Umbilical Artery Thrombosis Causing Fetal Distress: A Case Report

The umbilical cord (UC) is vital to maintain blood circulation between the mother and the growing fetus, which is sometimes disrupted. The umbilical artery thrombosis (UAT) is an infrequent complication of pregnancy that can lead to extreme perinatal outcomes, ranging from intrauterine growth restriction stillbirth to neonatal death. The prenatal diagnosis of UAT is essential and sometimes challenging to detect in clinical practice. Once it is detected, the emergent delivery through a cesarean section is considered after the steroidal lung maturity of the fetus. We report a primigravida diagnosed with this rare pregnancy complication, the UAT at delivery, along with the nuchal cord and abnormally coiled UC. The patient had an uneventful course of pregnancy except for the premature rupture of membranes and continuous fetal distress in the second stage of labor. As the labor progression was optimal, and prioritizing the patient's desire, she was vigilantly observed under the premise of continuous electronic fetal monitoring (EFM) to facilitate any emergency, ultimately resulting in the spontaneous vaginal delivery of an alive and healthy baby boy. The fetal distress detected through EFM is an indicator of several stressors predisposing the fetus to some unknown danger that carries an increased risk of perinatal mortality. Based on our experience, it is suggested that radiologists should routinely conduct UC sonographic studies on regular antenatal scans; obstetricians should also have a brief and precise awareness of the critical lifesaving sonographic parameters to measure. The UAT, nuchal cord, and abnormal UC coiling, as found in our case, are all rare factors and related to some extent of fetal morbidity and mortality; once such complications are prenatally suspected, one should manage it through close monitoring and timely decision of appropriate delivery time.