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Antenatal Diagnosis of Single Umbilical Artery: Is Fetal Echocardiography Warranted?

From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Mary-land.

OBJECTIVE: To estimate the utility of fetal echocardiography in the evaluation of the fetus with isolated single umbilical artery.

METHODS: A retrospective analysis of fetuses diagnosed with single umbilical artery by sonography was conducted between January 1995 and June 2000 (n = 127). In the 103 patients who had fetal echocardiograms, we examined the frequency of abnormal echocardiographic findings when the initial sonogram demonstrated a normal four-chamber view and cardiac outflow tracts.

RESULTS: Approximately 1% of fetal anomaly screens had a diagnosis of single umbilical artery. Of these, 72% were isolated (no other anomalies identified). No fetus in this group had an abnormal echocardiogram. There was one postnatal diagnosis of cardiac disease in this group; it was not predicted by either the four-chamber and outflow tract views or the echocardiogram. Among the group with other anomalies, the four-chamber view predicted every abnormal echocardiogram but one.

CONCLUSION: Fetal echocardiography does not appear to add further diagnostic information to the antenatal evaluation of the fetus with isolated single umbilical artery when normal four-chamber and outflow tract views of the heart have already been obtained.

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