Need Reassurance / Single Umbilical Artery

[Valerie Rake]

Hi,

I've done my internet research, but I'd like some reassurance, if you
all could provide it. We had an ultasound done this morning at 24
weeks. We'd had one done at 20 weeks, but the baby was positioned wrong
and the doc couldn't get a good look at the heart and since I'm 37, he
really wanted a good look at it.

At today's ultrasound, the heart looks good, but they found that the
baby has a single umbilical artery rather than the normal two arteries.

What the doc (at the perinatal ultasound clinic, not my usual OB) said
matches with what we've found on-line: the heart looks good, the
kidneys looked good, all the bones looked good, baby is actually
measuring a week larger than it "should" according to my due date (which
I'm pretty darned sure of), therefore, chances are very high for a
normal baby and a normal birth. I am reasonably reassured, but could
use some good anecdotal evidence and/or warnings!

The ultrasound doctor would have been willing to order an amniocentesis,
but it doesn't sound like it would tell us anything interesting, given
that no anomolies other the the SUA showed up on the ultrasound. Does
anyone advise otherwise? He strongly suggested and we agreed to having
ultrasounds every 4 weeks from here on out to double-check on fetal
growth and everything else. Overkill? I, myself, would like the
reassurance of the ultrasounds and my own personal risk assessment is
that there isn't likely to be any fetal harm from that many ultrasounds.

Our next OB visit is Aug 13. I'm already planning to ask her whether
she thinks the ultrasounds are warrented? Would she recommend the amnio?
Some sites suggested a fetal echocardiogram, what is that and would she
recommend it? Does this change her delivery policies? Any other
questions I should ask?

Valerie
(heart still a-flutter!)

[Cheryl]

On Mon, 04 Aug 2003 16:34:02 -0400, Valerie Rake
> wrote:


>Our next OB visit is Aug 13. I'm already planning to ask her whether
>she thinks the ultrasounds are warrented? Would she recommend the amnio?
>Some sites suggested a fetal echocardiogram, what is that and would she
>recommend it? Does this change her delivery policies? Any other
>questions I should ask?

I would go with the foetal echo if you can arrange it. Even a good
ultrasound at the 24 week mark can miss a few of the less common
cardiac defects and in my son's case his defects weren't picked up
until an ultrasound at 35-ish weeks. A foetal echo is basically a
targeted ultrasound that looks specifically at the heart and the major
arteries to make sure that there are no holes, nothing missing and
everything the right way around. My son's cardiologist likes to do
them between 22 and 28 weeks so that there is room for the baby to
still move if it isn't in a good position when they start the echo.
Generally if you have a baby with a heart defect diagnosed before
birth it shouldn't change your birth process but may change where you
plan to birth since they like to have you near a tertiary NICU. There
is absolutely no reason that it should affect your choices regarding
vaginal vs c/s, drugs vs no drugs.

--
Cheryl
Mum to DS#1 (11 Mar 99), DS#2 (4 Oct 00) and DD (30 Jul 02)

[juniper]

Valerie Rake wrote:

>
> At today's ultrasound, the heart looks good, but they found that the
> baby has a single umbilical artery rather than the normal two arteries.
> What the doc (at the perinatal ultasound clinic, not my usual OB) said
> matches with what we've found on-line:

My baby had one of those. We discovered it at 19 weeks. She was born in
late June and is very healthy! She was a little small -- only 6 lbs.,
(although a normal length, 19 3/4 inches), but is now 9 and a half lbs.
at five weeks of age.

> The ultrasound doctor would have been willing to order an amniocentesis,
> but it doesn't sound like it would tell us anything interesting, given
> that no anomolies other the the SUA showed up on the ultrasound. Does
> anyone advise otherwise? He strongly suggested and we agreed to having
> ultrasounds every 4 weeks from here on out to double-check on fetal
> growth and everything else. Overkill? I, myself, would like the
> reassurance of the ultrasounds and my own personal risk assessment is
> that there isn't likely to be any fetal harm from that many ultrasounds.

We had biophysicals every week starting at week 28 (but that was also
because of elevated HCG levels during tbe AFP screening, so I would have
had those anyway, even if there hadn't been issues with the cord.) We
also had Level II's every four weeks to check for fetal growth, etc. We
had the fetal echocardiogram. As has been mentioned, it's basically
just another ultrasound. I have to admit, the ultrasounds were all kind
of fun. It was great seeing Zoe and knowing that she was growing well.
No other issues developed.

It sounds like the advice and info you were given is pretty much the
same thing that I was told, also by the perinatal doctors at the hospital.

Zoe did get a renal ultrasound a couple of weeks after birth to look at
her kidneys,as ordered by her pediatrician and they were fine. That's
one of the things they look at in these babies.

>
> Does this change her delivery policies? Any other
> questions I should ask?

My OB said that it's preferred to not go overdue date with this type of
cord, and they would induce if she wasn't born on time. However, I
developed preeclampsia, and Zoe was delivered 10 days early because of
that.

Best of luck to you. At the hospital, I was told that they see this a
lot (it's one of the busier hospitals in the area), and that in most
cases everything turns out just fine. My child is healthy, and I hope
that everything goes well for your little one, too.

- Jennifer from Delaware

>
> Valerie
> (heart still a-flutter!)
>

[Valerie Rake]

H Schinske wrote:

>Valerie ) wrote:
>
>>At today's ultrasound, the heart looks good, but they found that the
>>baby has a single umbilical artery rather than the normal two arteries.
>>
>
>One of my twins had this and was perfectly fine. I was told that SUA is
>*associated with* some congenital anomalies, but in itself is not a problem and
>
That was what I was understanding. Thanks for confirming it.

>it often occurs with no other anomalies at all. If the ultrasound checks out
>fine (kidneys there and symmetrically placed, all the chambers of the heart
>present and opening/closing as they're supposed to, etc.), then the risk goes
>down to where you'd be without that marker at all. So basically it's a reason
>to *check* the baby closely, but if nothing is found, there is no reason to
>suppose there is any trouble.
>
Check again. ;-)

>
>I don't think any of the anomalies that are typically associated with it are
>things that would show up on an amnio anyway, but I'm not quite sure about
>that.
>
>We also had serial ultrasounds, but I was in for that anyway because it was
>twins, who are already at risk for preterm delivery and slower growth (neither
>of which happened -- full-term babies, a total of nearly 17 pounds!). All the
>ultrasounds reported a single umbilical artery for one twin, but the lab report
>after they were born said three-vessel cords for both. Of course, that's the
>same report that said they shared a placenta even though they have different
>blood types, so I'm inclined to think that lab tech was not very reliable!
>
>--Helen
>
I am so glad you babies were fine! I'm hoping all goes well here!

Valerie

>

[Valerie Rake]

This reply is to both Juniper and Carol's posts, since they were both
about SUA babies who did have some problems. Did you locate a pediatric
specialist right from the point of knowing there would be persistent
problems? (I've basically decided to think of the SUA a "temporary
problem," since it, in itself, will be a non-issue after the birth.)
Did/does your baby also see a "regular" pediatrician/FP? We were
planning to just stay with our usual family practice clinic, but might
want to rethink that now.

Valerie

juniper wrote:

> Valerie Rake wrote:
>
>>
>> At today's ultrasound, the heart looks good, but they found that the
>> baby has a single umbilical artery rather than the normal two
>> arteries. What the doc (at the perinatal ultasound clinic, not my
>> usual OB) said matches with what we've found on-line:
>
>
> My baby had one of those. We discovered it at 19 weeks. She was born
> in late June and is very healthy! She was a little small -- only 6
> lbs., (although a normal length, 19 3/4 inches), but is now 9 and a
> half lbs. at five weeks of age.
>
>> The ultrasound doctor would have been willing to order an
>> amniocentesis, but it doesn't sound like it would tell us anything
>> interesting, given that no anomolies other the the SUA showed up on
>> the ultrasound. Does anyone advise otherwise? He strongly suggested
>> and we agreed to having ultrasounds every 4 weeks from here on out to
>> double-check on fetal growth and everything else. Overkill? I,
>> myself, would like the reassurance of the ultrasounds and my own
>> personal risk assessment is that there isn't likely to be any fetal
>> harm from that many ultrasounds.
>
>
> We had biophysicals every week starting at week 28 (but that was also
> because of elevated HCG levels during tbe AFP screening, so I would
> have had those anyway, even if there hadn't been issues with the
> cord.) We also had Level II's every four weeks to check for fetal
> growth, etc. We had the fetal echocardiogram. As has been mentioned,
> it's basically just another ultrasound. I have to admit, the
> ultrasounds were all kind of fun. It was great seeing Zoe and knowing
> that she was growing well. No other issues developed.
>
> It sounds like the advice and info you were given is pretty much the
> same thing that I was told, also by the perinatal doctors at the
> hospital.
>
> Zoe did get a renal ultrasound a couple of weeks after birth to look
> at her kidneys,as ordered by her pediatrician and they were fine.
> That's one of the things they look at in these babies.
>
>>
>> Does this change her delivery policies? Any other
>> questions I should ask?
>
>
> My OB said that it's preferred to not go overdue date with this type
> of cord, and they would induce if she wasn't born on time. However, I
> developed preeclampsia, and Zoe was delivered 10 days early because of
> that.
>
> Best of luck to you. At the hospital, I was told that they see this a
> lot (it's one of the busier hospitals in the area), and that in most
> cases everything turns out just fine. My child is healthy, and I hope
> that everything goes well for your little one, too.
>
> - Jennifer from Delaware
>
>>
>> Valerie
>> (heart still a-flutter!)
>>
>
>

[Valerie Rake]

juniper wrote:

> Valerie Rake wrote:
>
>> This reply is to both Juniper and Carol's posts, since they were both
>> about SUA babies who did have some problems. Did you locate a
>> pediatric specialist right from the point of knowing there would be
>> persistent problems? (I've basically decided to think of the SUA a
>> "temporary problem," since it, in itself, will be a non-issue after
>> the birth.) Did/does your baby also see a "regular" pediatrician/FP?
>> We were planning to just stay with our usual family practice clinic,
>> but might want to rethink that now.
>>
>> Valerie
>
>
> Actually, Zoe does not have any problems. The SUA was, in our case, a
> temporary problem as you mentioned. The renal ultrasound after birth
> was done as a routine procedure just to make sure everything was okay,
> and the biophysicals and Level II's before birth were done to make
> sure that everything was progressing well.

Yes, I apologize. I realized my "mental grouping of posts" was a bit
off after I'd sent my message. It's perhaps looking like we can stick
with a regular family practice clinic for pediatric care UNLESS the
serial ultrasounds turn up a more persistent problem.

> While she was small, her size was still within the normal range -- the
> doctors were very happy with her growth, and while she was induced 10
> days early, that was because of my preeclampsia, not her SUA.

This is one of my questions for the OB--will the SUA, in and of itself,
change the point at which she will start suggesting I be induced. Her
generally policy right now is to wait for 41 weeks, and my response was
"Fine, and at that point, I'll probably say no, unless a stress test or
whatever says there's a problem"

Thanks.
Valerie

>
> Zoe only sees a regular pediatrician. Since I was having my
> ultrasounds at the hospital, that's why I was seen before her birth by
> the doctors in the perinatal area, but just for the ultrasounds.
>

[H Schinske]

wrote:

>This is one of my questions for the OB--will the SUA, in and of itself,
>change the point at which she will start suggesting I be induced. Her
>generally policy right now is to wait for 41 weeks, and my response was
>"Fine, and at that point, I'll probably say no, unless a stress test or
>whatever says there's a problem"

Since my OB didn't have a problem with scheduling a section for twins at 39
weeks 5 days, despite the SUA in one twin, I am pretty sure he would have been
okay with a singleton going to 42 weeks. But you know what they say about
assumptions :-)

(There are now doctors out there who will not *let* twins -- any twins, not
just those with possible problems -- go past 37 or 38 weeks, sometimes even 36!
I find this appalling, personally. Left alone over 40% go past 37 weeks,
according to the March of Dimes.)

--Helen