Single umbilical artery - prenatal care

[Frisbee]

I was told by my midwife on Monday that at the 20 week ultrasound they identified a single umbilical artery (SUA) aka a 2 vessel cord. There was also an echogenic intracardiac focus (aka shadow on the heart). The midwife seemed fairly unconcerned about this. She actually called me before a doctor had fully reviewed the results because she wanted to advise me to have the AFP test which I was going to decline since the first trimester screening showed the risk of down syndrome as very very low. I asked her what kind of issues these two findings might suggest and she said "I couldn't even tell you." All she said is that the SUA would mean they would monitor the growth of the baby carefully.

Ok, after I got off the phone I googled the SUA and EIF and of course started freaking out about the potential of chromosomal problems or other major defects. A nurse in the midwife's office said that they couldn't give me any more info until a doctor had reviewed the ultrasound.

So my question for all you folks who have been through this before - what
kind of follow up is normal/ should I ask for? I really want another ultrasound to carefully look for problems and to make sure there really is an EIF and a SUA.

[khaoskat]

My DD1 is one of the horrible SUA stats. I would request monitoring at the end of the pregnancy, and remember to do your kick counts, etc. I would also make sure that your baby is growing normally according to what you normally have.

(For me, I have large babies - 9lbs 2 oz, 10 lbs, 9 lbs 3 oz, 11 lbs 1 oz...DD1 was measuring on the low side of normal for a regular weight baby - at birth was 7 lbs 6 oz --- but as you can see, she was my 3 rd - between the 10lb and the second 9lb - she was small for my "normal" sized babies.)

You might ask for a more detailed US of the heart.

My best advise - go with your gut instincts - even if it is against the Midwife or Doc's advise or opinion....

[Frisbee]

Khaoskat - I'm almost afraid to ask, and I hope this isn't insensitive, but what happened with your DD? Did she have a heart defect? Did you know about the SUA in advance?

My DD was 7lbs 8oz so at least I have a benchmark. Thanks for the tip.

[WaitingForKiddos]

I also had a very bad outcome with a SUA present. For me, it is assumed that there was no genetic issue with Amelia (though we declined an autopsy) however there were issues with the sac and I had pprom at 20 weeks. It is my belief that what caused a SUA also affected the sac. I have no proof of this.

Should I have a baby with a SUA again I would insist on scans looking at placenta and cord location, structure, function and capability to support the pregnancy. I would be
extra careful of infections in case of a weak sac, of placenta location and structure to prevent injury during pregnancy or labor and placenta and cord function to make sure the baby was getting enough. I think that extra care could prevent a bad outcome.

[gonefishin]

I just got my results from my 20 week u/s and had the echogenic focus inthe heart of my little girl. No single vessel cord though. I too was encouraged to do the triple screen after I declined it, and got my tests back today, 1:14,000 for down syndrome. Dr says the EIF really means nothing and that I should continue on as normal, no elevated risk. Just thought Id share a positive situation regarding the EIF. Hugs

[Frisbee]

WaitingforKiddos I'm so sorry for what happened with your DD. Thanks for the advice.

Gonefishin' - it's nice to hear a story with a positive outcome.

Anyone else have any suggestions for things I should ask about when the doctor calls me back?

If I have to wait the entire July 4th weekend for the results I am going to go crazy.

[WaitingForKiddos]

And I've heard of far more good outcomes than bad. Mw wasn't concerned at all about it and considers a SUA a variation of normal.

[MaryLang]

My dd had a SUA, and also AVSD one of the most common heart defects occurring in babies with DS. I declined further testing, because having a child with DS would be a non-issue. Without the testing there was a 60% chance statistically she would have it. She doesn't.
The two most likely were related ( the SUA and AVSD).
She also had Intrauterine Growth Retardation.
There were many other issues with her pregnancy as well.
But not sure how they were all linked.
I have read that having a SUA alone is not really a problem at all, like pp said a variation of normal.

[Frisbee]

Update: Finally got the much-awaited follow up call from my midwife. Thankfully, the SUA and the EIF were isolated findings and everything else (heart, kidneys, brain, etc.) appeared normal. The results from the first trimester screening make chromosomal anomalies highly unlikely, so taking that into account they are considering the SUA a normal variant rather than an indication of something more serious. They are going to follow up with an ultrasound at 28 weeks for growth. As for the implications for labor and delivery she said they would probably monitor the fetal heartrate throughout but other than that treat it like a normal delivery.

[~Adorkable~]

Great news and so glad you got it before the weekend!
Go do something nice for yourself, you just went thru a huge rolercoaster!

[newmommy7-08]

DS was a SUA baby, and at the 20 week they had a hard time getting a good picture of his heart. Our followup was a fetal echocardiogram at 24 weeks and then monthly growth u/s after that just to make sure he was progressing. I know the jury is still out on frequent u/s but the level of follow up made me feel better.

We were very lucky and he was born 7#6oz at 37 weeks and no complications.