Cuad Med Forense 2004; 37:31-35

�Tanta importancia tiene pasar por alto la arteria umbilical �nica? Comentarios a partir de una sentencia judicial.
Does ignoring the single umbilical artery have so much importance? Commentaries concerning a judicial sentence.

A. Ortega P�rez (1)

(1) Doctor en Medicina. Profesor de Medicina Legal y Toxicolog�a. Facultad de Medicina y Ciencias de la Salud. Universidad "Rovira i Virgili".

RESUMEN
El Tribunal Supremo ha condenado a varios obstetras por informar que el cord�n umbilical ten�a los tres vasos, desactivando as� la b�squeda de enfermedades fetales que la arteria umbilical �nica (AUU) habr�a desencadenado. La condena ser� �ticamente correcta si la AUU est� realmente asociada a tales enfermedades. En la poblaci�n general se detecta un caso de AUU en cada 320 fetos estudiados ecogr�ficamente. En el 68 % de esas detecciones se tratar� de un hallazgo aislado, pero a�n as� aumenta el riesgo de parto prematuro, de peso bajo y de mortalidad perinatal. Por otra parte, el 17 % de estos fetos tendr�n, adem�s de la arteria �nica, cromosomopat�as y el 31 % malformaciones anat�micas. Concluyendo, la AUU es realmente un marcador cardinal de riesgo de trastornos fetales, que debe buscarse activamente durante el seguimiento ecogr�fico del embarazo.

Palabras clave: Alteraciones cromos�micas, arteria umbilical �nica, diagn�stico, ecoqrafia, embarazo, �tica, legislaci�n, malformaciones anat�micas, marcador de riesgo, obstetricia.
 

ABSTRACT
The Spanish Supreme Court has condemned several obstetricians after having informed that the umbilical cord of a fetus had the three vessels, therefore deactivating the search for fetal diseases that the single umbilical artery (SUA) would have provoked. The sentence will be ethically correct only if SUA is really associated with such diseases. SUA is found in about 1 out of every 320 fetuses studied sonographically. In 68 % of them, it will be an isolated finding, although it will increase the risks of premature delivery, low birthweight, and perinatal mortality. On the other hand, 17 % of these fetuses will have, besides SUA, chromosomal alterations, and 31 % of them, structural malformations. In conclusion, SUA is an important marker of fetal disorders, and it has to be actively searched for during the ultrasonographic monitoring of the gestation.

Key words: Chromosomal defects, diagnosis, ethics, gestation, legislation, obstetrics, risk marker, single umbilical artery, structural malformations, ultrasonography.

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