Li Gang, Yin Xiufeng, Guo Jianfeng, He Yeping
Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu Province, China.
Department of Gynaecology and Obstetrics, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu Province, China.
Medicine (Baltimore). 2025 Aug 15;104(33):e43776. doi: 10.1097/MD.0000000000043776.
Umbilical artery thrombosis (UAT) is a rare complication that is strongly associated with adverse neonatal outcomes, and the diagnosis and selection of an appropriate delivery time for good neonatal outcomes is challenging. Here, we present a case of prenatal suspicion and ultrasound diagnosis of UAT: a case report with targeted Doppler evaluation and timely delivery.
A 35-year-old (gravida 6, para 1) with reduced fetal movement at 32 weeks gestation, Doppler ultrasound showed that for gestational age, the pulsatility index (PI), resistance index, and peak systolic velocity/end-diastolic velocity ratio of the umbilical artery (UA), PI of the left uterine artery, and PI of the middle cerebral artery were all <5th centile; the systolic/atrial wave ratio of the ductus venosus was 50th to 95th centile. Then the examination focused on the umbilical cord, excessive torsion of the umbilical cord and 2 hyperechoic lesions in 1 UA were observed. Only 1 UA was detected in the bladder section by color Doppler flow, whereas previous ultrasound screening results in the mid-trimester showed 2 umbilical arteries in the same section. Additionally, electronic heart rate monitoring revealed a noncontractile stimulation test abnormality.
UAT with fetal and hemodynamic changes were observed.
Urgent cesarean section was performed 2 days later after comprehensive prenatal counseling.
The infant was born alive at 1740 g, and Apgar scores were 9-10-10 in 1-5-10 minutes respectively. Postoperative recovery of the pregnant woman was unremarkable.
Targeted Doppler evaluation and timely delivery are helpful for the diagnosis of UAT and obtaining a fine pregnancy result.
脐动脉血栓形成（UAT）是一种罕见的并发症，与不良新生儿结局密切相关，而诊断并选择合适的分娩时间以获得良好的新生儿结局具有挑战性。在此，我们呈现一例产前疑似并经超声诊断的UAT病例报告：包括靶向多普勒评估及适时分娩。
一名35岁（孕6产1）孕妇，孕32周时胎动减少，多普勒超声显示，按孕周计算，脐动脉（UA）的搏动指数（PI）、阻力指数、收缩期峰值速度/舒张末期速度比值、左子宫动脉PI及大脑中动脉PI均低于第5百分位数；静脉导管的收缩期/心房波比值处于第50至95百分位数。随后检查聚焦于脐带，发现脐带过度扭转且1条UA内有2个高回声病变。彩色多普勒血流检查在膀胱段仅检测到1条UA，而孕中期之前的超声筛查结果显示同一部位有2条脐动脉。此外，电子心率监测显示无应激试验异常。
观察到UAT伴胎儿及血流动力学变化。
在进行全面的产前咨询后2天实施紧急剖宫产。
婴儿出生时体重1740g，1分钟、5分钟及10分钟的阿氏评分分别为9分、10分、10分。孕妇术后恢复情况良好。
靶向多普勒评估及适时分娩有助于UAT的诊断并获得良好的妊娠结局。
