Expectant management for umbilical artery thrombosis: a report of two cases and literature review

Han, Caixia; Dong, Kun; Jia, Zongyang; Zhao, Guangcai; Chen, Wenhui; Liu, Haiying

doi:10.1080/14767058.2022.2029398

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Therefore, fetal protection should be considered for fetuses with very low gestational age, whereas urgent delivery is preferred for fetuses with higher gestational age to avert unnecessary fetal loss. For patients with UAT and good maternal and fetal status, particularly the preterm group with an urgent need to extend the pregnancy, expectant management with ultrasound screening and close fetal monitoring may be an alternative to emergent delivery [14], as seen in our case.…”

Section: Discussionmentioning

confidence: 87%

Expectant management for umbilical artery thrombosis in monochorionic diamniotic twin pregnancies: A Case Report

Wang

Zhang

Zhou

2023

Preprint

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Background Thrombosis of one of the umbilical arteries is a rare complication of pregnancy and is associated with adverse pregnancy outcomes, including stillbirth and intrauterine growth restriction. Although extremely rare, umbilical artery thrombosis (UAT) in monochorionic diamniotic twins is difficult to diagnose prenatally and manage. UAT has a poor prognosis and is associated with an increased perinatal mortality rate. In most previous cases, emergency cesarean section was performed or intrauterine fetal death occurred at the time of UAT diagnosis. Case presentation: Herein, we report an extremely rare case of sequential UAT in monochorionic diamniotic twins diagnosed via ultrasound at 29+ 5 weeks of gestation in a 34-year-old woman. Following expectant management with intensive monitoring for 16 days, two healthy infants were delivered through an emergency cesarean section. UAT in both fetuses was confirmed by pathological examination. The mother and twins described in this case underwent long-term follow-up and are currently in good health without any complications. Conclusions Based on our experience, we suggest that expectant management should be undertaken as long as the mother and infants are stable on ultrasonographic scans and are closely monitored. When UAT is suspected, we believe that the best delivery time should be determined by considering complaints of unusual fetal movements, non-stress test evidence, gestational age, amniotic fluid volume, and blood flow of the umbilical artery, middle cerebral artery, and ductus venosus. Obstetricians should ensure that the patients and their families are clearly informed about all potential risks of expectant management for UAT.

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Section: Discussionmentioning

confidence: 87%

Expectant management for umbilical artery thrombosis in monochorionic diamniotic twin pregnancies: A Case Report

Wang

Zhang

Zhou

2023

Preprint

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“…Umbilical artery thrombosis (UAT) can affect nutrient supply to the fetus, and even endanger the safety of the fetus, resulting in the risk of intrauterine fetal death (1)(2)(3). The incidence of UAT is reported to be between 0.025% and 0.045%, but can be up to 0.4% in high risk pregnancies (4).…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery thrombosis and maternal positive autoimmune antibodies: two case reports and a literature review

Li¹,

Chen²,

Liu³

et al. 2023

Front. Med.

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BackgroundPrevious studies have shown that abnormal increases in autoimmune antibodies in pregnant women may increase the risk of maternal thrombosis. However, at our hospital, two pregnant women presented with umbilical artery thrombosis and positive maternal autoantibodies were detected in both, which led us to consider whether maternal autoantibodies also played a role in umbilical artery thrombosis.Case presentationCase 1: Fetal ultrasound of a 34-year-old pregnant woman at 30+4 weeks gestation showed two umbilical arteries, with an inner diameter of approximately 0.15 cm for the smaller was artery. However, only a single umbilical artery blood flow signal was detected. Due to fetal distress, which was noted on abnormal cardiotocography and Doppler ultrasound, an emergency cesarean section was performed at 31+1 weeks gestation. The Apgar score of the newborn was 3-8-8. Umbilical cord examination detected thrombosis in the two umbilical arteries. Moreover, blood test results during pregnancy showed nRNP/Sm antibody (+) and SS antibody (+++). Case 2: The first systematic ultrasound of a 33-year-old twin pregnancy at 24+3 weeks gestation was normal, but routine fetal ultrasound at 27+1 weeks gestation showed only one umbilical artery between fetus A and the placenta. Blood test results showed that the patient was anti-nRNP/Sm antibody (+) in the rheumatoid immune activity test at 27+3 weeks gestation. An emergency cesarean section was performed at 34+6 weeks gestation because of the single umbilical artery and abnormal maternal coagulation. Both umbilical cords of fetus A and B blood test results showed anti-nRNP/Sm antibody (++). The pathological examination of the umbilical cord and placenta showed the presence of old thrombosis in one of the umbilical arteries of fetus A.ConclusionsAbnormal maternal autoantibodies may be a risk factor for umbilical artery thrombosis. For these pregnant women, conducting more detailed ultrasound monitoring might get early detection of UAT formation and avoid the occurrence of adverse pregnancy outcomes.

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Umbilical artery Thrombosis: A case report of prenatal diagnosis and systematic review of the literature

Romani,

Marinelli,

Ponziani

et al. 2024

European Journal of Obstetrics & Gynecology and Reproductiv

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Expectant management for umbilical artery thrombosis: a report of two cases and literature review

Cited by 6 publications

References 7 publications

Expectant management for umbilical artery thrombosis in monochorionic diamniotic twin pregnancies: A Case Report

Expectant management for umbilical artery thrombosis in monochorionic diamniotic twin pregnancies: A Case Report

Umbilical artery thrombosis and maternal positive autoimmune antibodies: two case reports and a literature review

Umbilical artery Thrombosis: A case report of prenatal diagnosis and systematic review of the literature

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