Association of isolated single umbilical artery with perinatal outcomes: Systemic review and meta-analysis

OBJECTIVE: The aim of this study was to evaluate the association between prenatally diagnosed isolated single umbilical artery (iSUA) and perinatal outcomes. METHODS: We searched Medline, Embase, the Cochrane Library, and KoreaMed from inception to January 2016, with no language or regional restrictions, for cohort and case-control studies reporting on the relationship of iSUA and perinatal outcomes. We assessed the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission, and perinatal mortality in fetuses with iSUA compared with those in fetuses with three vessel cord. RESULTS: Eleven articles totaling 1,731 pregnancies with iSUA met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that the presence of an iSUA was associated with small for gestational age (OR, 2.75; 95% CI, 1.97 to 3.83; P<0.00001), preterm birth (OR, 2.10; 95% CI, 1.72 to 2.57; P<0.00001), pregnancy-induced hypertension (OR, 1.62; 95% CI, 1.00 to 2.63; P=0.05), neonatal intensive care unit admission (OR, 2.06; 95% CI, 1.33 to 3.19; P=0.001), and perinatal mortality (OR, 2.29; 95% CI, 1.32 to 3.98; P=0.003). CONCLUSION: Pregnancies complicated by iSUA are at increased risk for small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission and perinatal mortality. Further, large prospective cohort studies are required to improve the quality of prenatal counseling and the neonatal care for pregnancies with iSUA.

Ocular Findings in Children with Single Umbilical Artery: A Case Series of 14 Children

PURPOSE: Single umbilical artery (SUA) is the most common malformation of the umbilical cord. However, there have been no studies on the ocular findings in SUA, except for one case report. This study aimed to investigate the ocular findings in children with SUA. METHODS: Fourteen children (eight boys and six girls) with SUA were evaluated retrospectively. All children underwent a complete ophthalmologic examination. RESULTS: The prevalence of abnormal ocular findings in children was up to 42.9%. Refractive errors are detected in four eyes (14.3%): myopia > or =-1.50 diopters (D) in one eye (3.6%) and hyperopia > or =+2.00 D in three eyes (10.7%). Epiblepharon was found in three children (21.4%), and strabismus was detected in one child (7.1%). CONCLUSIONS: Approximately half of the children with SUA showed abnormal ocular findings, therefore, our case series highlight the need for a comprehensive ocular examination and larger prospective research studies in young patients with SUA.

A Case of Chromosome 1q44 Deletion with Microcephaly and Multiple Congenital Anomalies / 대한주산의학회잡지

The 1q terminal deletion syndrome is a rare chromosomal disorder which was first reported by Mankinen et al. in 1976. This disorder has shown to have broad and diverse clinical phenotypes. Specific phenotypes of 1q terminal deletion syndrome include microcephaly, seizures, psychomotor retardation, growth retardation, abnormalities of extremities, corpus callosum, heart and genitalia. Although this disorder has diverse clinical manifestations, almost all cases of 1q44 deletion syndrome have growth, psychomotor, and mental retardation and progressive microcephaly. The first diagnosis of 1q44 deletion syndrome in Korea was made by fluorescent in situ hybridization analysis in a 4-month-old girl with craniofacial anomalies, multiple congenital anomalies, and growth and psychomotor retardation. We report the second domestic case of 1q44 deletion syndrome with cleft palate, facial dysmorphism, single umbilical artery, foot abnormality, progressive microcephaly, growth and psychomotor retardation which was confirmed by microarray for comparative genomic hybridization. We also compare this case with previously reported cases of 1q44 deletion syndrome.

Should fetal growth be a matter of concern in isolated single umbilical artery? / Artéria umbilical única isolada e restrição do crescimento fetal

Objective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500 g), very low birth weight (< 1.500 g) and fetal growth restriction below the 5th and 10th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840±701g) and control (n=730, 2.983 ± 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5thcentile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies. .

Objetivo: Examinar a frequência de peso ao nascer abaixo dos percentis 5 e 10, em gestações únicas com artéria umbilical única isolada (AUUI), de acordo com a presença de complicações maternas. Métodos: Estudo caso-controle. De acordo com a presença de doenças maternas prévias à gestação, ou ocorrência de complicações obstétricas, as gestações foram classificadas em "não complicadas" ou de "alto risco". As frequências de peso ao nascer abaixo dos percentis 5 e 10 foram comparadas entre os subgrupos. Resultados: O peso ao nascer foi significativamente menor em gestações com AUUI (n=134, 2840 ± 701 g) quando comparado com o grupo controle (n= 730, 2983 ± 671 g, p= 0,04; média da diferença=143 g, IC 95% = 17-269). Em gestações de alto risco, peso ao nascer abaixo do 5º percentil foi significativamente mais frequente no subgrupo com AUUI [10/35 (28,6%) versus 53/377 (14,1%), p= 0,04; razão de chances= 2.45 (IC 95% = 1,11- 5,38)]; não foi observada diferença em relação ao peso abaixo do 10º percentil (p= 0,11). Em gestações não complicadas, não foram observadas diferenças na frequência de peso ao nascer abaixo do 5º e 10º percentis entre os subgrupos com AUUI e cordão com 3 vasos (p= 0,21). Conclusão: Em gestações de alto risco, a frequência de peso ao nascer abaixo do percentil 5 é significativamente aumentada. .

Prenatal diagnosis of single umbilical artery: implications for chromosomal abnormalities and neonatal outcome / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the implications of a prenatal diagnosis of single umbilical artery (SUA) for chromosomal abnormalities and neonatal outcomes.</p><p><b>METHODS</b>From January, 2008 to June, 2012, color Doppler ultrasound identified 44 fetuses with SUA. Prenatal diagnoses with amniocentesis or umbilical blood sampling were subsequently ordered for routine chromosome karyotyping and the newborns were followed up for assessing the neonatal outcomes.</p><p><b>RESULTS</b>Of all the 44 fetuses, 24 had uncomplicated SUA, and 20 had other concurrent abnormalities (including 8 with abnormal ultrasound soft indexes and 12 with chromosomal abnormalities). The two groups of fetuses showed significant differences in gestational weeks at delivery and incidence of chromosomal abnormalities but not in neonatal weight, placenta weight or APGAR score.</p><p><b>CONCLUSIONS</b>Fetuses with a prenatal diagnosis of SUA and other development abnormities need to undergo prenatal chromosomal examination. For fetuses with uncomplicated SUA, careful ultrasound examination is necessary to avoid missed diagnosis of potential congenital abnormalities.</p>

Persistent Pulmonary Hypertension of the Newborn in a Preterm Infant Exposed to Methotrexate During the Early Gestational Period / 대한주산의학회잡지

Methotrexate (MTX) is used in the reproductive aged females for the management of medical conditions such as ectopic pregnancy, autoimmune diseases and malignancies. Because of its antimetabolite effect, exposure to MTX during the fetal period can cause multiple anomalies. The most common anomalies related to intrauterine MTX exposure include growth retardation, craniofacial dysmorphism, central nervous system anomalies, cardiac anomalies and skeletal defects. We report a premature baby boy born after 27(+5) weeks of gestation who presented intrauterine growth restriction, single umbilical artery, small chest and anomalies of rib and thoracic vertebra. His mother had received 50 mg of MTX for the treatment of misdiagnosed ectopic pregnancy at 5th week of gestation. During the hospitalization, he was ventilator dependent and pulmonary hypertension persisted despite medical treatment including nitric oxide and sildenafil. Open lung biopsy revealed nonspecific findings suggestive of lung hypoplasia. He died at 141 days after birth due to respiratory failure.

Incidencia y asociaciones de arteria umbilical única en recién nacidos: maternidad del Hospital Clínico de la Universidad de Chile, 1998-2010 / Incidence and associations of single umbilical artery in newborns: of Hospital Clínico de la Universidad de Chile maternity, 1998-2010, 1998-2010

ANTECEDENTES: La presencia de 2 vasos en el cordón umbilical es una anomalía con incidencia de 1% de todos los recién nacidos. Se asocia frecuentemente con restricción del crecimiento intrauterino (RCIU), malformaciones estructurales mayores y cromosómicas y prematuridad. Constituye un factor de riesgo que aumenta la mortalidad fetal tardía y neonatal. OBJETIVOS: Establecer la prevalencia al nacimiento de arteria umbilical única (AUU), la magnitud de las asociaciones con malformaciones congénitas (MFC), RCIU, prematuridad y su influencia en la morbimortalidad neonatal. MÉTODO: Se usó la base de datos que el Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC) tiene en la maternidad del Hospital Clínico de la Universidad de Chile. Incluyó a todos los recién nacidos vivos (RN) y mortinatos con peso de nacimiento 500 gramos o más en el período mayo 1998 a junio 2010. Se comparó algunas variables demográficas entre los casos y sus controles. RESULTADOS: En 22.011 nacimientos ocurridos hubo 65 RN con AUU (0,3%), 9 eran mortinatos (13,8%), 88,9% de ellos presentaban RCIU. Eran prematuros 55,4% de los RN. El 60% de los casos de AUU estaban asociados a MFC mayores, destacando las del aparato genitourinario (35,3%) y las cardiovasculares (29,4%); 23,8% eran parte de un síndrome, donde dominaban latrisomía 13 y 18 (12 casos, 18,5%). De los RN vivos fallecieron 13 (23,2%), 8 (61,5%) presentaban RCIU. CONCLUSIÓN: La AUU es un factor de alto riesgo de asociación con RCIU, MFC mayores estructurales y/o cromosómicas, prematuridad y de un aumento de la morbimartalidad neonatal.

BACKGROUND: The presence of only two blood vessels in the cord blood is a congenital anomaly that has an incidence about 1% among all newborns. Frequently, it is associated with intrauterine growth restriction (IUGR), major congenital malformations (MCMF), chromosome anomalies and prematurity. It represents a risk factor that increases late foetal and neonatal mortality and morbidity. AIMS: To estímate the prevalence at birth of unique umbilical artery (UUA), to know its association with congenital anomalies, IUGR, prematurity and to evaluate its influence in neonatal morbidity and mortality. METHODS: We studied data registered in the Latin American Study of Congenital Malformations (ECLAMC) from the Maternity of the Clinical Hospital of University of Chile from May 1998 and June 2010. All newborns (alive and stillbirths) with a birth weigh >500 g were included. Demographic variables were compared between cases and controls. RESULTS: 65 newborns with UUA (0.3%) was found among the 22.011 births registered: 9 was stillbirths (13.8%), 88.9% of them had IUGR and 55.4% were premature. 60% of cases has another MCMF (35.3% of the genitourinary system and 29.4% involved the cardiovascular system). 23.8% of cases were part of a syndrome, 13 and 18 trisomy were the most common (12 cases, 18.5%). 13 newborns died (23.2%), 8 of them (61.5%) had IUGR. CONCLUSION: The presence of UUA in a foetus or newborn represents a high risk for IUGR, MCMF, chromosome anomalies, prematurity and increase of neonatal morbidity and mortality.

Doppler fetoplacentario en hipertensión gestacional y preeclampsia leve / The usefulness of fetal placental doppler ultrasound in gestational hypertension and mild preeclampsia

Introducción: la preeclampsia se presenta en 6% de los embarazos en Colombia y se asocia con una elevada tasa de morbimortalidad maternofetal. Con frecuencia los casos severos se acompañan de restricción del crecimiento intrauterino; en estos casos el doppler fetoplacentario es útil para determinar el pronóstico fetal, pero su valor en preeclampsia leve o hipertensión gestacional no está bien definido. Objetivos: determinar en estas dos circunstancias la frecuencia de alteraciones en el doppler de las arterias umbilical y cerebral media. Materiales y métodos: búsqueda de casos en la base datos de la unidad de medicina maternofetal del Hospital de San José, entre agosto de 2006 y febrero de 2008. Se definió como casos las pacientes con gestaciones > a 28 semanas con HTG o PL y fetos con perfil de crecimiento normal. Se consideraron y analizaron variables demográficas, resultados del doppler fetoplacentario y las complicaciones. Resultados: se identificaron 85 pacientes. El 17% presentó alteración del doppler de la AU y 7% de la ACM; en gestaciones < 32 semanas los hallazgos anormales son bajos (75% AU y 85% ACM normales). Conclusiones: la frecuencia de alteraciones en el Doppler de AU y ACM fue similar en el grupo de mujeres que presentaron complicaciones y aquellas con un desenlace normal.

Introduction: In Colombia, around 6% of pregnant women will experience preeclampsia. It is associated with high maternal and fetal morbidity and mortality rates. Severe cases are frequently related to intrauterine growth restriction; placental and fetal Doppler has prognostic value in these cases, although, its usefulness in mild preeclampsia (MP) or gestational hypertension (GHT) is not yet well defined. Objectives: to determine the frequency of abnormal Doppler sonography of the umbilical artery (UA) and middle cerebral artery (MCA) in MP or GHT. Materials and methods: cases were searched for in the Maternal Fetal Unit databases at Hospital de San José between August 2006 and February 2008. Cases were defined as patients with > 28 week pregnancies complicated by GHT or MP with fetuses with a normal growth profile. Demographic variables, placental fetal Doppler evaluation results and complications were considered and analyzed. Results: 85 patients were identified. Seventeen percent (17 %) presented abnormal Doppler of the UA and 7% of the MCA; abnormal findings were low (normal UA in 75% and normal MCA in 85%) in < 32 week gestations. Conclusions: the frequency of abnormal Doppler results of the UA and MCA were similar in the group of women with complications and in those who had a normal pregnancy outcome.

Extra-renal anomalies associated with fetal renal dysgenesis / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate other anomalies associated with the fetal renal dysgenesis and prognosis. METHODS: Level II sonography were reviewed in the pregnant women who had been diagnosed with fetal renal dysgenesis antenatally from March 1998 to February 2005. Diagnosis was comfirmed by the autopsy or the postnatal studies including sonographic and radiologic evaluation. RESULTS: Thirty fetuses had a fetal renal dysgenesis. There were 2 cases of polycystic kidney, 4 cases of bilateral renal agenesis, 4 cases of unilateral renal agenesis, 3 cases of bilateral multicystic dysplastic kidney and 17 cases of unilateral multicystic dysplastic kidney. The common associated anomalies were congenital heart disease (7 cases), single umbilical artery (5 cases), imperforate anus (2 cases) and tracheo-esophageal fistula (2 cases). Hypospadia and scoliosis with hemivertebra were also noted. CONCLUSION: The most common anomaly associated with renal dysgenesis was congenital heart diseases. If fetal renal dysgenesis is detected antenatally, fetal echocardiography should be performed.

Multicenter clinical study on birth weight and associated anomalies of single umbilical artery / 소아과

PURPOSE: To compare birth weight between infants with a single umbilical artery (SUA) and normal infants, investigate the associated anomalies of infants with SUA and isolated SUA (no abnormality of external appearance on birth, except SUA), and determine the prognosis of infants with isolated SUA. METHODS: Live-born infants with SUA (n=59) detected by physical examination from among 15,193 live births in seven university hospitals in Korea between January 1, 2004, to August 1, 2007, were reviewed retrospectively, with 236 normal infants serving as the control group. RESULTS: A statistical difference was observed between the groups in birth weight and in vitro fertilization. The incidence of infants with SUA was 0.37%. Congenital malformations were observed in 21 infants with cardiovascular (n=15, 25.4%), gastrointestinal (n=2, 3.4%), genitourinary (n=9, 15.3%), neuromusculoskeletal (n=6, 10.2%), central nervous system (n=1, 1.7%), chromosomal (n=1, 1.7%), and other (n=3, 5.1%) abnormalities. There were 49 (83.1%) infants with isolated SUA in this study population; among them, the associated congenital malformations were cardiovascular (n=6, 12.2%) and genitourinary (n=6, 12.2%) abnormalities. Two infants with cyanotic heart disease were operated and four infants with acyanotic heart disease showed improvements without any treatment. Six infants with genitourinary abnormalities on renal ultrasound had mild hydronephrosis without further consequences. CONCLUSION: The incidence of structural abnormalities in the cardiovascular and genitourinary systems is high and the genitourinary anomalies associated with isolated SUA have relatively good prognosis.

A study in fetuses with prenatally diagnosed single umbilical artery by ultrasonund / 대한산부인과학회지

OBJECTIVE: To evaluate the incidence, combined anomaly, and prognosis of prenatally diagnosed Single Umbilical Artery (SUA) by ultrasound. METHODS: From January 2001 to December 2005, a single umbilical artery (SUA) was observed in 41 cases out of 22,868 deliveries. Among 41 cases, 39 cases were examined by targeted imaging to rule out fetal anomalies in the mid trimester (intrauterine pregnancy 16-27 weeks). The remaining two cases were detected in the third trimester, which were transferred from a local clinic, and were examined by routine sonogram. Pregnancy and perinatal outcome data were retrieved by review of the medical records. RESULTS: The incidence of SUA in our population was 0.18%. Of 41 fetuses with SUA, 8 cases presented congenital malformations (19.5%) such as acrania (n=1), Tetralogy of Fallot (n=1), renal anomalies (unilateral renal agenesis n=2, pyelectasis n=1), esophageal atresia (EA) with tracheoesophageal fistula (TEF)(n=1), omphalocele with choroid plexus cyst (CPC)(n=1), and congenital diaphragmatic hernia with hypoplastic left heart syndrome (n=1). Of 33 fetuses with isolated SUA, 3 (9.1%) demonstrated growth restriction. Karyotype analysis was performed in three cases. Two were normal and omphalocele with CPC was Trisomy 18. CONCLUSION: During the prenatal period, the fetus with SUA by ultrasound examination must be carefully monitored with targeted prenatal ultrasound because of its frequent association with fetal congenital anomalies (19.5%). Isolated SUA without associated anomaly dose not affect the outcome of the pregnancy.

A Case of Sirenomelia without Oligohydramnios Diagnosed in Early Second Trimester / 대한주산의학회잡지

Sirenomelia is rare congenital malformation characterized by fusion of the lower extrimities associated anomalies included absence of urogenital system (bilateral renal agenesis, absent ureter, urinary bladder, absent internal and external genitalia), induced severe oligohydramnios, anorectal atresia, single umbilical artery, pulmonary hypoplasia. The incidence is 1:60000 births. Survival is extremely rare, and only possible, in the absence of bilateral renal agenesis. In view of the dismal prognosis, early diagnosis allows for earlier and less traumatic therapeutic abortion. We report a case of sirenomelia without oligohydramnios diagnosed in early second trimester.

Prenatal Sonographic Diagnosis of Acardiac Twins

PURPOSE: This study was performed to present the prenatal sonographic findings and the associated abnormalities of acardiac twins. MATERIALS AND METHODS: Seven cases of acardiac twins were reviewed retrospectively. Prenatal ultrasonography was performed in all patients at a gestational age between 12 and 27 weeks (mean 17.6 weeks). Autopsy was performed in four cases. The sonographic and autopsy findings were reviewed to report the associated abnormalities of the acardiac and donor fetuses. RESULTS: The diagnosis of acardiac twins was made on the basis of ultrasonography (n=6) or autopsy (n=1). The associated abnormalities of the acardiac fetuses were single umbilical artery (SUA) (n=5), abdominal wall defect (n=4), club feet (n=4), scoliosis (n=1), cleft lip and palate (n=1), digital anomaly (n=1), and umbilical cord cyst (n=1). In four of the donor fetuses, sonographic abnormalities were found. Autopsy was performed in three of the four cases to reveal hydropic change (n=2), diaphragmatic hernia (n=1) and multiple structural abnormalities of interventricular septal defect, polydactyly, club feet and SUA (n=1). Intrauterine fetal death occurred in five donors and follow-up was lost in the remaining two. CONCLUSION: Meticulous sonography enables the diagnosis of acardiac twins at an early gestational age and can reveal the associated abnormalities of the donor fetus as well as the acardiac fetus.

Associated anomalies and perinatal outcomes in the fetus with single umbilical artery / 대한산부인과학회지

OBJECTIVE: To evaluate the pattern of associated structural anomalies, perinatal outcomes and obstetrical complications in fetuses with single umbilical artery. METHODS: 27 fetuses with a single umbilical artery were detected between May 1995 and June 2005 at our hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications and perinatal outcome. RESULTS: Of the 27 fetuses, 1 (3.7%) was terminated and 1 (3.7%) was expired. 13 fetuses (48.1%) had an associated structural anomalies. The structural anomalies found in association with single umbilical artery were in the cardiovascular system (6 cases, 46.2%), urogenital system (6 cases, 46.2%), central nervous system (3 cases, 23.1%), neuromuscular system (3 cases, 23.1%) and gastrointestinal system (1 case, 7.7%). 6 cases (46.2%) among these had multiple malformations. Karyotypic analyses were available only in 3 cases and one of these was chromosomally abnormal. CONCLUSION: Scanning the umbilical cord should be one of the essential parts of the second trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities.

A Case of Congenital Laryngeal Atresia with Single Umbilical Artery Who Required a Tracheotomy / 소아과

Congenital laryngeal atresia is a rare cause of airway obstruction that is almost always lethal within a few minutes after birth. Therefore congenital laryngeal atresia should be diagnosed in the prenatal period. If not, it should be considered in newborn infant with life-threatening symptoms at birth such as cyanosis and dyspnea that need emergent procedures like a tracheotomy. We report a case of congenital laryngeal atresia with single umbilical artery diagnosed in a one-day-old neonate who required a tracheotomy and ventilator care after intubation failure.

A Case of Simple Renal Cortical Cyst in Neonate

We report a case of simple renal cortical cyst in neonate with review of literature. A female infant weighing 3, 400 g was delivered. Because of single umbilical artery found on physical examination, abdominal ultrasonogram was performed. A 3 mm sized renal cortical cyst was found in right kidney, but no associated symptoms or signs including renal functions were found. Follow up ultrasonogram was performed a month later and it was spontaneously disappeared.

An Unbalanced Translocation of Chromosome 16 Associated with Multiple Congenital Anomalies

We present a case of de novo reciprocal unbalanced translocation of chromosome 16, [46, XX, 8p+, der(8)t(8;16)(p23;q13)enh(16)], associated with clinical features, including anal atresia, vertebral anomaly, urogenital anomaly, single umbilical artery, ventricular septal defect and bilateral sensorineural hearing losses.

Patterns of Hyrtl's Anastomosis and their Effects on Obstetric Outcomes / 대한산부인과학회잡지

OBJECTIVE: This study was conducted to investigate the presence and pattern of Hyrtl anastomosis, and to examine the effect that each type has on obstetrical outcome. METHODS: This study was carried out from January of 2001 to May of 2003 on 904 randomly selected patients who had given birth by Cesarean section or vaginal delivery at Catholic University Holy Family Hospital. Immediately proceeding delivery, barium sulfate was infused into the umbilical artery. This was followed by umbilical artery dissection to grossly confirm Hyrtl anastomosis. In order to evaluate the effect that each type of anastomosis has on obstetrical outcome, we retrospectively examined chart for birth weight, Apgar score, results of cord blood gas analysis, obstetrical complications, etc. RESULTS: Out of the 904 cases studied, 99.7% possessed Hyrt's anastomosis with frequency according to type as follows: 50.8% oblique, 48.0% transverse, 1.8% of anastomosis between one umbilical artery and the branch of the other, 1.6% of fusion of branches of each umbilical artery, 0.6% of anastomosis represented by two separate vessels between umbilical arteries, 0.1% of anastomosis between branches of each umbilical artery, 0.1% lacking anastomosis, and 0.2% of a single umbilical artery. In terms of obstetrical outcome, there was no significant difference for term and preterm infants in the frequency of type of Hyrtl's anastomosis according to birth weight, maternal age, Apgar score, obstetrical complications, etc. CONCLUSION: In an attempt to verify the presence and type of Hyrtl anastomosis, 8 types of Hyrtl's anastomosis were found, of which the oblique and transverse variety were the most common. There was no significant difference in the types of Hyrtl's anastomosis in relation to obstetrical outcome. Frequency was also similar with oblique and transverse types being the most common. Further studies detailing anatomical features of and blood flow/volume through the anastomosis are required in order to better understand the effects of Hyrtl's anastomosis on obstetrical outcome.

Successful Management with Intra-abdominal Alcohol Ablation of Acardiac Twin and Amniodrainage in Twin Reversed Arterial Perfusion Sequence with Severe Polyhydramnios / 대한산부인과학회잡지

Twin reversed arterial perfusion (TRAP) sequence is a unique complication of monochorionic twinning, in which normal pump or donor twin paradoxically perfuses the recipient or acardiac twin through arterial- arterial anastomoses. This results in reversed flow of poorly oxygenated blood through the recipient twin and is usually associated with partial or complete lack of heart development. The pump twin has a mortality rate of 50% as a result of high-output heart failure, preterm labor, and polyhydramnios. We present here a case of twin reversed arterial perfusion (TRAP) sequence complicated by severe polyhydramnios during the second trimester. The blood supply to acardiac twin was interrupted successfully at 25 weeks of gestation by injecting 1.5 mL of absolute alcohol into the intra-abdominal portion of the single umbilical artery, under ultrasound guidance. Serial ultrasound showed normal growth and normal amniotic fluid volume in normal pump twin, but arrest of growth in femur length and decrease in amniotic fluid volume in acardiac twin. The normal pump twin was delivered at 384 weeks of gestation and had uneventful neonatal course.

Usefulness of Routine Screening for Infants with Single Umbilical Artery

PURPOSE: Single umbilical artery is usually detected by antenatal fetal sonography or by postnatal primary physical exams. Routine screening test is usually recommended because of frequent association with abnormalities in multiple organs or in chromosomes. This study was performed to find the necessity of evaluating combining anomalies and chromosomes in neonates with single umbilical artery. METHODS: Retrospective analysis had been performed based on admission records and laboratory data, including simple X-ray, echocardiography, abdominal sonography, and chromosomal study, of 6, 636 neonates born last decade from September, 1993 to August, 2003 at Ewha Womans University hospital. RESULTS: There were 73 (1.1%) neonates born with single umbilical artery that matched the incidence in general population. Congenital malformation was observed in 28 neonates which included cardiovascular (n=16, 21.9%), gastrointestinal (n=6, 8.2%), geni tourinary (n=5, 6.8%), musculoskeletal (n=4, 5.5%), central nervous system (n=1, 1.4%), and other (n=1, 1.4%) abnormalities. No chromosomal abnormalities were detected in this group. CONCLUSION: Because the incidences of structural abnormalities in genitourinary system, gastrointestinal system and cardiovascular system were high as previously reported, it is highly recommended to perform imaging studies including echocardiography and abdominal sonography to screen these anomalies. However necessity of the chromosomal study should be reconsidered based on large study population in isolated single umbilical artery patient.