Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis? (2024)

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  • Clin Case Rep
  • v.2(6); 2014 Dec
  • PMC4270709

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Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis? (1)

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Clin Case Rep. 2014 Dec; 2(6): 271–273.

Published online 2014 Nov 17. doi:10.1002/ccr3.111

PMCID: PMC4270709

PMID: 25548629

Author information Article notes Copyright and License information PMC Disclaimer

Abstract

Key Clinical Message

Umbilical vein thrombosis is a rare anomaly with high mortality that frequently occurs in association with fetomaternal conditions. The unfavorable outcome of our case highlights the need for consensus on severity criteria, including the percentage of vascular occlusion determined by power Doppler, in order to improve outcome.

Keywords: Fetal loss, prenatal diagnosis, thrombosis, umbilical vein

What's already known about this topic?

  • Umbilical vein thrombosis is a rare anomaly of uncertain clinical significance, with high mortality and morbidity.

  • It frequently occurs in association with fetomaternal conditions.

What does this study add?

  • We provide a clinical-pathological description of a case of antenatally diagnosed umbilical cord thrombosis with an unfavorable outcome.

  • It highlights the need for consensus on severity criteria, including the percentage of vascular occlusion determined by power Doppler, in order to improve outcome.

The umbilical vein thrombosis is a rare event and its management at the time of diagnosis remains undefined.

We present the unfavorable course of umbilical cord thrombosis revealed by ultrasound scan at 32 weeks of gestation (WG). Despite the close follow-up, the fetus died in utero.

The 27-year-old mother, gravida 1, had a previously unremarkable medical and obstetrical history. Her first (12 WG) and second (22 WG) ultrasound scans were normal. The oral glucose tolerance test, performed because of familial diabetes, was recorded normal at 28 weeks. The third 32-week scan revealed a large insertion of the umbilical cord on the placental side, suggestive of a cyst, and the patient was referred to our tertiary care prenatal center. The repeat scan indicated ectasia of the umbilical vein at the level of placental cord insertion, with turbulent and pulsatile flow, extended by partial thrombosis of the umbilical vein (Fig.​(Fig.1).1). The cord displayed 3 vessels and the coiling index was not increased (0.2/cm). The rest of the cord was normal, including the intra-abdominal part of the umbilical vein. Doppler ultrasound of the umbilical artery indicated a slightly increased resistance index of 0.76 (93rd percentile). Doppler ultrasound indicated a normal ductus venosus. Placental location and appearance was normal. The estimated fetal weight (2091 g) was concordant with the gestational age (48th percentile), as was the amount of amniotic fluid. Fetal movements were appropriate. Fetal heart rate patterns were normal. We decided to follow up the patient with daily fetal heart monitoring at home, and weekly ultrasound scans at our institution. Nevertheless, 3 days later, the mother presented to the emergency room because of perceived reduced fetal movements over the previous 12 h. Examination revealed intrauterine fetal demise. Induction of labor was followed by a normal vagin*l delivery of a stillborn girl weighing 2200 g.

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Figure 1

US scan: ectasia of the umbilical vein at the level of placental cord insertion with turbulent and pulsatile flow extended by partial thrombosis of the umbilical vein.

Histopathological examination revealed a macerated, eutrophic fetus with no malformations. The placental examination revealed a massively dilated chorionic vein with a 5 cm vascular ectasia and intimal dysplasia with thrombosis (Fig.​(Fig.2).2). The cord displayed 3 vessels and was highly twisted (coiling index: 1/1 cm), counter-clockwise. Histological examination of placental parenchyma showed, in addition to venous thrombosis, generally avascular chorionic villi.

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Figure 2

Pathology: vascular wall intimal dysplasia with thrombosis.

Thrombosis of the umbilical cord vessels is a rare but life-threatening event. Its incidence varies from 1/1300 to 1/1500 deliveries and 1/1000 in perinatal autopsies [1,2]. The male/female ratio is 1.6:1. Umbilical vein thrombosis appears to occur more often than umbilical artery thrombosis (71–85% vs. 11–15%), but poor fetal outcome is more frequently reported in the literature with umbilical artery thrombosis [1].

Heifetz [1] has reported fifty-two cases of umbilical cord thrombosis, in over 90% of which thrombosis was associated with additional umbilical cord abnormalities (i.e., knots, vessel stretching…), obstetrical complications (infection, preeclampsia, phlebitis), or systemic fetal conditions (diabetes, fetomaternal hemorrhage) that the author considered the likely cause of both the thrombosis and the poor fetal outcome. Cord compression may cause stasis of the blood and lead to thrombosis in the umbilical vessels. This mechanism may occur in true umbilical cord knots formed in a long cord. Inversely, short cords are more susceptible to vessel stretching during labor, which may also lead to vessel damage and eventually thrombosis [3,4].

Maternal diabetes mellitus is another known risk factor for fetal thrombus formation [5]: infants of diabetic mothers have an increased level of α 2-antiplasmin and decreased fibrinolysin activity with a higher risk of developing thrombosis. They also have an imbalance between vasodilatation and vasoconstriction factors, with enhanced susceptibility to vasoconstriction and platelet aggregation.

The other fetal conditions reported to play a role in the development of thrombi are hemolytic diseases, fetal hydrops, and fetomaternal transfusion, with anemia as a common factor, resulting in fetal heart failure, stasis of blood and thrombosis [1,2].

Redline et al. [6] reported extensive avascular villi (obliterative fetal vasculopathy) as a distinct process with substantial perinatal morbidity. The mother tested negative for thrombophilia.

Kanenishi et al. [7] presented a case of umbilical cord thrombosis with a favorable outcome. An elective cesarean section was performed because of bidirectional turbulent blood flow inside the varix on power Doppler.

It might be argued that in our case we should have decided on elective cesarean section at the time of diagnosis of umbilical vein anomaly in light of the usual complications linked to the late preterm delivery. However, in the absence of the established severity criteria, particularly the percentage of vascular occlusion, we were unable to predict fetal well-being, and so favored (on the basis of risk-benefit balance) ongoing fetal development with close follow-up.

Doppler sonography, particularly power Doppler, is considered as an essential ancillary technique for the documentation of thrombus [8,9], but the criteria used to define the frequency of monitoring should be evaluated. We think that cord thrombosis should be considered as indicating high severity and should prompt an increased frequency of monitoring to improve outcome.

Conflict of Interest

None declared.

References

1. Heinfetz SA. Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Pediatr. Pathol. 1988;8:37–54. [PubMed] [Google Scholar]

2. Schröcksnadel H, Holböck E, Mitterschiffthaler G, Tötsch M, Dapunt O. Thrombotic occlusion of an umbilical vein varix causing fetal death. Arch. Gynecol. Obstet. 1991;248:213–215. [PubMed] [Google Scholar]

3. Hasaart TH, Delarue MW, de Bruine AP. Intra-partum fetal death due to thrombosis of the ductus venosus: a clinicopathological case report. Eur. J. Obstet. Gynecol. Reprod. Biol. 1994;56:201–203. [PubMed] [Google Scholar]

4. Devlieger H, Moerman P, Lauweryns J, et al. Thrombosis of the right umbilical artery, presumely related to shortness of the umbilical cord: an unusual case of fetal distress. Eur. J. Obstet. Gynecol. Reprod. Biol. 1983;16:123–127. [PubMed] [Google Scholar]

5. Fritz MA, Christopher CR. Umbilical vein thrombosis and maternal diabetes mellitus. J. Reprod. Med. 1981;26:320–324. [PubMed] [Google Scholar]

6. Redline RW, Ariel I, Baergen RN, Desa DJ, Kraus FT, Roberts DJ, et al. Fetal vascular obstructive lesions: nosology and reproducibility of placental reaction patterns. Pediatr. Dev. Pathol. 2004;7:443–452. [PubMed] [Google Scholar]

7. Kanenishi K, Nitta E, Mashima M, Hanaoka U, Koyano K, Tanaka H, et al. HDlive imaging of intra-amniotic umbilical vein varix with thrombosis. Placenta. 2013;34:1110–1112. [PubMed] [Google Scholar]

8. Viora E, Sciarrone A, Bastonero S, Errante G, Campogrande M. Thrombosis of umbilical vein varix. Ultrasound Obstet. Gynecol. 2002;19:212–213. [PubMed] [Google Scholar]

9. Allen SL, Bagnall C, Roberts AB, Teele RL. Thrombosing umbilical vein varix. J. Ultrasound Med. 1998;17:189–192. [PubMed] [Google Scholar]

Articles from Clinical Case Reports are provided here courtesy of Wiley

Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis? (2024)

FAQs

Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis? ›

The umbilical vein thrombosis is a rare event and its management at the time of diagnosis remains undefined. We present the unfavorable course of umbilical cord thrombosis revealed by ultrasound scan at 32 weeks of gestation (WG).

What happens if blood clot in umbilical cord? ›

Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally.

What maternal condition is linked to umbilical vein thrombosis? ›

Umbilical vein thrombosis is a rare pregnancy complication that leads to poor fetal outcomes. Umbilical cord anomalies, abnormal fetal coagulation function, intrauterine infection, and maternal diabetes could be likely etiologies.

What is the survival rate for umbilical vein varix? ›

Mean GA at delivery was 35.4 ± 5.6 weeks. Survival rate was 85%.

What is the umbilical vein Varix at delivery? ›

UVV is a dilation of the fetal umbilical veins (of 9 mm or greater) as it runs through the fetal abdomen. At delivery, blood-flow through the umbilical vein stops and therefore UVV does not cause problems for the baby after delivery.

Can you pass clots and still be pregnant? ›

Bleeding in pregnancy may be light or heavy, dark or bright red. You may pass clots or “stringy bits”. You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Can a blood clot harm a unborn baby? ›

A blood clot in the placenta can stop blood flow to your baby and harm your baby.

What causes umbilical vein thrombosis? ›

The etiology of umbilical vessel thrombosis may be understood through Virchow's triad of reduced blood flow, hypercoagulability, and vascular abnormality. Hypercoagulability may be associated with inherited or acquired, maternal or fetal, thrombophilia.

Which procedure directly increases the risk of umbilical vein thrombosis? ›

CONCLUSION: Portal venous thrombosis is frequently associated with the place- ment of an umbilical venous catheter, and spontaneous resolution is expected in many cases. The duration of catheter placement should be minimized, and US monitoring is recommended as a guide to catheter removal.

Does the umbilical vein contain maternal blood? ›

Oxygen and nutrients from the mother's blood are transferred across the placenta to the fetus through the umbilical cord. This enriched blood flows through the umbilical vein toward the baby's liver. There it moves through a shunt called the ductus venosus. This allows some of the blood to go to the liver.

Is umbilical vein varix rare? ›

Fetal intra-abdominal umbilical vein varix (FIUVV) is uncommon (0.4–1.1/1000 fetuses),[1] characterized by focal dilation of the umbilical vein from its entry in the abdominal wall to the portal system.

What are the risks of umbilical vein varix? ›

During pregnancy, umbilical vein varix (UVV) commonly occurs in the intra-abdominal part of the umbilical vein and is associated with an increased risk of foetal anaemia and umbilical vein thrombosis.

What is the significance of the umbilical vein? ›

The umbilical arteries carry deoxygenated fetal blood toward the placenta for replenishment, and the umbilical vein carries newly oxygenated and nutrient-rich blood back to the fetus.

What happens to umbilical artery and vein after birth? ›

After birth, the proximal portions of the intra‐abdominal umbilical arteries become the internal iliac and superior vesical arteries, while the distal portions are obliterated and form the medial umbilical ligaments. The umbilical veins arise from a convergence of venules that drain the extra‐embryonic allantois.

What is the umbilical vein in pregnancy? ›

The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs.

What is dilation of umbilical veins? ›

Dilatation of the umbilical vein can arise from a number of pathologies: umbilical venous varix (UVV): particularly if focal. fetal hydrops: a focal dilatation due to an umbilical venous varix with an ensuing thrombosis can also give to fetal hydrops as a consequence 5.

Can a blood clot in the placenta harm a baby? ›

A blood clot in the placenta can block blood being supplied to the baby, which can result in a miscarriage or stillbirth. Who's at Risk for Blood Clots During Pregnancy? Pregnant women are more at risk for getting blood clots for several different reasons.

How do you get dried blood out of your umbilical cord? ›

Here's how to do that:
  1. Use a cotton swab or washcloth dampened with water (and soap if you must) to wipe away any blood or secretions. ...
  2. Dab the area dry. ...
  3. Keep the front of your baby's diaper folded down (or use diapers with an umbilical cord peephole) so that the area is open to the air.
Nov 11, 2020

When should I be concerned about umbilical cord bleeding? ›

But you should call your baby's healthcare professional right away if: Bleeding from the stump gets worse, or you still notice a few drops of blood after three days. The umbilical area oozes thick fluid, especially if it's yellow.

What does blood in the umbilical cord mean? ›

Slight bleeding from the umbilical cord stump is generally not serious and usually resolves within the first few weeks after birth. In rare cases, newborn belly button bleeding can indicate the baby has an infection at the site of the umbilical cord stump.

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