Obstet Gynecol Sci.  2017 May;60(3):266-273. 10.5468/ogs.2017.60.3.266.

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

• Kim HJ
• Kim JH
• Chay DB
• Park JH
• Kim MA

• KMID: 2378588
• DOI: http://doi.org/10.5468/ogs.2017.60.3.266

Abstract

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.

Keyword

Meta-analysis; Perinatal outcome; Single umbilical artery

MeSH Terms

Case-Control Studies
Cohort Studies
Counseling
Female
Fetus
Gestational Age
Hypertension, Pregnancy-Induced
Infant, Newborn
Intensive Care, Neonatal
Odds Ratio
Patient Selection
Perinatal Mortality
Pregnancy
Premature Birth
Prospective Studies
Single Umbilical Artery*

Figure

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  Fig. 1 Flow chart of filtering for literature search. SUA, single umbilical artery.

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  Fig. 2 Forest plot of odds ratio with 95% confidence interval (CI) for small for gestational age in fetuses with isolated single umbilical artery (SUA) compared with fetuses with three vessel cord (TVC). M-H, Mantel-Haenszel test.

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  Fig. 3 Forest plot of odds ratio with 95% confidence interval (CI) for preterm birth in fetuses with isolated single umbilical artery (SUA) compared with fetuses with three vessel cord (TVC). M-H, Mantel-Haenszel test.

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  Fig. 4 Forest plot of odds ratio with 95% confidence interval (CI) for pregnancy-induced hypertension in fetuses with isolated single umbilical artery (SUA) compared with fetuses with three vessel cord (TVC). M-H, Mantel-Haenszel test.

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  Fig. 5 Forest plot of odds ratio with 95% confidence interval (CI) for neonatal intensive care unit admission in fetuses with isolated single umbilical artery (SUA) compared with fetuses with three vessel cord (TVC). M-H, Mantel-Haenszel test.

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  Fig. 6 Forest plot of odds ratio with 95% confidence interval (CI) for perinatal mortality in fetuses with isolated single umbilical artery (SUA) compared with fetuses with three vessel cord (TVC). M-H, Mantel-Haenszel test.

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