Li Xin, Chen Wei, Liu Tianjiao, Cai Jian, Wei Sumei, Du Yuhua, Liu Chunyan, Gong Zhaolin, Cheng Linbo, Zhou Xiaoling, Xiong Min, Wang Tao, Li Yalan, Yang Xiao, Lai Fan
Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China.
Front Med (Lausanne). 2023 Jun 16;10:1187492. doi: 10.3389/fmed.2023.1187492. eCollection 2023.
Previous 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 1: Fetal ultrasound of a 34-year-old pregnant woman at 30 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 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 weeks gestation was normal, but routine fetal ultrasound at 27 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 weeks gestation. An emergency cesarean section was performed at 34 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.
Abnormal 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.
既往研究表明，孕妇自身免疫抗体异常升高可能增加母体血栓形成风险。然而，在我院，有两名孕妇出现脐动脉血栓形成，且两人均检测出母体自身抗体阳性，这使我们思考母体自身抗体在脐动脉血栓形成中是否也起作用。
病例1：一名34岁孕妇在妊娠30周时的胎儿超声检查显示有两条脐动脉，较细的脐动脉内径约为0.15厘米。然而，仅检测到单一脐动脉血流信号。由于异常胎心监护和多普勒超声检查提示胎儿窘迫，于妊娠31周行急诊剖宫产。新生儿阿氏评分分别为3 - 8 - 8。脐带检查发现两条脐动脉均有血栓形成。此外，孕期血液检查结果显示nRNP/Sm抗体（+）、SS抗体（+++）。病例2：一名33岁双胎妊娠孕妇在妊娠24周时首次系统超声检查正常，但妊娠27周时的常规胎儿超声检查显示胎儿A与胎盘之间只有一条脐动脉。血液检查结果显示，该患者在妊娠27周时类风湿免疫活性检查抗nRNP/Sm抗体（+）。因单脐动脉及母体凝血异常，于妊娠34周行急诊剖宫产。胎儿A和B的两条脐带血液检查结果均显示抗nRNP/Sm抗体（++）。脐带和胎盘的病理检查显示胎儿A的一条脐动脉存在陈旧性血栓。
母体自身抗体异常可能是脐动脉血栓形成的危险因素。对于这些孕妇，进行更详细的超声监测可能有助于早期发现脐动脉血栓形成并避免不良妊娠结局的发生。
