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Dr. Andrew Rynne

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20 weeks pregnant. Ultrasound showed anterior placenta of grade 1 maturity. Any suggestion?

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Dr. Sudhir

Internal Medicine Specialist

Practicing since :2000

Answered : 1417 Questions

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Posted on Tue, 8 Jan 2013 in Pregnancy
Question: Hi Doctor,
My wife is running 20 weeks 6 days. This is our 2nd child. Her Ultrasound pregnancy level II reports show the following:
A single live intrauterine fetus is seen in breech presentation at the time of scanning. Fetal movements are good. Fetal heart rate is regular and is 157 beats/ minute.
Placenta is anterior, of grade 1 maturity. Lower limit of placenta is not reaching the XXXXXXX os. XXXXXXX os is closed. Cervical length is 34 mm. Liquor amnii is adequate.
BPD is 46 mm
OFS is 62 mm
HC is 176 mm
TCD is 19 mm
IOD is 12 mm
BOD is 35 mm
PLV is 5.6 mm in width
CM is 3.2 mm in depth
NF is 4.6 mm, Nasal bone is 10 mm
FL is 33 mm
AC is 148 mm
HL is 32
CI is 74
HC/ AC is 1.2

Featal weight is 338 gm.

A single umbilical artery is noted. The fetus has echogenic bowel.

I request you to kindly guide me on this.

regards,
XXXXXXX
doctor
Answered by Dr. Sudhir 3 hours later
Hello,

Normally fetal umbilical cord has three blood vessels. When one of the artery is absent it is called as two vessel cord. With single umbilical artery there are chances of other congenital anomalies, though this can be isolated condition with no other abnormalities. But chances of anomalies are high among the fetuses with single umbilical artery as compared to other normal vessel cord fetus.

Single umbilical artery fetuses and neonates have a 6.77 times greater risk of congenital anomalies and 15.35 times greater risk of chromosomal abnormalities.

The most common congenital anomalies in chromosomally normal fetuses and neonates were genitourinary (6.48%), followed by cardiovascular (6.25%) and musculoskeletal (5.44%).

For isolated single umbilical artery, placental abnormalities , hydramnios and amniocentesis occurred more frequently than with three vessel cords.

Neonates with single umbilical artery and isolated single umbilical artery had increased rates of prematurity, growth restriction, and adverse neonatal outcomes.

Echogenic bowel is again a soft marker of anomalies. But it can be entirely normal finding as well.

Although one artery can certainly perform the job of two and sustain a perfectly healthy pregnancy, your doctor is likely keep a close eye on your baby's development, and may want to run further tests, including more scans and possibly even a chromosomal analysis to rule out any genetic abnormalities or other congenital problems.

So there are chances that everything can turn out normal but to confirm this more tests and monitoring would be needed. And if any anomalies are found over a period then you will have to discuss outcome with your doctor.

Hope this answers your question. Please ask if there are doubts.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir 1 hour later
Doctor,

I would like to know:

1. Are there any chances of having good new.
2. What is the majour risk factor if the results to not turn out favourable.
3. Should we take the risk or is better to discontinue the pregnancy. I am told that discontinue of pregnancy is better
doctor
Answered by Dr. Sudhir 17 hours later
Hello,

First two question I have already answered.Please refer the first answer.

1.There are chances of having normal baby.But it's difficult to predict which baby will be completely normal.There are few things which cannot be tested before birth.
2.The risk factors are anomalies/malformation of organs and altered growth of baby. - The most common congenital anomalies in chromosomally normal fetuses and neonates are genitourinary (6.48%), followed by cardiovascular (6.25%) and musculoskeletal (5.44%).

For isolated single umbilical artery, placental abnormalities , hydramnios and amniocentesis occurred more frequently than with three vessel cords.

Neonates with single umbilical artery and isolated single umbilical artery had increased rates of prematurity, growth restriction, and adverse neonatal outcomes.

3.This question is extremely difficult to answer.You will get both kind of suggestions but you have to go by your instinct and take your own decision.It would be entirely decision of both husband and wife. While taking decision do consider results of all tests.

Few factors to consider while taking decision are test results, if tests show any abnormality then can it be corrected after birth or how will it affect baby's life, age of baby,how precious is baby,was it easy to get pregnant, is it possible to get pregnant in future, are there chances of future baby getting similar anomalies, any parental genetic issues leading to such anomalies, any possible pregnancy and delivery related complications and willing to handle the issue.

Hope answer helps you.Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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