Acute antenatal umbilical cord artery thrombosis in a pregnant woman with concomitant somatic diseases: 618.38

Abstract

Summary. Umbilical artery thrombosis (UAT) is a rare and difficult to diagnose prenatal complication of pregnancy, that’s why there are neither generally accepted principles nor clinical practice guidelines for the prevention and management of this condition. In this article we present a clinical case of pregnancy with somatic concomitant diseases that culminated in the development of acute UAT. Antenatal medical preventive measures of venous and arterial thromboembolic events must have been delayed the development of acute UAT till the full term — the peak time for all the thromboembolic events during pregnancy. Fetal distress was an indication for emergency operative delivery and, despite the quickly taken measures, was realized in severe asphyxia at birth. An analysis of the possible causes of UAT development is given, and modern approaches to pharmacological prophylaxis of cardiovascular complications during pregnancy are discussed. It is necessary to draw attention to somatic diseases in the formation of perinatal risks, as well as the importance of individual selection of pharmacological prophylaxis of possible adverse consequences for the mother and fetus.

References

1. Late Intrauterine Fetal Death and Stillbirth (Green-top Guideline No. 55). RCOG. 2010, updated 2017. Available at: https://www. rcog.org.uk/en/guidelines-research-services/guidelines/gtg55. 2. Bardymova T.P., Protasov K.V., Tsyretorova S.S., Donirova O.S. Type 2 diabetes mellitus and coronary heart disease. Acta Biomedica Scientifica. 2017;2(1):100–6. (In Russ.). DOI: 10.12737/article_5955 e6b60d5bf2.66416553. 3. Bockeria O.L., Akhobekov A.A. Ventricular premature complexes. Annaly aritmologii. 2015;12(1):16–24. (In Russ.). DOI: 10.15275/annaritmol. 2015.1.3. 4. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (green-top guideline No. 37a). RCOG. 2015. Updated 2019. Available at: https://www.rcog.org.uk/en/ guidelines-research-services/guidelines/gtg37a. 5. The prevention of venous thromboemoliс complications in obstetrics and gynecology. Clinical guidelines. (Treatment protocol). Moscow, 2014. 33 рр. (In Russ.). 6. Clinical guidelines “Algorithms for specialized medical care for patients with diabetes mellitus.” Eds. I.I. Dedova, M.V. Shestakova, A. Yu. Mayorov. 10th edition. Moscow, 2021. 222 рр. (In Russ.). Available at: https://webmed.irkutsk.ru/doc/pdf/algosd.pdf. 7. FIGO Subcommittee on Standards in Perinatal Medicine. Guidelines for the use of fetal monitoring. Int J Gynecol Obstet. 1987;25(2):159–67. 8. Ayres-de-Campos D., Spong C.Y., Chandraharan E., FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring; cardiotocography. Int J Gynecol Obstet. 2015;131(1):13–24. DOI: 10.1016/j.ijgo. 2015.06.020. 9. Genkel V.V., Sumerkina V.A., Shaposhnik I.I. Abnormalities in protein С system and atherosclerosis of peripheral arteries in patients with high and very high risk of cardiovascular complications. Tromboz, gemostaz i reologiya. 2019;(2):45–51. (In Russ.). DOI: 10.25555/THR.2019.2.0879. 10. Iwunze E.C., Iwunze C.I. Umbilical cord thrombosis, a cause of intra-uterine fetal demise: A case study. N Niger J Clin Res. 2018;7:32–4. DOI: 10.4103/nnjcr.nnjcr_13_17. 11. Kalofoutis C., Piperi C., Kalofoutis A. et al. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Exp Clin Cardiol. Spring. 2007;12(1):17–28. 12. Klaritsch P., Haeusler M., Karpf E. et al. Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction. Placenta. 2008;29(4):374–7. DOI: 10.1016/j.placenta.2008.01.004. 13. Ailamazyan E.K. Diabetes mellitus and the female reproductive system: a guide for doctors. Moscow: GEOTAR-Media, 2017. 432 pp. (In Russ.). 14. Akhetova N.P. Diabetes in pregnancy, risks to mother, fetus and newborn. Medicina. 2015;(2):69–72. (In Russ.). 15. Stogianni A., Lendahls L., Landin-Olsson M., Thunander M. Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden. BMC Pregnancy Childbirth. 2019;19(1):159. DOI: 10.1186/s12884–019–2269–8. 16. Hypertension in pregnancy: diagnosis and management. NICE guideline, 2019. 55 p. Available at: https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancy-diagnosis-andmanagement-pdf-66141717671365. 17. State registry of medicines. (In Russ.). Avalable at: http://grls.r.osminzdrav.ru/Default.aspx. 18. Clinical guidelines. Preeclampsia. Eclampsia. Oedema, proteinuria and hypertensive disorders during pregnancy, intrapartum and postpartum. Moscow, 2021. 79 pp. (In Russ.). Available at: https:// mosgorzdrav.ru/ru-RU/science/default/download/863.html. 19. Rolnik D.L., Wright D., Poon L.C.Y. et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2017;50(4):492–5. DOI: 10.1002/uog.18816. 20. Caron N., Rivard G.É., Michon N. et al. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J Obstet Gynaecol Can. 2009;31(11):1022–7. DOI: 10.1016/S1701– 2163(16)34346–8. 21. Brown M.A., Magee L.A., Kenny L.C. et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2018;13:291–310. DOI: 10.1016/j.preghy.2018.05.004. 22. Zabolotskikh I. B., Kirov M. Yu., Afonchikov V. S. et al. Perioperative management of patients receiving long-term antithrombotic therapy. Russian Federation of anesthesiologists and reanimatologists guidelines. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2021;(3):7–26. (In Russ.). DOI: 10.21320/1818–474X2021–3–7–26. 23. Klaritsch P., Haeusler M., Karpf E. et al. Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction. Placenta. 2008;29(4):374–7. DOI: 10.1016/j.placenta.2008.01.004. 24. Li H., Wu Q., Wei W. et al. Umbilical artery thrombosis: two case reports. Medicine (Baltimore). 2020;99(2):e18563. DOI: 10.1097/ MD.0000000000018170. 25. Lutfallah F., Oufkir N., Markou G.A. et al. A case of umbilical artery thrombosis in the third trimester of pregnancy. Am J Case Rep. 2018;19:72–5. DOI: 10.12659/ajcr.906859. 26. Alhousseini A., Jaiman S., Hernandez-Andrade E. et al. Umbilical artery thrombosis with associated acute and severe fetal growth restriction and transient severe protein S deficiency: report of a case with prenatal ultrasound diagnosis allowing for timely intervention and good outcome. Case Rep Obstet Gynecol. 2018;2018:6324362. DOI: 10.1155/2018/6324362.