UMBILICAL ARTERY-OCCLUSION AND FETOPLACENTAL THROMBOEMBOLISM

Background: To our knowledge, fetoplacental thromboembolism has been d escribed only in autopsy specimens. We report the antepartum diagnosis of an umbilical artery occlusion and neonatal diagnosis of an aortic thrombus and placental emboli. Case: A gravida at 31 weeks' gestation was referred for evaluation of decreased fetal movement and an enlarge d fetal bladder. A two-vessel umbilical cord with a collapsed, echogen ic third vessel was noted, whereas views of a normal three-vessel cord were available from an examination 5 weeks earlier. A positive oxytoc in contraction test prompted delivery. Neonatal color now Doppler imag ing demonstrated an aortic thrombus below the renal arteries and above the bifurcation. Gross and microscopic study of the placenta demonstr ated necrosis of the collapsed umbilical artery and numerous placental emboli. The aortic thrombus resolved gradually, and the infant went h ome on the 39th day of life. Conclusion: Umbilical artery occlusion ca n be diagnosed ultrasonographically and may be a sign of fetoplacental thromboembolism. Assessment of fetal oxygenation status by biophysica l profile or contraction stress test may be helpful in the evaluation of umbilical artery occlusion.