Absent Umbilical Artery: A Review of 113 Cases

Abstract

A total of 113 cases of absence of 1 umbilical artery are presented and analysed, together with a review of the literature. The abnormality is slightly increased among the younger primigravidae and the older multigravidae, but does not increase in incidence as parity rises. A total of 59 multiparous women had had 155 previous pregnancies from which only 107 (69%) infants survived. A total fetal loss of 48 (31%) is considered excessive and indicates that these women, as far as reproduction is concerned, belong to a high risk group. Hydram-nios occurred 19 times; all (100%) the infants suffered from major congenital abnormalities and only 2 survive as a result of surgical treatment for oesophageal atresia. There is, at present, no evidence to show that the condition is hereditary. The incidence of absent umbilical artery is 1% of all births and 7% of twin pregnancies. The fetal loss in a consecutive series was 20% but in the total of 113 instances the fetal loss was 65 (58%). Fourteen of the 48 infants who survive are known to suffer from congenital abnormalities. Major congenital abnormalities were present in 58 (51%) of the infants; only 40 (35%) were developmentally normal and a further 15 (14%) were thought to suffer from a congenital anomaly. The abnormalities were mostly multiple and not confined to any particular system. Obstructive lesions or atresia of the gastro-intestinal and urinary tracts were relatively common. Fifty-six (59%) of the 95 viable infants of known weight were premature by weight at birth, but the average weight of all the infants at birth was less than normal. The placenta was considered to be abnormal in 32 (29%) of the pregnancies. It is suggested that routine examination of the cut end of the umbilical cord at delivery might result in early diagnosis of some of the associated congenital abnormalities.