Intrauterine thrombosis of umbilical artery - case report / Trombose intrauterina de artéria umbilical - relato de caso

ABSTRACT: CONTEXT: Umbilical cord thrombosis is related to greater fetal and perinatal morbidity and mortality. It is usually associated with umbilical cord abnormalities that lead to mechanical compression with consequent vascular ectasia. Its correct diagnosis and clinical management remains a challenge that has not yet been resolved. CASE REPORT: This study reports a case of umbilical artery thrombosis that occurred in the second half of a pregnancy. The umbilical cord was long, thin and overly twisted and the fetus presented severe intrauterine growth restriction. The clinical and histopathological findings from this case are described. CONCLUSIONS: This case report emphasizes the difficulty in diagnosing and clinically managing abnormalities of intrauterine life with a high chance of perinatal complications.

RESUMO: CONTEXTO: A trombose do cordão umbilical está relacionada com o aumento da morbimortalidade fetal e perinatal. É geralmente associada a alterações do cordão umbilical que levam à compressão mecânica com consequente ectasia vascular. Seu correto diagnóstico e manejo clínico é um desafio que não está ainda bem esclarecido. RELATO DE CASO: Neste relato se descreve caso de trombose da artéria umbilical de ocorrência na segunda metade da gravidez associada a cordão umbilical longo, fino, excessivamente retorcido, associado a feto com restrição de crescimento intrauterino grave. São descritos seus achados clínicos e histopatológicos correlacionados. CONCLUSÃO: Este relato de caso reforça a dificuldade diagnóstica e de manejo clínico em alteração da vida intrauterina com grande possibilidade de complicações perinatais.

effects of pregnancy: induced hypertension on umbilical artery blood flow in the third trirnester

Doppler ultrasound of umbilical vessels is a method of evaluating fetoplacental blood flow which is very important in high risk pregnancies and can predict both the duration of maternal hospitalization and fetal mortality rates in IUGR. Pregnancy induced hypertension is one of the most important causes of high-risk pregnancies. In this study, the rate of blood flow through umbilical artery as well as its degree of resistance were measured, using Doppler ultrasound in the patients with pregnancy induced hypertension. This is a cross-sectional study which was carried out on 35 pregnant women with pregnancy induced hypertension in the year of 2004. All of the cases were studied during their third trimester. 61 pregnant women in their third trimester were selected as the control group. They all had normal blood pressure. Doppler ultrasound of umbilical artery was performed for both the case and the control groups. Then, Peak Systolic Velocity [PSV], End Diastolic Velocity [EDV] and mean velocity were measured, based of which Resistive Index [RI], Pulsatility Index [PI] and Systolic to Diastolic ratio [S/D ratio] were calculated. Finally the statistical analysis was performed on the obtained recorded data, using SPSS software. The results indicate a measure of 0.77 for RI; 1.39 for PT and 4.88 for S/D ratio in the case group while in the control group, such measurements were calculated as 0.64; 1.08 and 2.97, respectively. As a whole, the comparison of the mean values of the mentioned indices revealed a significant difference between the two groups [P<0.01]. The case group were significantly rated higher in terms of the above mentioned indices. In patients with pregnancy induced hypertension without having other risk factors [such as diabetes, mellitus and IUGR], Doppler ultrasound should be used for evaluating the degree of fetoplacental blood flow in order to decrease the risk of pregnancy complications

Flujo ausente o reverso al final del diástole en aorta descendente o arteria umbilical / Ausent flow or reversal at the end of descendent aorta diastole or umbilical artery

Se presenta el resultado perinatal de 15 embarazos de alto riesgo que mostraron flujo ausente o reverso al final del diástole en arteria umbilical o aorta descendente. Este hallazgo representa una situación fetal muy comprometida. Todos fueron retardos de crecimiento intrauterino severos y la mortalidad perinatal fue de 47%. El parámetro más importante para predecir el resultado perinatal fue el peso del recién nacido; 900 g o más se asoció con buen resultado. En menor medida lo fue la edad gestacional al nacimiento