Ultrasound Report Analysis - Baljeet Kaur (24F, Date: 26/07/2026)

Summary of Findings

Diagnosis

1. Single Umbilical Artery (SUA) - Two-Vessel Cord

• Incidence: ~1 in 200 singleton pregnancies
• Clinical significance: Approximately one-third of fetuses with SUA have associated structural anomalies - cardiovascular, gastrointestinal (esophageal/anal atresia), and renal malformations. Chromosomal anomalies (especially trisomy 18) are possible, particularly when other anomalies co-exist (Creasy & Resnik's Maternal-Fetal Medicine).
• Risks with SUA: Fetal growth restriction (OR 2.75), preterm birth (OR 2.10), NICU admission (OR 2.06), perinatal mortality (OR 2.29)

2. Mild Oligohydramnios (AFI = 7)

• Uteroplacental insufficiency / early FGR
• Fetal renal anomaly (though kidneys, bladder reported normal in this scan)
• Idiopathic
• Rupture of membranes (must be excluded clinically)
• Chromosomal anomaly (in context of SUA)

Workup Recommended (as suggested by the radiologist)

Treatment and Management Plan

Immediate Steps

1. Hydration - Encourage adequate oral hydration (shown to modestly improve AFI in mild cases); aim for >2-3 L/day
2. Lateral decubitus rest - Improves uteroplacental perfusion
3. Treat any underlying cause - e.g., optimize BP if hypertension present, treat infections if identified

Monitoring Protocol

• Serial growth scans every 2-4 weeks - watch for onset of fetal growth restriction (FGR)
• Serial AFI monitoring every 2 weeks - if AFI drops below 5, escalate care
• Umbilical artery Doppler - fortnightly from 28 weeks onwards to detect placental insufficiency early
• Biophysical Profile (BPP) - from 28-32 weeks if oligohydramnios persists or FGR develops
• Non-stress tests (NST) - from 32 weeks or earlier if deterioration

Delivery Planning

• If SUA is isolated (no other anomalies, normal karyotype, normal growth): aim for term delivery (37-40 weeks)
• If associated with FGR, abnormal Doppler, or persistent/worsening oligohydramnios: consider delivery at 34-37 weeks in a Level III/tertiary center
• Mode of delivery: as per obstetric indications; SUA alone is not an indication for cesarean section

Neonatal Considerations

• Pediatric neonatologist should be aware at delivery
• Newborn assessment for undiagnosed structural anomalies (cardiac echo in neonate, renal US)
• NICU access should be available

Key Points Summary

This is a high-risk pregnancy that warrants referral to a Maternal-Fetal Medicine specialist for co-management. The combination of SUA and oligohydramnios at 20 weeks warrants thorough investigation before reassurance can be given. The radiologist has already flagged fetal echo and quadruple marker testing as priorities - these should be acted on without delay.

Direct Answer: Should This Pregnancy Be Continued or Terminated?

The honest answer: Termination is NOT indicated or recommended at this stage.

What We Actually Know Right Now

• ✅ Normal brain, spine, face
• ✅ Normal heart (4 chambers, intact septum, normal 3-vessel view)
• ✅ Normal liver, gallbladder, kidneys, bladder, bowel
• ✅ Normal limbs and long bones
• ✅ Normal fetal heart rate (158 bpm)
• ✅ Normal growth (all biometry appropriate for dates)
• ⚠️ Single umbilical artery (SUA) - a finding that needs follow-up
• ⚠️ Mild oligohydramnios (AFI 7) - currently mild, not severe

Breaking Down Each Concern

Finding 1 - Single Umbilical Artery (SUA)

Finding 2 - Mild Oligohydramnios (AFI = 7)

• AFI 7 is borderline/mild - it is not anhydramnios (AFI <2) or even moderate oligohydramnios
• At 20 weeks, causes include: uteroplacental underperfusion, fetal renal issues (already checked and reported normal), or simply positional/transient variation
• With normal kidneys and bladder on scan, the most likely cause is mild placental underperfusion or idiopathic - both manageable
• This level of oligohydramnios does not indicate a doomed pregnancy

The Correct Path Forward (Step by Step)

Step 1 - Do these tests FIRST before any decision:

Step 2 - Based on results, one of three paths:

• Continue pregnancy with close monitoring
• Serial scans every 3-4 weeks for growth and AFI
• High chance of a healthy delivery, possibly slightly early
• No termination warranted

• Counseling with MFM specialist and genetic counselor
• Informed discussion about prognosis, quality of life, and ALL options including:
  • Continuing pregnancy with palliative/comfort care planning
  • Termination of pregnancy (MTP under the MTP Act - in India, legal up to 24 weeks with medical opinion)
• This decision belongs to the parents, made with full information

• Amniocentesis for definitive karyotype
• MFM specialist co-management
• Decisions made after full information

On the Question of Termination - Being Honest

Bottom Line

Right now, this pregnancy should NOT be terminated. The scan has not found a confirmed lethal or severely disabling anomaly. The two abnormal findings (SUA + mild oligohydramnios) are warning flags that demand urgent investigation - not immediate termination.

The next 2 weeks are the most important: get the fetal echo, NIPT/quadruple marker, and a repeat detailed scan by an MFM specialist. Only after those results should any final decision be made.

This family deserves complete, accurate information - not fear, and not false reassurance. Refer urgently to a Maternal-Fetal Medicine (MFM) / Perinatology specialist at a tertiary centre.