Fetal umbilical artery thrombosis: prenatal diagnosis, treatment and follow-up

Wu, Xiafang; Wei, Chuanliang; Chen, Ruifeng; Yang, Linxian; Huang, Weifei; Huang, Liang; Yan, Xinxin; Deng, Xuedong; Gou, Zhongshan

doi:10.1186/s13023-022-02563-8

Cited by 12 publications

(12 citation statements)

References 30 publications

(35 reference statements)

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“…Therefore, in the expectant management treatment of this patient, an increase in the dose of low molecular weight heparin may be considered to be beneficial in prolonging the gestational age, which needs to be further confirmed in subsequent studies. In the study by Wu et al ( Wu et al, 2022 ), it was found that the expectant management group did not have worse fetal outcomes compared to the urgent treatment group when current screening and therapeutic strategies were implemented ( Li et al, 2019b ), thirty-five pregnant women with thrombosis of umbilical cord were included in these analyses. Sometimes, sudden intrauterine fetal death due to umbilical cord thrombosis is unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Expectant management for umbilical artery thrombosis in the third trimester of pregnancy: a case report

Gong,

Zhang,

Wang

2024

Front. Pharmacol.

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BackgroundUmbilical artery thrombosis (UAT) is a rare complication of pregnancy and is associated with adverse pregnancy outcomes, including fetal intrauterine distress, intrauterine growth restriction, and still birth. UAT is unpredictable, and prenatal diagnosis is challenging. There is no consensus on the treatment strategy of UAT, especially for patients with prenatal detection of one of the umbilical artery embolisms. In most previous cases, an emergency cesarean section was performed, or intrauterine fetal death occurred at the time of UAT diagnosis.Case presentationIn this report, we describe a case of thrombosis in one of the umbilical arteries detected by routine ultrasonography at 31+3 weeks of gestation in a 34-year-old woman. Following expectant management with intensive monitoring for 4 four days, an emergency cesarean section was performed because of abnormal fetal umbilical cord blood flow and middle cerebral artery blood flow; the newborn was in good condition at birth. The final umbilical cord histopathology revealed thrombosis in one of the umbilical arteries. Both mother and newborn described in this case underwent long-term follow-up for nearly 2 two years and are currently in good health without any complications.ConclusionsBased on our experience, obstetricians should comprehensively consider the current gestational age and fetal intrauterine status when UAT is suspected to determine the best delivery time. The appropriate gestational age should be prolonged as long as the mother and fetus are stable when the fetus is immature, trying our best to complete the corticosteroid treatment to promote fetal lung maturity and magnesium sulfate to protect fetal brain. During expectant management, ultrasound monitoring, electronic fetal heart monitoring, and fetal movement counting should be strengthened. Clinicians should ensure that the patients and their families are informed about all potential risks of expectant management for UAT.

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Section: Discussionmentioning

confidence: 99%

Expectant management for umbilical artery thrombosis in the third trimester of pregnancy: a case report

Gong,

Zhang,

Wang

2024

Front. Pharmacol.

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“…Three key factors are responsible for thrombosis: hypercoagulability, blood ow stasis, and endothelial injury [4]. Using logistic regression, Wu et al recently revealed that maternal gestational diabetes mellitus and fetal umbilical cord abnormalities were also independent risk factors for UAT in their retrospective cohort study [5]. However, the study had major limitations: rst, the data collected were based on retrospective studies and registry data, and second, the generalizability to a broader population with UAT remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Wu et al, it was found that the expectant management group did not have worse fetal outcomes compared to the urgent treatment group when current screening and therapeutic strategies were implemented [5]. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Maternal diabetes has been reported as a non-genetic risk factor of DAA as well as umbilical artery thrombosis. 17 Although the effect size of MTHFR variants (C677T, A1298C) is weak, a recent integrative study demonstrated the significant risk of heterozygous MTHFR C677T (odds ratio: 1.33). 18 We did not conduct a genetic study for MTHFR variants in the present patient because (1) approximately half of healthy Japanese individuals have an allele of MTHFR C677T (AV genotype), and (2) the VV but not the AV genotype is a significant risk factor for adult Japanese patients with deep vein thrombosis.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Ductus Arteriosus Aneurysm and Pulmonary Artery Thromboses in a Protein S-Deficient Newborn

Shirozu

Ichiyama

Ishimura

et al. 2023

AJP Rep

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Ductus arteriosus aneurysm (DAA) asymptomatically occurs in newborn infants and resolves spontaneously. High-risk DAA with compression, rupture and thrombosis requires early surgical intervention. Newborn infants have the highest risk of thrombosis among pediatric patients, but the genetic predisposition is difficult to determine in infancy. We herein report a neonatal case of massive thromboses in DAA and pulmonary artery. Desaturation occurred in an active full-term infant two days after birth. Echocardiography and contrast-enhanced computed tomography indicated thrombotic occlusion of the DAA and pulmonary artery thrombus. Urgent thrombectomy and ductus resection were successfully performed. After six months of anticoagulant therapy, the dissociated low plasma activity levels of protein S from protein C suggested protein S deficiency. A genetic study of PROS1 identified a heterozygous variant of protein S K196E, a low-risk variant of thrombophilia in Japanese populations. There have been seven reported cases with neonatal-onset symptomatic thromboses of DAA involving the pulmonary artery. All survived without recurrence after surgical intervention in five and anticoagulant therapy alone in two. Two newborns had a heterozygous methylenetetrahydrofolate reductase variant, but information on thrombophilia was not available for any other cases. A genetic predisposition may raise the risk of DAA thrombosis, leading to rapid progression.

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Fetal umbilical artery thrombosis: prenatal diagnosis, treatment and follow-up

Cited by 12 publications

References 30 publications

Expectant management for umbilical artery thrombosis in the third trimester of pregnancy: a case report

Expectant management for umbilical artery thrombosis in the third trimester of pregnancy: a case report

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

Ductus Arteriosus Aneurysm and Pulmonary Artery Thromboses in a Protein S-Deficient Newborn

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