The presence of a single umbilical artery (SUA) in a newborn is a soft marker that should prompt the nurse to assess for associated congenital anomalies. Which organ system is most frequently affected in infants with SUA?

1. A

   Musculoskeletal

2. B

   Neurological

3. C

   Cardiovascular

4. D

   Respiratory

Appeared in: NORCET 9 Prelims-2025

Explanation

Listen in Hindi

• A single umbilical artery (SUA), or a two-vessel cord, is a condition where the umbilical cord has one artery instead of the usual two.
• It is considered a soft marker, which means it is a finding that can be associated with an increased risk of other underlying congenital anomalies.
• The cardiovascular system is the most frequently affected organ system in infants with SUA. Congenital heart defects are the most common specific anomalies found.
• The genitourinary system is the second most commonly affected system, but cardiovascular anomalies occur with greater frequency.

Why Other Options Were Wrong

• Option A: While musculoskeletal anomalies can be associated with SUA, they are significantly less common than cardiovascular or genitourinary defects.
• Option B: Neurological system anomalies are associated with SUA, but their incidence is much lower compared to cardiovascular anomalies.
• Option D: Primary congenital malformations of the respiratory system are not the most common finding associated with SUA. Respiratory distress in a newborn with SUA is more likely to be secondary to a severe cardiac anomaly.

Related Visual

• Visual 1: Diagram - A clear illustration comparing a cross-section of a normal three-vessel umbilical cord (two arteries, one vein) with a two-vessel cord (single umbilical artery).
• Visual 2: Infographic - A chart ranking the organ systems by frequency of associated anomalies in infants with SUA, showing Cardiovascular at the top, followed by Genitourinary, and then other systems.

Clinical Relevance

• Nursing practice connection: Knowing Association of Single Umbilical Artery (SUA) with congenital anomalies helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• When a nurse identifies an SUA at birth, a meticulous and comprehensive newborn assessment is critical. The nurse should specifically look for subtle signs of cardiac or renal dysfunction, such as heart murmurs, abnormal femoral pulses, or decreased urine output.
• The finding of an SUA must be clearly documented and communicated to the pediatrician or neonatologist. This finding often prompts further diagnostic workup, such as an echocardiogram to evaluate the heart and a renal ultrasound to check for kidney abnormalities.
• What if? If an SUA is identified as an isolated finding on a detailed prenatal ultrasound with no other structural defects noted, the prognosis is generally excellent. However, a thorough postnatal physical examination remains essential to confirm the absence of other anomalies.

How to Approach the Question

• First, identify the key term in the question: 'single umbilical artery' (SUA).
• Recognize that the question is asking for the 'most frequently' affected organ system, which requires knowledge of relative risk and incidence.
• Recall that SUA is a well-known 'soft marker' for other congenital anomalies.
• Access your knowledge base regarding the types of anomalies associated with SUA. The most common are cardiovascular and genitourinary.
• Compare the given options (Musculoskeletal, Neurological, Cardiovascular, Respiratory) against this knowledge.
• Select 'Cardiovascular' as it has the highest incidence of associated anomalies among the choices.

Concept Tested & Keywords

• Concept Tested: Association of Single Umbilical Artery (SUA) with congenital anomalies.
• Stem keywords: single umbilical artery (SUA), newborn, soft marker, congenital anomalies, organ system
• Lead-in keywords: most frequently
• Clinical cues: Presence of a single umbilical artery

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