Single umbilical artery: accurate diagnosis?
OBJECTIVE
We sought to evaluate the accuracy of ultrasonographic, obstetric, and neonatal diagnosis of a single umbilical artery.


METHODS
We studied 17,777 consecutive singleton births from women who had undergone ultrasonographic examination at our hospital. A single umbilical artery was confirmed in 37 cases (0.2%) by two clinical methods or by pathologic assessment. Outcome of neonates with a single umbilical artery was compared with the outcome of neonates with either two or three vessel cords.


RESULTS
Ultrasonographic diagnosis had a 65% sensitivity and positive predictive value. Obstetricians and pediatricians failed to diagnose 24% and 16% of the cases, respectively. On average, neonates with a single umbilical artery weighed 320 gm less, were delivered 1 week earlier, and had lower Apgar scores than neonates with three vessel cords (p < 0.01 in each case.)


CONCLUSIONS
Although early gestational age may account for some cases not diagnosed by ultrasonography, there is a little justification for missing the diagnosis after delivery. Greater emphasis on clinical examination of the umbilical cord is needed to identify neonates at risk of associated malformations.
Jones
T B
TB
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201.
Sorokin
Y
Y
Bhatia
R
R
Zador
I E
IE
Bottoms
S F
SF
D001034:Apgar Score; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000000981:diagnostic imaging; D003951:Diagnostic Errors; D005069:Evaluation Studies as Topic; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010808:Physical Examination; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging