Thrombosis and hematoma of umbilical cord vessels: their role in perinatal complications

Abstract

Umbilical cord pathology is a common cause of perinatal complications, including asphyxia, stillbirth, and neonatal mortality. Certain forms, such as thrombosis of the umbilical arteries or vein and hematoma, are rare but are associated with a high risk of severe hypoxia and adverse perinatal outcomes. Although prenatal diagnosis of these conditions is possible with umbilical cord pathology, in most cases, the pathology is only detected intra- or postnatally.

Aim - to investigate the spectrum of umbilical cord pathologies as a risk factor for lethal pregnancy complications, to clarify the clinical significance of specific anomalies, and to identify early diagnostic pathways for improving pregnancy and labor management protocols.

Clinical case. A 29-year-old pregnant woman, gravida 1, had a physiological pregnancy course. During labor, she developed acute fetal bradycardia, which required an emergency cesarean section. A boy was born in a state of severe asphyxia (Apgar 3/4), with subsequent development of convulsive syndrome and hypoxic-ischemic encephalopathy. During delivery, a double nuchal cord, umbilical cord hematoma, and umbilical vein thrombosis were found. The newborn received therapeutic hypothermia, intensive care, and anticonvulsant therapy. The infant was discharged on day 16 in a satisfactory condition with subsequent normal development. Histological examination confirmed the presence of umbilical vein thrombosis and hematoma. The mother was found to have homozygous thrombophilia gene mutations. Umbilical cord pathology can significantly affect fetal development and the course of labor. Vascular thrombosis and umbilical cord hematoma are associated with a high risk of severe asphyxia and stillbirth. Antenatal diagnosis is often difficult, which is why clinical alertness and readiness for an emergency delivery are crucial. This case demonstrates a combination of two rare umbilical cord pathologies (umbilical vein thrombosis and hematoma) that led to acute fetal distress and neonatal asphyxia. However, due to a timely cesarean section and modern intensive care, a fatal outcome was avoided.

Conclusions. Umbilical cord thrombosis and hematoma are rare but potentially lethal complications of pregnancy. Timely detection of changes in the fetal condition during labor monitoring and prompt reaction from medical staff determine the prognosis for the newborn. Further research is needed to clarify the role of umbilical cord pathology in the structure of perinatal mortality and the possibilities for its early diagnosis.

The study was performed in accordance with the principles of the Declaration of Helsinki. The patient's informed consent was obtained for the publication of the case report.

The authors declare that there is no conflict of interest.