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doi: 10.1016/S0210-573X(04)77310-4
Actualización en el diagnóstico prenatal de arteria umbilical única
J. Lázaro, M.J. Cid, M. Repollés
Servicio de Ginecología. Unidad de Ecografía. Hospital Universitario Ramón y Cajal. Madrid. España.
Aceptado 08 enero 2003
Resumen

La presencia de arteria umbilical única (AUU) se asocia con malformaciones congénitas fetales y anomalías cromosómicas.

La visualización del cordón umbilical debería ser una de las partes esenciales del examen ecográfico. Cuando se detecta una AUU es necesario realizar una exploración ecográfica detallada,para excluir anomalías asociadas.

Cuando se detecta una anomalía estructural asociada se debe proponer un procedimiento invasivo de diagnóstico prenatal.

En las gestaciones con AUU aislada se debe realizar un cuidadoso seguimiento para evidenciar una restricción del crecimiento fetal.

El riesgo incrementado de crecimiento intrauterino retardado y los resultados del estudio Doppler son motivo de controversia en la bibliografía.

En los fetos con AUU,la totalidad del flujo sanguíneo es transportado a la placenta por una sola arteria y se produce un incremento significativo del diámetro arterial. La dilatación de la arteria reduce la impedancia y preserva el suficiente flujo sanguíneo fetoplacentario.

Los fetos con AUU y estudio Doppler anormal presentan un incremento significativo del riesgo de restricción del crecimiento,de malformaciones complejas o de cariotipo anormal respecto a los que fetos con AUU y estudio Doppler normal.

Los fetos con AUU tienen un buen pronósticocuando no presentan anomalías estructurales o cromosómicas.

Las implicaciones que conlleva el control de las gestaciones con AUU aislada ha sido una materia de continua controversia en el campo del diagnóstico prenatal,y la respuesta definitiva sobre su significado clínico en la población de bajo riesgo es aún debatida.

Abstract

The presence of a single umbilical artery (SUA) is associated with congenital fetal malformations and genetic anomalies.

Scanning the umbilical cord should be an essential part of ultrasound examination. When a single umbilical artery is detected, a detailed ultrasound examination is necessary to rule out associated abnormalities. Pregnancies with associated structural anomalies should be offered invasive prenatal diagnostic procedures. Pregnancies with a single umbilical artery should be carefully monitored for evidence of fetal growth retardation.

An increased risk of intrauterine growth retardation and the Doppler findings are controversial in the literature.

In fetuses with SUA the entire blood flow to the placenta is transported through only one artery, producing a significant increase in the arterial diameter. The dilatation of the artery occurs to reduce the resistance in this vessel, and to preserve a sufficient feto-placental blood flow.

Fetuses with a SUA and abnormal Doppler veloci-metry have a significantly increased risk of growth retardation, complex malformations or an abnormal karyotype than those with a SUA but normal Doppler studies.

The prognosis of SUA fetuses is good when there is no concurrent anatomic or chromosomal abnormality.

The implications for pregnancy management when there is SUA only has been a matter of continuos controversy in the field of prenatal diagnosis, and yet the definitive answer on their clinical significance in low risk population is still debated.

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