Zhu Ying, Beejadhursing Rajluxmee, Liu Yanyan
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Arch Gynecol Obstet. 2021 Jul;304(1):59-64. doi: 10.1007/s00404-020-05910-x. Epub 2021 Jan 2.
Thrombosis of umbilical vessels is a rare occurrence that is difficult to detect during routine antenatal examinations but can lead to poor perinatal outcomes.
The aim of this study is to examine the association between meaningful clinical manifestations and features associated with thrombosis of umbilical vessels, and to evaluate optimal management options.
A retrospective study of umbilical cord thrombi cases enrolled between 2015-2019 was carried out. Data were analyzed from the medical archives where the diagnosis of all cases was established by histopathology.
Gross examination reported additional cord abnormalities (7/10), including the irregular length of the umbilical cord, narrowed cord with hyper-coiling, swollen cord with deficiency of Wharton's jelly, placenta velamentous and umbilical infarction. Pathological examination accounted for 10 cases of umbilical cord thrombosis including umbilical artery embolism (3/10), umbilical vein thrombi (5/10) and funisitis (2/10). Clinical findings depicted that the chief complaint was decreased fetal movement companied by nonreactive NST tests (5/10). With the exception of two stillbirths, the remaining pregnancies (8/10) were terminated by cesarean section. All neonates are alive, including one VLBW and three LBW cases.
We have observed that umbilical structural dysplasia, maternal coagulation disorder, vascular endothelial injury and elevated blood glucose may lead to the formation of thrombosis. Focus on specific signs during a prenatal ultrasound, EFM monitoring and counting fetal movements can help in early identification of umbilical cord thrombi. Our results support the more effective approach of emergency cesarean section during the third trimester.
脐血管血栓形成是一种罕见的情况，在常规产前检查中很难发现，但可能导致围产期不良结局。
本研究的目的是探讨与脐血管血栓形成相关的有意义的临床表现和特征之间的关联，并评估最佳管理方案。
对2015年至2019年登记的脐带血栓病例进行回顾性研究。从医疗档案中分析数据，所有病例的诊断均通过组织病理学确定。
大体检查报告了其他脐带异常（7/10），包括脐带长度不规则、脐带狭窄伴过度卷曲、脐带肿胀伴华通胶缺乏、帆状胎盘和脐梗死。病理检查发现10例脐带血栓形成，包括脐动脉栓塞（3/10）、脐静脉血栓（5/10）和脐带炎（2/10）。临床发现表明，主要症状是胎动减少伴无反应性NST试验（5/10）。除2例死产外，其余妊娠（8/10）均通过剖宫产终止。所有新生儿均存活，包括1例极低出生体重儿和3例低出生体重儿。
我们观察到脐结构发育异常、母体凝血障碍、血管内皮损伤和血糖升高可能导致血栓形成。在产前超声、电子胎心监护和计数胎动期间关注特定体征有助于早期识别脐带血栓。我们的结果支持在孕晚期采用更有效的紧急剖宫产方法。
