Gong Mei-Qin, Zhang Yong-Qing, Wang Xiao-Dong
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Front Pharmacol. 2024 May 13;15:1395344. doi: 10.3389/fphar.2024.1395344. eCollection 2024.
Umbilical 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.
In this report, we describe a case of thrombosis in one of the umbilical arteries detected by routine ultrasonography at 31 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.
Based 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.
脐动脉血栓形成（UAT）是一种罕见的妊娠并发症，与不良妊娠结局相关，包括胎儿宫内窘迫、宫内生长受限和死产。UAT不可预测，产前诊断具有挑战性。对于UAT的治疗策略，尤其是产前检测到脐动脉栓塞之一的患者，尚无共识。在大多数既往病例中，在UAT诊断时进行了紧急剖宫产，或发生了宫内胎儿死亡。
在本报告中，我们描述了一名34岁女性在妊娠31周时通过常规超声检查发现一条脐动脉血栓形成的病例。在进行了4天的密切监测的期待治疗后，由于胎儿脐血流和大脑中动脉血流异常，进行了紧急剖宫产；新生儿出生时状况良好。最终脐带组织病理学检查显示一条脐动脉血栓形成。本病例中的母亲和新生儿均接受了近2年的长期随访，目前身体健康，无任何并发症。
根据我们的经验，产科医生在怀疑UAT时应综合考虑当前孕周和胎儿宫内状况，以确定最佳分娩时间。当胎儿不成熟时，只要母亲和胎儿情况稳定，应尽量延长合适的孕周，尽力完成糖皮质激素治疗以促进胎儿肺成熟，并使用硫酸镁保护胎儿大脑。在期待治疗期间，应加强超声监测、电子胎心监护和胎动计数。临床医生应确保患者及其家属了解UAT期待治疗的所有潜在风险。
