical artery, malperfusion, placenta, middle cerebral artery, perinatal mortality, trisomy.
For citation: Trusov Yu.V., Kramarskiy V.A., Faizullina N.I. Practice importance of the results of population studies on the single umbilical artery. Russian Journal of Woman and Child Health. 2020;3(4):242–247. DOI: 10.32364/2618-8430-2020-3-4-242-247.
2. Murphy-Kaulbeck L., Dodds L., Joseph K.S. et al. Single umbilical artery risk factors and pregnancy outcomes. Obstet Gynecol. 2010;116(4):843–850. DOI: 10.1097/AOG.0b013e3181f0bc08.
3. Ebbing C., Jörg Kessler J., Moster D., Rasmussen S. Isolated single umbilical artery and the risk of adverse perinatal outcome and third stage of labor complications: A population‐based study. Acta Obstet Gynecol Scand. 2020;99(3):374–380. DOI: 10.1111/aogs.13747.
4. Fujikura T. Fused umbilical arteries near placental cord insertion. Am J Obstet Gynecol. 2003;188(3):765–767. DOI: 10.1067/mob.2003.165.
5. Benirschke K., Burton G.J., Baergen R.N. Pathology of the Human Placenta. Verlag-Berlin-Heidelberg: Springer; 2012. DOI: 10.1007/978-3-642-23941-0.
6. Mailath-Pokorny M., Worda K., Schmid M. et al. Isolated single umbilical artery: evaluating the risk of adverse pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2015;184:80–83. DOI: 10.1016/j.ejogrb.2014.11.007.
7. Gardosi J., Kady S.M., Pat McGeown P. et al. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005;331(7525):1113–1117. DOI: 10.1136/bmj.38629.587639.7C.
8. Australian Institute of Health and Welfare 2018. Perinatal deaths in Australia: 2013–2014. Cat. no. PER 94. Canberra: AIHW.
9. Grivell R.M., Wong L., Bhatia V. Regimens of fetal surveillance for impaired fetal growth. Cochrane Database Syst Rev. 2012;2012(6): CD007113. DOI: 10.1002/14651858.CD007113.pub3.
10. McCowan L.M., Figueras F., Anderson N.H. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol. 2018;218(2):S855–868. DOI: 10.1016/j.ajog.2017.12.004.
11. Gardosi J., Madurasinghe V., Williams M. et al. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108. DOI: 10.1136/bmj.f108.
12. Kehl S., Dötsch J., Kurt Hecher K. еt al. Intrauterine growth restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-level, AWMF registry no. 015/080, October 2016). Geburtshilfe Frauenheilkd. 2017;77(11):1157–1173. DOI: 10.1055/s-0043-118908.
13. De Vore G.R. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015;213(1):5–15. DOI: 10.1016/j.ajog.2015.05.024.
14. Morales‐Roselló J., Khalil A., Morlando M. еt al. Poor neonatal acid-base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet Gynecol. 2015;45(2):156–161. DOI: 10.1002/uog.14647.
15. Lees C., Marlow N., Arabin B. et al. Perinatal morbidity and mortality in early‐onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol. 2013;42(4):400–408. DOI: 10.1002/uog.13190.
16. Fong K.W., Ohlsson A., Hannah M.E. et al. Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiology. 1999;213(3):681–689. DOI: 10.1148/radiology.213.3.r99dc08681.
17. Morales‐Roselló J., Khalil A., Morlando M. et al. Changes in fetal Doppler indices as a marker of failure to reach growth potential at term. Ultrasound Obstet Gynecol. 2014;43(3):303–310. DOI: 10.1002/uog.13319.
18. Parra-Saavedra M., Crovetto F., Triunfo S. et al. Placental findings in late-onset SGA births without Doppler signs of placental insufficiency. Placenta. 2013;34(12):1136–1141. DOI: 10.1016/j.placenta.2013.09.018.
19. Putri R.A., Amir R.I. EP19. 14: Modified biophysical profile score and middle cerebral artery Doppler as predictor of perinatal outcome in Indonesian tertiary hospital. Ultrasound Obstet Gynecol. 2019;54:355. DOI: 10.1002/uog.21516.
20. Клинические рекомендации. Профилактика, алгоритм ведения, анестезия и интенсивная терапия при послеродовых кровотечениях. 2019. [Clinical recommendations. Prevention, management algorithm, anesthesia and intensive care for postpartum hemorrhages. 2019 (in Russ.)].
21. Ebbing C., Kessler J., Moster D., Rasmussen S. Single umbilical artery and risk of congenital malformations: a population‐based study in Norway. Ultrasound Obstet Gynecol. 2020;55(4):510–515. DOI: 10.1002/uog.20359.
22. Клинические рекомендации. Атрезия пищевода у детей. М.; 2016. [Clinical recommendations. Atresia of the esophagus in children. M.: 2016 (in Russ.)].
23. Аверин В.И., Ионов А.Л., Караваев С.А. и др. Аноректальные мальформации у детей (федеральные клинические рекомендации). Детская хирургия. 2015;4:29–35. [Averin V.I., Ionov A.L., Karavaev S.A. et al. Anorectal malformations in children (federal clinical recomendation). Detskaya Khirurgya. 2015;4:29–35 (in Russ.)].
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Распечатать