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A single umbilical artery, two vessel cord, is a fairly common finding in

Obstetrics. In fact, it is present in about 0.5-1% of fetuses. It is also more


common in twin fetuses. Normally, the fetus has one vein bringing the baby
blood from the placenta in the cord. Two arteries leave the fetus and return
blood to the placenta. Sometimes, however, only one artery develops. More
frequently, the artery may develop but clots off early in pregnancy. Because the
artery is clotted off, we cannot visualize the blood flow through it, and therefore
it is invisible during the ultrasound exam. Examination under a microscope after
delivery can usually differentiate the two varieties of single umbilical artery
cords. In the pictures above, on the left is the normal arrangement with two
arteries going around the fetal bladder, one on each side. On the left is a single
umbilical artery going around the bladder. Because these are visualized best
with Dopplers, and Doppler simply requires blood flow, we cannot see if the
artery is there, but clotted, or absent entirely.

A two vessel cord is present in 0.5- 1% of pregnancies. Though most


pregnancies are uncomplicated, several issues can be of concern in a pregnancy
affected by a two vessel cord. A two vessel cord appears more commonly in
fetuses with other malformations, especially of the heart and kidneys. In fact,
there have been studies stating the incidence of major birth defects in fetuses
with a two vessel cord is abut 20%. Therefore, a detailed "Level II" ultrasound
in an experienced center is mandatory when a two vessel cord is suspected.
Specifically there is data that fetuses with a two vessel cord are more likely to
have chromosome abnormalities. If there are associated abnormal findings,
consideration of an amniocentesis should be undertaken (see link below). If this
is an isolated finding, and a mother is otherwise low risk for chromosome
abnormalities, then an amniocentesis may be avoided. In addition to
chromosome disorders, defects in the urogenital, cardiovascular, and nervous
system of the baby have been reported.

Growth restriction of the fetus has also been reported with a greater frequency
in fetuses with two vessel cords. Finally, initial studies did show an increase risk
of perinatal mortality, or fetal death, however the impact of other anomalies in
this data was unclear. These two complications, however, are difficult to study
secondary to the impact of the other anomalies seen with a two vessel cord. In
addition, this is a more common finding in twins, and again they are also at risk
for growth restriction and stillbirth. To be safe, consider fetal monitoring in the
last 4-6 weeks of pregnancy as well as growth scans through the third trimester.

If a two vessel cord is diagnosed, the first step is a detailed Level II genetic
ultrasound to examine for other anomalies. Particular attention should be paid
to the fetal heart and kidneys, since these are common areas for associated
malformations. If there are other abnormalities, or if a patient is higher risk, an
amniocentesis should be considered to rule out chromosome abnormalities, like
Down Syndrome. The fetal growth profile should be followed. Close third
trimester surveillance for stillbirth should also be undertaken as above. The vast
majority of cases, however, progress without incident resulting in a successful
pregnancy outcome.