PDF(Pubmed)
Abstract：
BACKGROUND: Thrombosis of one of the umbilical arteries is a rare complication of pregnancy and is associated with adverse pregnancy outcomes, including stillbirth and intrauterine growth restriction. Although extremely rare, umbilical artery thrombosis (UAT) in monochorionic diamniotic twins is difficult to diagnose prenatally and manage. UAT has a poor prognosis and is associated with an increased perinatal mortality rate. In most previous cases, emergency cesarean section was performed or intrauterine fetal death occurred at the time of UAT diagnosis.
METHODS: Herein, we report an extremely rare case of sequential UAT in monochorionic diamniotic twins diagnosed via ultrasound at 29+ 5 weeks of gestation in a 34-year-old woman. Following expectant management with intensive monitoring for 16 days, two healthy infants were delivered through an emergency cesarean section. UAT in both fetuses was confirmed by pathological examination. The mother and twins described in this case underwent long-term follow-up and are currently in good health without any complications.
CONCLUSIONS: Based on our experience, we suggest that expectant management should be undertaken as long as the mother and infants are stable on ultrasonographic scans and are closely monitored. When UAT is suspected, we believe that the best delivery time should be determined by considering complaints of unusual fetal movements, non-stress test evidence, gestational age, amniotic fluid volume, and blood flow in the umbilical artery, middle cerebral artery, and ductus venosus. Obstetricians should ensure that the patients and their families are clearly informed about all potential risks of expectant management for UAT.
METHODS: Herein, we report an extremely rare case of sequential UAT in monochorionic diamniotic twins diagnosed via ultrasound at 29+ 5 weeks of gestation in a 34-year-old woman. Following expectant management with intensive monitoring for 16 days, two healthy infants were delivered through an emergency cesarean section. UAT in both fetuses was confirmed by pathological examination. The mother and twins described in this case underwent long-term follow-up and are currently in good health without any complications.
CONCLUSIONS: Based on our experience, we suggest that expectant management should be undertaken as long as the mother and infants are stable on ultrasonographic scans and are closely monitored. When UAT is suspected, we believe that the best delivery time should be determined by considering complaints of unusual fetal movements, non-stress test evidence, gestational age, amniotic fluid volume, and blood flow in the umbilical artery, middle cerebral artery, and ductus venosus. Obstetricians should ensure that the patients and their families are clearly informed about all potential risks of expectant management for UAT.
摘要：
背景：其中一个脐动脉血栓形成是一种罕见的妊娠并发症，与不良妊娠结局有关，包括死产和宫内生长受限。虽然极为罕见,单绒毛膜双胎的脐动脉血栓形成（UAT）很难在产前诊断和管理。UAT预后不良，并与围产期死亡率增加有关。在大多数以前的情况下，在UAT诊断时进行了紧急剖宫产或宫内胎儿死亡。
方法：这里，我们报告了1例34岁女性在妊娠29+5周时通过超声诊断的单绒毛膜双胎顺次UAT极为罕见的病例.经过预期管理和16天的密集监测，两名健康婴儿通过紧急剖宫产分娩.病理检查证实了两个胎儿的UAT。在这种情况下描述的母亲和双胞胎接受了长期随访，目前身体健康，没有任何并发症。
结论：根据我们的经验，我们建议,只要母亲和婴儿在超声检查中表现稳定并受到密切监测,就应进行期待管理.当UAT被怀疑时，我们认为，最佳分娩时间应通过考虑胎儿异常运动的投诉来确定，非压力测试证据，胎龄,羊水体积,脐动脉的血流，大脑中动脉,还有静脉导管.产科医生应确保患者及其家人清楚地了解UAT预期管理的所有潜在风险。
方法：这里，我们报告了1例34岁女性在妊娠29+5周时通过超声诊断的单绒毛膜双胎顺次UAT极为罕见的病例.经过预期管理和16天的密集监测，两名健康婴儿通过紧急剖宫产分娩.病理检查证实了两个胎儿的UAT。在这种情况下描述的母亲和双胞胎接受了长期随访，目前身体健康，没有任何并发症。
结论：根据我们的经验，我们建议,只要母亲和婴儿在超声检查中表现稳定并受到密切监测,就应进行期待管理.当UAT被怀疑时，我们认为，最佳分娩时间应通过考虑胎儿异常运动的投诉来确定，非压力测试证据，胎龄,羊水体积,脐动脉的血流，大脑中动脉,还有静脉导管.产科医生应确保患者及其家人清楚地了解UAT预期管理的所有潜在风险。
