CASE REPORT article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606697
From Dual to Single Umbilical Artery: A Case of Umbilical Artery Thrombosis with hypercoiling and Literature Review
Provisionally accepted
- 1Department of Obstetrics, Wenling Maternal and Child Health Care Hospital, Wenling, China
- 2Department of Ultrasound, Wenling Maternal and Child Health Care Hospital, Wenling, China
- 3Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Umbilical artery thrombosis (UAT) is an extremely rare but severe obstetric complication associated with adverse perinatal outcomes, including fetal growth restriction (FGR), fetal distress, and intrauterine fetal demise. This case report highlights the diagnostic challenges of UAT and its potential misdiagnosis as a single umbilical artery (SUA). A 32-year-old woman with a history of uncomplicated vaginal delivery was initially misdiagnosed with SUA at 29 3/7 weeks of gestation. At 32 1/7 weeks, detailed ultrasound examination revealed a single umbilical artery, FGR, and hypercoiling. Following a multidisciplinary evaluation and administration of fetal lung maturation therapy, a cesarean section was performed at 32 3/7 weeks of gestation. Intraoperatively, the umbilical cord measured 90 cm in length (normal range: 30–70 cm) with 50 coils and exhibited localized discoloration. A male neonate weighing 1490 g (5th percentile for gestational age) was delivered with an Apgar score of 10-10. Postnatal pathological examination confirmed UAT with arterial occlusion and hypercoiling. The neonate was treated in the neonatal intensive care unit (NICU) for respiratory distress syndrome (RDS) and prematurity-related complications, achieving a favorable outcome with discharge at 27 days and normal developmental follow-up. This case underscores the diagnostic challenges of differentiating UAT from SUA and emphasizes the importance of meticulous prenatal ultrasound evaluation, particularly in cases of FGR. The hypercoiling observed in this case is exceptionally rare and may have contributed to the thrombotic event. Early recognition, timely intervention, and multidisciplinary management are critical to optimizing maternal and neonatal outcomes. This report also provides a comprehensive literature review on the etiology, diagnostic strategies, and management of UAT, highlighting the role of ultrasound and pathological examination in accurate diagnosis. The findings suggest that hypercoiling and abnormal cord length may be significant risk factors for UAT, warranting further investigation into their pathophysiological mechanisms and clinical implications.
Keywords: Umbilical artery thrombosis, Single Umbilical Artery, fetal growth restriction, Prenatal ultrasound, Hypercoiling, abnormal cord length
Received: 06 Apr 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Ding, Yan, Lin, Yan and Tao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Enfu Tao, Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.