Skip to main content
SpringerLink
Log in

10 cases of umbilical cord thrombosis in the third trimester

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Thrombosis of umbilical vessels is a rare occurrence that is difficult to detect during routine antenatal examinations but can lead to poor perinatal outcomes.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Heifetz SA (1988) Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Pediatr Pathol 8(1):37–54

    Article  CAS  Google Scholar 

  2. Avagliano L et al (2010) Thrombosis of the umbilical vessels revisited. An observational study of 317 consecutive autopsies at a single institution. Hum Pathol 41(7):971–979

    Article  Google Scholar 

  3. Alhousseini A et al (2018) Umbilical artery thrombosis with associated acute and severe fetal growth restriction and transient severe protein s deficiency: report of a case with prenatal ultrasound diagnosis allowing for timely intervention and good outcome. Case Rep Obstet Gynecol 2018:6324362

    PubMed  PubMed Central  Google Scholar 

  4. Oliveira GH et al (2016) Intrauterine thrombosis of umbilical artery—case report. Sao Paulo Med J 134(4):355–358

    Article  Google Scholar 

  5. Starnberg J et al (2018) Lower cognitive test scores at age 7 in children born with marginally low birth weight. Pediatr Res 83(6):1129–1135

    Article  Google Scholar 

  6. Kim CJ et al (2015) Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 213(4 Suppl):S29-52

    Article  Google Scholar 

  7. Valero PM, Blazquez DG (2014) Aortic thrombosis in a newborn. Arch Argent Pediatr 112(6):262–265

    Google Scholar 

  8. Trasca LF et al (2019) Therapeutic implications of inherited thrombophilia in pregnancy. Am J Ther 26(3):e364–e374

    Article  Google Scholar 

  9. Konkle BA (2015) Diagnosis and management of thrombosis in pregnancy. Birth Defects Res C Embryo Today 105(3):185–189

    Article  CAS  Google Scholar 

  10. Fritz MA, Christopher CR (1981) Umbilical vein thrombosis and maternal diabetes mellitus. J Reprod Med 26(6):320–324

    CAS  PubMed  Google Scholar 

  11. Peng HQ et al (2006) Umbilical cord stricture and overcoiling are common causes of fetal demise. Pediatr Dev Pathol 9(1):14–19

    Article  Google Scholar 

  12. Trevisanuto D et al (2007) Overcoiling of the umbilical cord. J Pediatr 150(1):112

    Article  Google Scholar 

  13. Devlieger H et al (1983) Thrombosis of the right umbilical artery, presumably related to the shortness of the umbilical cord: an unusual cause of fetal distress. Eur J Obstet Gynecol Reprod Biol 16(2):123–127

    Article  CAS  Google Scholar 

  14. Matsumoto Y et al (2019) A case report of umbilical vein varix with thrombosis: prenatal ultrasonographic diagnosis and management. Case Rep Obstet Gynecol 2019:7154560

    PubMed  PubMed Central  Google Scholar 

  15. Redline RW (2006) Inflammatory responses in the placenta and umbilical cord. Semin Fetal Neonatal Med 11(5):296–301

    Article  Google Scholar 

  16. Kim CJ et al (2001) Histo-topographic distribution of acute inflammation of the human umbilical cord. Pathol Int 51(11):861–865

    Article  CAS  Google Scholar 

  17. Donepudi RV, Moise KJ Jr (2019) Intrauterine transfusion complicated by umbilical artery thrombosis. Case Rep Obstet Gynecol 2019:5952326

    PubMed  PubMed Central  Google Scholar 

  18. Smith JF Jr et al (1999) Umbilical artery regression: a rare complication of intravascular fetal transfusion. Obstet Gynecol 93(5 Pt 2):828–829

    PubMed  Google Scholar 

  19. Van Kamp IL et al (2005) Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol 192(1):171–177

    Article  Google Scholar 

  20. Hasegawa J et al (2009) Ultrasound diagnosis and management of umbilical cord abnormalities. Taiwan J Obstet Gynecol 48(1):23–27

    Article  Google Scholar 

  21. Burshtein S et al (2011) Is single umbilical artery an independent risk factor for perinatal mortality? Arch Gynecol Obstet 283(2):191–194

    Article  Google Scholar 

  22. Lutfallah F et al (2018) A case of umbilical artery thrombosis in the third trimester of pregnancy. Am J Case Rep 19:72–75

    Article  Google Scholar 

  23. Klaritsch P et al (2008) Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction. Placenta 29(4):374–377

    Article  CAS  Google Scholar 

  24. Shilling C et al (2014) Umbilical artery thrombosis is a rare but clinically important finding: a series of 7 cases with clinical outcomes. Pediatr Dev Pathol 17(2):89–93

    Article  Google Scholar 

  25. Sato Y, Benirschke K (2006) Umbilical arterial thrombosis with vascular wall necrosis: clinicopathologic findings of 11 cases. Placenta 27(6–7):715–718

    Article  CAS  Google Scholar 

  26. Cook V et al (1995) Umbilical artery occlusion and fetoplacental thromboembolism. Obstet Gynecol 85(5 Pt 2):870–872

    Article  CAS  Google Scholar 

  27. Dussaux C et al (2014) Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis? Clin Case Rep 2(6):271–273

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Ying Zhu, Rajluxmee Beejadhursing & Yanyan Liu

Authors
  1. Ying Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajluxmee Beejadhursing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanyan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YZ recruited the patients and drafted the article, RB and YL critically revised the manuscript. Three authors have read and approved the final manuscript.

Corresponding author

Correspondence to Yanyan Liu.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

The retrospective study was approved by the ethics committee on human research at Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, Y., Beejadhursing, R. & Liu, Y. 10 cases of umbilical cord thrombosis in the third trimester. Arch Gynecol Obstet 304, 59–64 (2021). https://doi.org/10.1007/s00404-020-05910-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05910-x

Keywords

Search

Navigation