Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2024; 12(2): 240-248
Published online Jan 16, 2024. doi: 10.12998/wjcc.v12.i2.240
Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis: A retrospective analysis
Si-Jie Hong, Li-Wei Hong, Xiao-Qin He, Xiao-Hong Zhong
Si-Jie Hong, Xiao-Qin He, Xiao-Hong Zhong, Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
Li-Wei Hong, Ministry of Science and Education, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
Co-first authors: Si-Jie Hong and Li-Wei Hong.
Author contributions: Hong SJ and Hong LW contributed equally to this work, especially in data collection, analysis, and drafting of the initial manuscript; Zhong XH conceived the study; He XQ helped to revise the manuscript; all authors contributed to interpret data; all authors have read and approve the final manuscript.
Supported by Natural Science Foundation of Xiamen, No. 3502Z202373120; and National Key R&D Program of China, No. 2022YFF0606301.
Institutional review board statement: The study was reviewed and approved by the research ethics committee (REC) of Xiamen Women and Children's Hospital (Approval No. KY-2023-081-K01).
Informed consent statement: This study is a retrospective study in which de-identified data was extracted from accumulative database, and the study complies with the Declaration of Helsinki of posing no more than minimal risk to participants. The research ethics committee of Xiamen Women and Children's Hospital approved the waiver of informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Hong Zhong, MS, Chief Physician, Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, No. 10 Zhenhai Road, Xiamen 361000, Fujian Province, China. 232738827@qq.com
Received: August 30, 2023
Peer-review started: August 30, 2023
First decision: December 7, 2023
Revised: December 18, 2023
Accepted: December 26, 2023
Article in press: December 26, 2023
Published online: January 16, 2024
Processing time: 133 Days and 16.1 Hours
Abstract
BACKGROUND

Umbilical artery thrombosis (UAT) is extremely uncommon and leads to adverse perinatal outcomes. Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT. Ultrasound is an effective way to detect thrombosis. The mother can monitor her own fetal health using ultrasound, which enables her to take preventative action in case of emergency.

AIM

To investigate ultrasonic blood signal after UAT in the umbilical artery, and evaluate the relationship between hypercoagulability and UAT.

METHODS

We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow, and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital. Patients’ information was collected from medical archives, including maternal clinical data, neonatal outcomes, pathological findings and ultrasonic indices of umbilical artery blood flow, such as systolic-diastolic duration ratio (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV). Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R (version 4.2.1) including car (version 3.1-0) and stats (version 4.2.1), and visualized by ggplot2 package (version 3.3.6).

RESULTS

A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow (within 2.5th of reference ranges) in a short period of time. Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D, RI, and PI and increase of PSV during the disease process was greater than that of non-UAT. All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery, most of which (16/18) showed umbilical cord abnormalities, with 15 umbilical cord torsion and 1 pseudoknot. Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.

CONCLUSION

Significant changes in ultrasound indicators after UAT were demonstrated. PSV can play important roles in the diagnosis of UAT. Hypercoagulability alone is not sufficient for the occurrence of UAT.

Keywords: Umbilical artery thrombosis; Obstetric ultrasonography; Peak systolic velocity; Hypercoagulation; Umbilical cord abnormalities; Fetus

Core Tip: A case of umbilical artery thrombosis (UAT) occurring within a short period of time was reported, resulting in significant changes in the ultrasound flow indices of the umbilical artery. Then, a retrospective study of 19 patients revealed a high prevalence of umbilical cord abnormalities among those with UAT, while the coagulation status did not significantly differ from that of normal pregnant women. Notably, the proportion of decrease in systolic-diastolic duration ratio, resistance index and pulsatility index, and increase in peak systolic velocity were considerably higher in UAT cases compared to normal pregnant women, which might help to detect UAT in advance using ultrasound.