title: Umbilical artery aneurysm: a case report, literature review, and management recommendations.
abstract: BACKGROUND
  Umbilical artery aneurysm is a rare and often lethal condition frequently associated with fetal anomalies, fetal demise, and neonatal complications.
  
  
  METHODS
  We report a case of umbilical artery aneurysm discovered at 21 weeks 2 days of gestation in a fetus of normal karyotype. Maternal hospitalization occurred at 28 weeks for antenatal testing, betamethasone administration, and monitoring for expansion of the aneurysm. Delivery of a live neonate by repeat cesarean delivery was performed at 32 weeks 2 days. Pathology confirmed a 3-vessel cord with an umbilical artery aneurysm. Neonatal course was complicated by respiratory distress of the newborn, hyperbilirubinemia, anemia, difficulty feeding, and cardiac defects. The newborn was discharged from the neonatal intensive care unit on day of life 19.
  
  
  CONCLUSIONS
  Umbilical artery aneurysm is highly associated with fetal complications including trisomy 18, single umbilical artery, cardiac anomalies, and intrauterine fetal demise. A normal karyotype, antenatal monitoring, and early delivery have been suggested to impact the likeliness of survival. Antenatal management strategies include consideration of nonstress testing 3 times daily, serial ultrasound assessments, testing to identify intrauterine growth restriction, and delivery by planned cesarean delivery between 32 and 34 weeks. We recommend that patients be counseled on the high risks associated with umbilical artery aneurysm and be included in discussions regarding antenatal management and delivery planning.
authors.affiliation: Obstetrics and Gynecology Resident, Department of Obstetrics and Gynecology, Banner Good Samaritan Medical Center, Phoenix, AZ.
authors.forename: Pooja
authors.initials: P
authors.lastname: Doehrman
authors.affiliation: Medical Student, University of Arizona College of Medicine, Phoenix, AZ.
authors.forename: Brenna J
authors.initials: BJ
authors.lastname: Derksen
authors.affiliation: Director, Maternal-Fetal Medicine, Banner Good Samaritan Medical Center, Phoenix, AZ.
authors.forename: Jordan H
authors.initials: JH
authors.lastname: Perlow
authors.affiliation: Maternal-Fetal Medicine and Director of Obstetric Ultrasound, Banner Good Samaritan Medical Center, and Clinical Professor of Obstetrics and Gynecology, University of Arizona College of Medicine, Phoenix, AZ.
authors.forename: William H
authors.initials: WH
authors.lastname: Clewell
authors.affiliation: Diagnosic Radiology, Banner Good Samaritan Medical Center, Phoenix, AZ.
authors.forename: Harris J
authors.initials: HJ
authors.lastname: Finberg
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D002585:Cesarean Section; D005260:Female; D005817:Genetic Counseling; D006801:Humans; D007231:Infant, Newborn; D007621:Karyotyping; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries