Lone Umbilical Artery Indicates Need for Fetal ECG


MIAMI BEACH — A prenatal sonographic finding of single umbilical artery is an indication for fetal echocardiography, Dr. Lami Yeo said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a case series of 430 fetuses with this finding who were identified retrospectively from a database of more than 42,600 patients, 13% had sonographic structural cardiac abnormalities, said Dr. Yeo of Robert Wood Johnson Medical School, Piscataway, N.J.

About 67% of the 430 patients had isolated single umbilical artery, and the remaining 20% had only noncardiac defects, she noted.

Of the structural cardiac abnormalities, 26% were complex cardiac defects, 26% were septal defects only, 19% were left or right hypoplastic heart, 15% were conotruncal abnormalities, 6% were defects of the atrioventricular canal, and 9% were classified as “other” defects. (Percentages add to more than 100% due to rounding.) Nearly 75% of the defects were significant defects, Dr. Yeo said.

Furthermore, 80% of those with structural cardiac defects also had other anomalies.

The patients were all diagnosed with single umbilical artery from 1994 to 2005 using color Doppler imaging around the fetal bladder. Previous studies have suggested a connection between single umbilical artery and cardiac defects, but the studies were small, and the rates varied from 2% to 23%, Dr. Yeo noted.

This series—the largest reported from a single institution—confirms the significant incidence of structural cardiac abnormalities and therefore the need for fetal echocardiography in those with a prenatal diagnosis of single umbilical artery.

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