Clinical analysis of umbilical artery embolism in 18 cases / 中华围产医学杂志

ABSTRACT

Objective:To investigate the clinical characteristics and pregnancy outcomes of fetal umbilical artery embolism.Methods:This retrospective case series recruited 18 cases of fetal umbilical artery embolism delivered at Xiamen Maternal and Child Healthcare Hospital from January 2018 to February 2020. Maternal age, complications, umbilical artery condition revealed by prenatal ultrasound, delivery mode, perinatal outcomes, and placental pathological examinations were analyzed using descriptive statistical methods.Results:(1) The total prenatal detection rate of umbilical artery embolism was 0.062% (18/29 130). The average maternal age was (30.1±6.1) years old. Four of the 18 cases aged other 35 and one was younger than 18 years old; 17 cases were singleton pregnancy, and the other one was a dichorionic diamniotic twin pregnancy. The mean gestational age was (35.1±2.6) weeks when an abnormal umbilical artery was first indicated by ultrasound, including 16 with a single umbilical artery shown in the third trimester and two with suspected umbilical artery embolism. The main complications were followed as gestational diabetes mellitus (8/18), fetal growth restriction (4/18), and abnormal umbilical cord insertion (3/18). (2) Cesarean section was performed for 16 cases, resulting in live births, while the other two cases had intrauterine death. Among the 16 neonates, nine were premature infants, and seven were full-term infants, with an average birth weight of (2 434±816) g; four were small for gestational age, and neonatal asphyxia occurred in three cases. Eleven were admitted to the neonatal intensive care unit, including five with brain injury. (3) Placental pathological examinations showed embolism in one of the two umbilical arteries in 17 cases and the umbilical vein in one case. Excessive torsion of the umbilical cord was observed in 11 cases and the umbilical cord's abnormal insertion in three cases. One case refused placental pathological examination.Conclusions:Umbilical artery embolism should be considered when a single umbilical artery is indicated by ultrasound in the third trimester. The time of delivery should be based on the risk of premature birth and unexpected adverse events. A cesarean section is suggested.