Ding Weimin, Yan Jiajia, Lin Xinyu, Yan Liangqi, Tao Enfu
Department of Obstetrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China.
Department of Ultrasound, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China.
Front Med (Lausanne). 2025 Aug 21;12:1606697. doi: 10.3389/fmed.2025.1606697. eCollection 2025.
Umbilical artery thrombosis (UAT) is an extremely rare but severe obstetric complication associated with adverse perinatal outcomes, including fetal growth restriction (FGR), fetal distress, and intrauterine fetal demise. This case report highlights the diagnostic challenges of UAT and its potential misdiagnosis as a single umbilical artery (SUA). A 32-year-old woman with a history of uncomplicated vaginal delivery was initially misdiagnosed with SUA at 29 3/7 weeks of gestation. At 32 1/7 weeks, detailed ultrasound examination revealed a single umbilical artery, FGR, and hypercoiling. Following a multidisciplinary evaluation and administration of fetal lung maturation therapy, a cesarean section was performed at 32 3/7 weeks of gestation. Intraoperatively, the umbilical cord measured 90 cm in length (normal range: 35-70 cm) with over 50 coils and exhibited localized discoloration. A male neonate weighing 1,490 g (5th percentile for gestational age) was delivered with Apgar scores of 10/10 at 1 and 5 minutes. Postnatal pathological examination confirmed UAT with arterial occlusion and hypercoiling. The neonate was treated in the neonatal intensive care unit (NICU) for respiratory distress syndrome (RDS) and prematurity-related complications, achieving a favorable outcome with discharge at 27 days and normal developmental follow-up. This case underscores the diagnostic challenges of differentiating UAT from SUA and emphasizes the importance of meticulous prenatal ultrasound evaluation, particularly in cases of FGR. The hypercoiling observed in this case is exceptionally rare and may have contributed to the thrombotic event. Early recognition, timely intervention, and multidisciplinary management are critical to optimizing maternal and neonatal outcomes. This report also provides a comprehensive literature review on the etiology, diagnostic strategies, and management of UAT, highlighting the role of ultrasound and pathological examination in accurate diagnosis. The findings suggest that hypercoiling and abnormal cord length may be significant risk factors for UAT, warranting further investigation into their pathophysiological mechanisms and clinical implications.
脐动脉血栓形成（UAT）是一种极其罕见但严重的产科并发症，与不良围产期结局相关，包括胎儿生长受限（FGR）、胎儿窘迫和宫内胎儿死亡。本病例报告强调了UAT的诊断挑战及其被误诊为单脐动脉（SUA）的可能性。一名有顺产史的32岁女性在妊娠29 3/7周时最初被误诊为SUA。在32 1/7周时，详细的超声检查发现单脐动脉、FGR和过度盘绕。经过多学科评估并给予胎儿肺成熟治疗后，于妊娠32 3/7周进行了剖宫产。术中，脐带长度为90厘米（正常范围：35 - 70厘米），有50多个盘绕，并出现局部变色。一名体重1490克（孕龄第5百分位数）的男婴出生，1分钟和5分钟时阿氏评分均为10/10。产后病理检查证实为UAT伴动脉闭塞和过度盘绕。该新生儿在新生儿重症监护病房（NICU）接受呼吸窘迫综合征（RDS）和早产相关并发症的治疗，27天时出院，发育随访正常，预后良好。本病例强调了区分UAT与SUA的诊断挑战，并强调了产前超声细致评估的重要性，特别是在FGR病例中。本病例中观察到的过度盘绕极为罕见，可能促成了血栓形成事件。早期识别、及时干预和多学科管理对于优化母婴结局至关重要。本报告还对UAT的病因、诊断策略和管理进行了全面的文献综述，强调了超声和病理检查在准确诊断中的作用。研究结果表明，过度盘绕和脐带长度异常可能是UAT的重要危险因素，有必要进一步研究其病理生理机制和临床意义。
