| Background Single umbilical artery (SUA):umbilical core contain only one umbilical artery, the other absence. Tt is one of umbilical core congenital anomalies normally. The presence of SUA is associated with a poorer perinatal outcome compared to that in fetuses with three vessels in the cord. A number of reports have shown that the presence of SUA may be associated with a variety of congenital anomalies, some are followed by multi-fatality congenital anomalies, even if fetuses who have a single umbilical artery appear to be structurally normal, the perinatal outcome would be poorer than the normal. The risk will increase obviously about abortion, pre-term delivery, low birth weight, fetal growth restriction (FGR), small generational age(SGA), and perinatal death.It is the key point to discover SUA early, deal with the SUA fentuses with the congenital anomalies as soon as possible errorlessly, and for the fetuses who have a single umbilical artery but appear to be structurally normal, we should observe its growth and development condition closely, discover FGR and other complication, to decrease the perinatal risk.Objective:To analyze the perinatal prognosis about SUA fetus and associated with congenital anomalies:(1) To evaluate the relevance of single umbilical artery (SUA) and fetal congenital malformations. (2) To evaluate the impact of SUA to fetus in growth and development, and the compensation of SUA.Materials and Methods:(1) Retrospective analysis 12436 fetuses (including 106 bigeminal) who were screened by prenatal ultrasound in the Central south university Second Affiliated Hospital and Haikou city people hospital of Xiang-ya Medical College from Jan.2004 to Dec. 2009, including scanning umbilical and organ system, and record the associated anomalies category and proportion, the umbilical cord of 92 SUA fetuses diagnose by US are examined routinely by a midwife following every delivery. Analysis the associated anomalies category and proportion of the fetuses with SUA; (2) We followed-up 46 isolated SUA fetuses and a control group, in the control group, we used the synchronization newborns in the same hospital with matched age and without congenital malformations delivered,these fetuses all had a confirmed 3-vessel umbilical cord at birth. Recalled the birth record of birth weight, stem length and gestational age of the two groups, contrast and analysis the incidence of fetal growth restriction (FGR) and small generational age(SGA), the umbilical artery S/D and RI. At the same time, we followed-up 2886 fetuses with normal cord, to contrast and analyze the perinatal mortality.Results:During the study period, there were 12436 fetuses were screened by ultrasound (including 106 bigeminal),92 cases were identified representing an incidence of a single umbilical artery, the incidence of SUA is 0.74%, including 87 single, incidence is 0.71% and 5 twins, incidence is 4.7%.(1) SUA combined malformations was diagnosed in 46/92 cases in all cases (50%).10 cases with little or temporary abnormalities were borned, survival rate is 10/46(20.74%).36 cases were induced abortion for the multiplicity and fatality abnormity.Of the total 19 cases combine single abnormity,11 cases combine 2 kinds of abnormities,9 cases combine 3 kinds of abnormities,7 cases combine more than 3 kinds of abnormities. Fetal anomalies almost comprise all apparatus and system. The abnormalities include 31(33.7%) cardiovascular anomalies, 15(16.3%) central nervous system anomalies,13(14.1%) urinary system anomalies, and 14(15.2%) anterior abdominal wall abnormities with internal organs extraversion and enteron abnormities,11 (12.0%) dysmelia,7 (7.6%) chest-abdominal dropsy and hydroderma,2 (2.2 %) cervical cyst,7 (7.6%) thoracocyllosis and pulmonary hypoplasia, 2 (2.2%) cheilognathus,4 (4.4%) else abnormities.(2) 46 cases with isolated SUA were registered,46 were birthed, 45 survival, survival ratio is 97.83%. The birth weight is lighter than the control group 285g (2982±469g vs.3267±447g, P=0.004), the difference of stem length is 1.71cm (48.57±2.81cm vs.50.28±2.96cm, P=0.006), the gestational age is smaller than control group about 9 days (265.7±13.9 days vs.274.7±8.3 days, P=0.000), the incidence of FGR (7/46 15.2%vs.2/46 4.3%, P=0.000), SGA/FGR (4/7 vs 2/3, P=1.00), in SUA group 5 cases (5/46) S/D and RI value raise up,3 (3/5) combine IUGR, in control group 3 cases (3/46) S/D and RI value raise up,1(1/3) combine IUGR, P>0.05.Conclusion:(1) The presence of SUA is associated with a poorer perinatal outcome compared to that in fetuses with three vessels in the cord, there are determinate the relevance between single umbilical artery (SUA) and congenital malformations accompanied. (2) Fetuses with isolated SUA is smaller in birth weight, length and gestational ages than the control group, we deem isolatid SUA can impact the growth and development determinatly, but for the SUA can compensate umbilical artery blood flow in part, isolated SUA affect slightly to fetal growth and development.
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