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When in the womb, your baby’s connection to you is through the umbilical cord and placenta which is connected to the uterus. Oxygen, nutrients and essential blood supply reach the baby’s bloodstream through the umbilical cord, which normally has three blood vessels. Two are arteries and one is a vein. Understanding the abnormality that occurs in this important link between you and the baby can help you take the steps to prevent it.
What is a Normal Umbilical Cord?
A normal umbilical cord will have two arteries and a vein forming a three vessel cord. It is covered with Wharton’s Jelly, which is a gelatinous substance called and is about 20cms in length. The important functions of these blood vessels are
- The arteries carry the waste products like deoxygenated impure blood and carbon dioxide from the foetus to the mother’s bloodstream, which is then eliminated through the mother’s kidneys.
- The vein carries nutrients and oxygen from the mother to the foetus.
What is a Two-Vessel Umbilical Cord?
Sometimes during the development of the baby, an abnormality occurs, and only one artery and a vein are present. The umbilical cord is then called a two vessel umbilical cord or single artery umbilical cord (SUA).
How Common is It?
Less than 1% of single pregnancies and about 6-11% of multiple pregnancies have this condition. This is quite rare and could occur either due to the improper splitting of cells when forming the umbilical cord (around the 5th week of pregnancy) or due to improper formation of the second artery which gets suppressed.The exact cause is unknown. However certain mothers are at a higher risk.
Causes and Risk Factors of Single Umbilical Artery
As explained above the exact cause of SUA is unknown, and depends on the way the arteries split and form during pregnancy.
The risk factors contributing to such formation are:
- Being a Caucasian woman
- Becoming pregnant after 40 years of age
- Having had diabetes or high blood sugar levels during the timeline of the pregnancy
- Multiple pregnancies
- Being pregnant with a girl child
How is Two-Vessel Cord Diagnosed?
The attending doctors assess the risks for this condition by checking:
- The medical history of the mother
- Foetal echocardiogram
- Genetic abnormality screening or aneuploidy screening)
These tests can detect the problem and determine if your baby will be affected. Mothers who are at a risk of two-vessel umbilical cord abnormality are asked to undergo a colour flow Doppler ultrasound scan around the 14th week of pregnancy. Ultrasound scans are normal in the 18th week of gestation to help detect a two-vessel cord.
Can a Single Artery Umbilical Cord Affect Your Baby?
While in some cases there are no complications, in others there are risks to the baby and its development. Single umbilical artery complications do not necessarily harm your baby. However, certain risks that the baby is exposed to are:
- Preterm labour
- Restricted growth of the central nervous system
- Congenital heart problems in the baby
- Kidney problems in the baby
- Gastrointestinal problems in the baby
- Intrauterine growth restriction (IUGR)
- High risk of the genetic abnormality known as VATER – vertebral defects, anal atresia, trans-oesophageal fistula with oesophagal atresia, and radial dysplasia.
How is a Two-Vessel Cord Treated?
The doctor will monitor the baby’s growth through ultrasound scans even if there are no complications. When the low-speed ultrasound findings indicate the possibility of SUA, a high-speed ultrasound will be done. If the baby is diagnosed to have a Single Artery Umbilicus or other abnormalities, an amniocentesis, where the foetus is tested for congenital abnormalities using a sample of amniotic fluid, is done. High-Speed Doppler Ultrasound scans and colour flow scans will be scheduled to view the baby’s development and if it is age appropriate. In spite of all precautions, if the baby is born with organ dysfunction, additional monitoring is performed in the NICU.
Can You Prevent Single Umbilical Artery?
Since there are certain risk factors that increase the possibilities of single umbilical artery associated anomalies a mother-to-be should:
- Quit smoking
- Discuss risk factors that may lead to SUA with the doctor
- Regularly attend appointments with the doctor
- Report any untoward symptoms to the doctor
- Educate herself and take an informed decision on her delivery
Educating yourself and being able to take an informed decision is the best way to go for mothers. Remember that the phenomenon of two-vessel umbilical cord complications is rare. Even if present, it may not affect your baby. Always discuss your fears and concerns with your doctor and make an informed decision.