Umbilical arteries

Systemic & remnants · SaO2 ~55-58% PO2 20-25 mmHg

Paired branches of the internal iliac arteries that run up the inner anterior abdominal wall beside the bladder to the umbilicus and carry desaturated post-ductal blood back to the placenta, completing the circuit.

Traced from the start

  1. Placenta
  2. Umbilical vein
  3. Ductus venosusHepatic sinusoids (portal and umbilical mixing)
  4. Right atrium to right ventricle and pulmonary trunk
  5. Foramen ovale to left atrium and left ventricle
  6. Ductus arteriosusAscending aorta and arch (pre-ductal)
  7. Umbilical arteries

Detail

Saturation
~55-58% (PO2 ~20-25 mmHg), the lowest arterial value in the fetus; cord arterial gas reflects fetal acid-base status
Origin
Anterior division of the internal iliac artery; the proximal segment stays patent after birth as the superior vesical artery
Share
Carry roughly a third (up to 40%) of combined ventricular output to the placenta
Closure
Constrict within seconds to minutes of birth (stretch, cooling, rising PO2) before the vein does; distal segments fibrose over 2-3 months
Adult remnant
Medial umbilical ligaments raising the medial umbilical folds; median fold = urachus (allantois), lateral folds = inferior epigastric vessels; the medial inguinal fossa between them is the site of direct inguinal hernia

When it goes wrong

Single umbilical artery on the morphology scan (~1% of pregnancies)

Associated with renal, cardiac and gastrointestinal malformations and trisomy 18; even an isolated finding warrants a postnatal renal ultrasound

Umbilical artery Doppler with absent or reversed end-diastolic flow

High placental resistance and severe fetal compromise; indication for intensive surveillance or delivery

Paired cord gases at a compromised delivery

Arterial pH below 7.0 with base deficit of 12 mmol/L or more defines significant metabolic acidaemia and supports a diagnosis of hypoxic-ischaemic encephalopathy

Practise this structure

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