Single umbilical artery: Does side matter?
BACKGROUND
The aim of this study was to determine if laterality of an absent umbilical artery (AUA) is associated with specific sonographic findings, chromosomal defects or postpartum birth defects.


METHODS
In this retrospective cohort study, ultrasound reports and medical records of patients who received an obstetric ultrasound at the University of Iowa Hospitals and Clinics with an identified laterality of the AUA from 1989 to 2007 (n = 405) were reviewed. Rates of sonographic abnormalities between fetuses with a right versus left AUA were compared using Fisher's exact test. Adjustments for confounding were made using logistic regression modeling. The significance level was set at 0.05.


RESULTS
Right AUAs on ultrasound demonstrate higher unadjusted rates of ultrasound abnormalities with a higher percentage of fetuses with >1 additional abnormality (51.1 vs. 37.0%; p = 0.0043). The left AUA group had a significantly higher percentage of isolated AUA (63.0 vs. 48.8%; p = 0.004). In a multivariate analysis, a sonographic right AUA was significantly associated with gastrointestinal (GI) and genitourinary (GU) abnormalities. No other ultrasonographic and umbilical artery Doppler abnormalities, chromosomal defects or postpartum birth defects were significantly associated with a specific laterality of the AUA.


CONCLUSIONS
Our study identified a significant association between a right AUA and concomitant fetal GI and GU abnormalities. Contrary to previous reports, we conclude that laterality of the AUA may prove to be an easily identified early marker of fetal abnormalities.
Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. mark-santillan@uiowa.edu
Mark
M
Santillan
Donna
D
Santillan
Diedre
D
Fleener
Barbara
B
Stegmann
Gideon
G
Zamba
Stephen
S
Hunter
Jerome
J
Yankowitz
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D041981:Gastrointestinal Tract / Q000002:abnormalities; D006785:Hospitals, University; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D008499:Medical Records; D010044:Outpatient Clinics, Hospital; D011247:Pregnancy; D012189:Retrospective Studies; D058529:Single Umbilical Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D014564:Urogenital Abnormalities / Q000150:complications / Q000453:epidemiology / Q000209:etiology
D015415:Biomarkers