背景:单脐动脉(SUA)与胎儿结构异常密切相关;然而,这种关联的确切模式尚未描述。我们旨在调查中国SUA单胎妊娠畸形的发生情况,并研究脐动脉缺失侧与胎儿畸形之间的关系。
方法:这是一项单胎妊娠的回顾性研究,在11+0-13+6孕周进行常规的妊娠早期解剖筛查,如果怀孕继续,在20+0-24+0周进行了中期妊娠扫描.数据是从转诊中心的记录中提取的,复旦大学附属妇产科医院,2011年1月至2019年4月(n=47,894)。使用逻辑回归,计算与SUA相关的畸形的比值比(OR)和95%置信区间(CIs).
结果:我们研究中SUA的发生率为2.0%(970/47,894)。在所有患有SUA的胎儿中,387例(39.9%)存在结构畸形。畸形类型不同,心血管并发症是最常见的。观察到SUA与食管狭窄或闭锁之间存在强关联(OR:25.33),其次是心血管(OR:9.98-24.02),脊柱侧凸(OR:18.62),泌尿生殖系统(OR:2.45-15.66),脑畸形(OR:4.73-9.12)。左脐动脉缺失(n=445,45.9%)与右脐动脉缺失(n=431,44.4%)一致。此外,在胎儿畸形的SUA中观察到右脐动脉缺失率明显高于左脐动脉缺失率(p<0.01)。
结论:总体而言,我们观察到SUA胎儿发生各种特定畸形的风险更高,SUA与食管狭窄或闭锁之间有很强的关联。右脐动脉的缺失在患有SUA和结构畸形的胎儿中最常见。本研究为超声医师进行SUA孕妇胎儿结构筛查提供参考。
BACKGROUND: Single umbilical artery (SUA) is strongly associated with foetal structural abnormalities; however, the exact pattern of this association has not been described. We aimed to investigate the occurrence of malformations in singleton pregnancies with SUA in
China and to study the association between the absent side of the umbilical artery and foetal malformations.
METHODS: This was a retrospective study of singleton pregnancies for which routine first-trimester anatomical screening was performed at 11+ 0-13+ 6 gestational weeks and, if the pregnancy continued, a second-trimester scan was performed at 20+ 0-24+ 0 weeks. Data were extracted from records at the referral centre, the Obstetrics and Gynecology Hospital of Fudan University, between January 2011 and April 2019 (n = 47,894). Using logistic regression, the odds ratios (OR) with 95% confidence intervals (CIs) were calculated for malformations associated with SUA.
RESULTS: The incidence of SUA in our study was 2.0% (970/47,894). Of all foetuses with SUA, 387 (39.9%) had structural malformations. The malformation type varied, with cardiovascular complications being the most common. A robust association was observed between SUA and oesophageal stenosis or atresia (OR: 25.33), followed by cardiovascular (OR: 9.98-24.02), scoliosis (OR: 18.62), genitourinary (OR: 2.45-15.66), and brain malformations (OR: 4.73-9.12). The absence of the left umbilical artery (n = 445, 45.9%) was consistent with that of the right umbilical artery (n = 431, 44.4%). Furthermore, a significantly higher rate of an absent right than the left umbilical artery (p<0.01) was observed in SUA with foetal abnormalities than in SUA with no malformations.
CONCLUSIONS: Overall, we observed a higher risk of various specific malformations in foetuses with SUA, and a strong association between SUA and oesophageal stenosis or atresia. The absence of the right umbilical artery was most common in foetuses with SUA and structural malformations. This study provides a reference for ultrasonographers in conducting foetal structural screening for pregnant women with SUA.