Hemodynamic changes and perinatal outcome associated with umbilical artery thrombosis: a retrospective study

作者全名："Tu, Peng; Zhang, Xiaohang; Zhong, Chunyan; Ran, Qian; Ran, Suzhen"

作者地址："[Tu, Peng; Zhang, Xiaohang; Zhong, Chunyan; Ran, Qian; Ran, Suzhen] Chongqing Med Univ, Dept Ultrasound, Women & Childrens Hosp, Chongqing 401147, Peoples R China; [Tu, Peng; Zhang, Xiaohang; Zhong, Chunyan; Ran, Qian; Ran, Suzhen] Chongqing Hlth Ctr Women & Children, Dept Ultrasound, Chongqing 401147, Peoples R China"

通信作者："Ran, SZ (通讯作者)，Chongqing Med Univ, Dept Ultrasound, Women & Childrens Hosp, Chongqing 401147, Peoples R China.; Ran, SZ (通讯作者)，Chongqing Hlth Ctr Women & Children, Dept Ultrasound, Chongqing 401147, Peoples R China."

来源：ORPHANET JOURNAL OF RARE DISEASES

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001180243900001

JCR分区：Q2

影响因子：3.4

年份：2024

卷号：19

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Umbilical artery thrombosis; Hemodynamic changes; Perinatal outcomes

摘要："Objective Poor fetal and perinatal outcomes in fetuses associated with umbilical artery thrombosis (UAT), such as severe intrauterine growth restriction (IUGR) and intrauterine asphyxia have been reported by some case series. Its hemodynamic impact remains unclear. The aim of this study was to evaluate the hemodynamic changes and perinatal outcome in UAT fetuses with a relatively large sample. Methods We included singleton fetuses diagnosed with UAT and with at least one available Doppler evaluation before the end of pregnancy in our center from 2016 to 2023. Fetuses with structural abnormalities and with no follow-up results were excluded. Doppler waveforms from the Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and uterine artery (UtA) were routinely evaluated according to ISUOG Practice Guidelines from diagnosis. The same sample of GA-matched normal fetuses with Doppler measurements during the same period were randomly selected as control group. Results Eighty-nine singleton fetuses with UAT with at least one Doppler evaluation before the end of pregnancy were identified, 13 fetuses with no follow-up results were excluded. After comprehensive prenatal counseling, 14 cases received urgent cesarean section, the remaining 55 cases received expectant management, the median day between GA at diagnosis and end of pregnancy was 13 (5-53) days (range, 2-159). 7 (7/76, 9.2%) cases occurred stillbirth, and the incidence of IUGR and Neonatal Intensive Care Unit (NICU) admission were 18.4% (14/76) and 13.2% (10/76) respectively. 49 fetuses (49/76, 64.5%) combined with Doppler abnormalities. UA abnormalities (35/76, 46.1%) and MCA abnormalities (34/76, 44.7%) were the most changes at presentation. Compared to control group, UA-EDV was significantly increased in UAT fetuses [21.84 (15.59-26.64) vs. 16.40 (12.43-20.70) cm/s, p < 0.001], UA-PI and UA-RI significantly decreased [0.68 (0.57-0.84) vs. 0.92 (0.79-1.11), p<0.001; 0.51 (0.44-0.59) vs. 0.62 (0.55-0.68), p < 0.001, respectively]. Both the MCA-PSV and MCA-EDV were significantly higher in UAT fetuses [54.60 (48.00-61.34) vs. 44.47 (29.66-57.60) cm/s, p < 0.001; 11.19 (7.84-17.60) vs. 8.22 (5.21-12.00) cm/s, p < 0.001, respectively], this led to a lower MCA-PI and MCA-RI. Meanwhile, DV-PIV was significantly higher in UAT fetuses [0.6 (0.47-0.87) vs. 0.45 (0.37-0.55), p < 0.001], CPR and UtA-PI were no significant difference between these two groups. Multivariate logistic regression analysis showed that DV-PIV was an independent risk factor for adverse pregnancy outcomes (OR 161.922, p<0.001), the area under the ROC curve (AUC) was 0.792 (95% CI 0.668-0.917; p < 0.001). Conclusion Our data showed serious adverse pregnancy consequences are combined with UAT fetuses. Hemodynamic changes in UAT fetuses showed the remaining artery for compensation and brain perfusion derangement. With a comprehensive and standardized Doppler evaluation, progression of fetal deterioration may be detailed presented."

基金机构：Joint Medical Research Program of Chongqing Municipal Health Commission and Chongqing Science and Technology Bureau

基金资助正文：Thanks Ms Qian Ran to transfer this data and take care of all patients.