Κατεύθυνση Έρευνα στην Γυναικεία ΑναπαραγωγήLibrary of the School of Health Sciences
Μεδίτσκου-Ευθυμιάδου Σουλτάνα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΑΠΘ, Επιβλέπουσα
Μηλιαράς Δημοσθένης, Καθηγητής, Ιατρική Σχολή, ΑΠΘ
Νόννη Αφροδίτη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μονήρης ομφαλική αρτηρία. Συχνότητα και συσχέτιση με επιδημιολογικούς παράγοντες, διαταραχές αύξησης και συγγενείς διαμαρτίες σε νεκροτομικό υλικό εμβρυϊκών θανάτων από τη Βόρεια Ελλάδα
Single umbilical artery: Frequency and correlation with demographic data, growth and congenital malformations on a series of fetal autopsies from Northern Greece
The umbilical cord consists normally of three vessels: two umbilical arteries and one umbilical vein, which are surrounded by a gelatinous substance called Wharton’s jelly. The physiological role of the umbilical vein is to transfer oxygenated blood to the fetus, whereas the umbilical arteries carry deoxygenated blood from the fetus to the placenta. The presence of a single umbilical artery (SUB) is one of the most common congenital malformations that have been described in humans (approximately 0.2-2% of deliveries). This frequency is approximately 2-4 times more in autopsy cases. The role of SUB remains controversial. Multiple mechanisms have been implicated in the pathogenesis of this disorder, such as aplasia or atresia of one of the umbilical arteries during embryogenesis or persistence of a single anomalous vessel of omphalomesenteric origin in the body stalk of the embryo. SUB can be an isolated finding or it can be associated with other congenital anomalies that affect the cardiovascular, genitourinary, musculoskeletal, nervous and gastrointestinal systems. Poly- or oligohydramnios, velamentous insertion of the cord and placental abnormalities have been described at a greater frequency in embryos with SUB. Furthermore, these pregnancies carry a higher risk of preterm delivery, perinatal mortality, intrauterine growth restriction and chromosomal anomalies.
The aim of this study is to determine the prevalence of SUB in autopsy cases obtained from the Laboratory of Histology and Embryology of the Medical School of Aristotle University of Thessaloniki, Greece and to correlate this malformation with multiple epidemiologic parameters, such as fetal weight, maternal age, structural defects, sex and age of the fetuses.
Materials and Methods:
We retrospectively retrieved 649 fetal and neonatal autopsy cases from the archives of Ηistopathology lab of Hippocrateion General Hospital and the laboratory of Pathology of General Clinic of Thessaloniki, Greece during the period of 1992 to 2008. The data were reviewed and analyzed at the Laboratory of Histology and Embryology of Medical Faculty of Aristotle University of Thessaloniki.
The data were categorized according to the maternal and gestational age, fetal and neonatal gender and weight, presence or absence of congenital anomalies and the histopathology of the umbilical cord. The statistical analysis software used was SPSS with a significance level set at 5%. An association between the presence of single umbilical artery and demographic and histopathologic data is being sought. The presence or absence of association between two categorical variables in the sample was determined with the use of Pearson’s chi-squared (χ2) test. Single umbilical artery was the most commonly observed congenital anomaly in the examined material with a relative frequency of 4.46%. Statistically significant association was found between the presence of single umbilical artery and growth restriction, presence of other congenital anomalies and perinatal mortality. No association was described between the presence of the anomaly and maternal and fetal age.
Our data suggest an increased risk between the presence of single umbilical artery and co-existing congenital anomalies. The results of the study were derived from autopsy material and not from prenatal data, so no information can be given about the prognosis of the pregnancies with single umbilical artery. We hope that the creation of a national registry containing demographic and biometric information about the characteristics of fetal abortuses and stillborns will increase our understanding about the correlation and prevalence of congenital anomalies.
Main subject category:
Single umbilical artery, Umbilical cord, Placenta, Congenital malformations, Perinatal mortality
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