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

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• A normal umbilical cord consists of two arteries and one vein.
• A single umbilical artery (SUA), or a two-vessel cord, is a common variation but is recognized as a soft marker for underlying congenital anomalies.
• Among the potential associated defects, anomalies of the cardiovascular system, such as congenital heart defects, are the most frequently observed.
• The presence of an SUA warrants a more detailed investigation of the newborn, particularly focusing on cardiac and renal structures.

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: Significant neurological anomalies are rarely associated with an isolated finding of a single umbilical artery.
• Option D: Primary congenital anomalies of the respiratory system are not a frequent finding with SUA. Respiratory distress in a newborn with SUA is more likely to be secondary to an underlying cardiac defect.

Related Visual

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.
• A nurse's identification of an SUA during the initial newborn assessment is a critical finding that must be documented and communicated to the healthcare team.
• This finding triggers a more focused physical assessment, paying close attention to heart sounds for murmurs, palpating femoral pulses, and assessing for any signs of genitourinary or other anomalies.
• An echocardiogram and/or a renal ultrasound are often ordered to screen for associated structural defects that may not be apparent on physical exam.

How to Approach the Question

• First, identify the key clinical finding in the question stem: 'single umbilical artery (SUA)'.
• Recall the normal anatomy of the umbilical cord, which is two arteries and one vein (AVA). Recognize that SUA is an anatomical variation.
• Understand that SUA is considered a 'soft marker,' which means it's a finding that increases the risk for other problems, specifically congenital anomalies.
• The question asks for the 'most frequently' affected organ system. This requires you to recall the hierarchy of associated risks.
• Evaluate the options. While anomalies can occur in any system, clinical knowledge indicates that the cardiovascular and genitourinary systems are the most common associations.
• Between the given options, select 'Cardiovascular' as it is established to have the highest incidence of associated major anomalies in infants with SUA.

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 affected

Question ID

Qa2l78e8Nn9_SE6NgtvyPq

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 135-137

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 30-38