Новости | Магазин | Журналы | Контакты | Правила | Доставка | |
Вход Регистрация |
В статье описаны 7 случаев спонтанного тромбоза артерии пуповины и 3 случая тромбоза, связанного с внутриутробными вмешательствами (внутриутробное внутрисосудистое переливание крови плоду). 6 из 7 случаев спонтанного тромбоза артерии пуповины подтверждены морфологически. Тромбоз артерии пуповины сопровождается уменьшением диаметра артерии. Со временем артерия превращается в структуру повышенной эхогенности или становится изоэхогенной вартонову студню. В этом случае обнаруживается “исчезновение” одной из артерий. Диаметр оставшейся артерии увеличивается. С учетом особенностей эмбриогенеза сделаны выводы о необходимости тщательного изучения корня пуповины, свободных петель, области пупочного кольца, активного поиска аномалий пуповины, что важно для своевременной диагностики острых расстройств кровообращения в пуповине.
Ключевые слова:
пренатальная ультразвуковая диагностика, тромбоз артерии пуповины, допплерография плода, внутри/ утробная задержка развития, фетальная тромботическая ангиопатия.
Литература:
1. Klaritsch P., Haeusler M., Karpf E. et al.
Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction //
Placenta. 2008. V. 29. № 4. P. 374–377.
2. Parast M.M., Crum C.P., Boyd T.K. Placental histologic criteria for umbilical blood flow restriction
in unexplained stillbirth // Hum. Pathol. 2008.
V. 39. № 6. P. 948–953.
3. Heifetz S.A. Thrombosis of the umbilical cord:
analysis of 52 cases and literature review //
Pediatr. Pathol. 1988. V. 8. № 1. P. 37–54.
4. McDonald D.G., Kelehan P., McMenamin J.B. et al.
Placental fetal thrombotic vasculopathy is associated with neonatal encephalopathy // Hum. Pathol.
2004. V. 35. № 7. P. 875–880.
5. Redline R.W. Severe fetal placental vascular lesions
in term infants with neurologic impairment // Am.
J. Obstet. Gynecol. 2005. V. 192. № 2. P. 452–457.
6. Sato Y., Benirschke K. Umbilical arterial thrombosis with vascular wall necrosis: clinicopathologic
findings of 11 cases // Placenta. 2006. V. 27.
№№6–7. P. 715–718.
7. Hadar A., Hallak M. Single umbilical artery and
umbilical cord torsion leading to fetal death. A case
report // J. Reprod. Med. 2003. V. 48. № 9.
P. 739–740.
8. Peng H.Q., Levitin-Smith M., Rochelson B., Kahn E.
Umbilical cord stricture and overcoiling are common causes of fetal demise // Pediatr. Dev. Pathol.
2006. V. 9. № 1. P. 14–19.
9. Kim J.S., Romero R., Tarca A.L. et al. Gene expression profiling demonstrates a novel role for foetal
fibrocytes and the umbilical vessels in human fetoplacental development // J. Cell. Mol. Med. 2008.
V. 12. № 4. P. 1317–1330.
10. Solano Sanchez S.R., Baquera Heredia J.J., Reyes
Cuervo H., Buen Abad E.I. Umbilical artery thrombosis. A report of a case and review of the literature //
Ginecol. Obstet. Mex. 2005. V. 73. № 6. P. 332–335.
11. Cook V., Weeks J., Brown J., Bendon R. Umbilical
artery occlusion and fetoplacental thromboembolism // Obstet. Gynecol. 1995. V. 85. № 5.
P. 870–872.
12. Hill M.A. Early human development // Clin.
Obstet. Gynecol. 2007. V. 50. № 1. P. 2–9.
13. Persutte W.H., Hobbins J. Single umbilical artery:
a clinical enigma in modern prenatal diagnosis //
Ultrasound Obstet. Gynecol. 1995. V. 6. № 3.
P. 216–229.
14. Кнорре А.Г. Краткий очерк эмбриологии человека с элементами сравнительной, экспериментальной и патологической эмбриологии. Изд. 2-е.
Л.: Медицина, 1967. 267 с.
15. Sepulveda W., Dezerega V., Carstens E., Gutierrez J. Fused umbilical arteries: prenatal sonographic diagnosis and clinical significance // J.
Ultrasound Med. 2001. V. 20. № 1. P. 59–62.
16. Walker C., Ward J. Intrapartum umbilical cord
rupture // Obstet. Gynecol. 2009. V. 113. № 2.
P. 552–554.
17. Devlieger H., Moerman P., Lauweryns J. et al.
Thrombosis of the right umbilical artery, presumably related to the shortness of the umbilical cord:
an unusual cause of fetal distress // Eur. J. Obstet.
Gynecol. Reprod. Biol. 1983. V. 16. № 2.
P. 123–127.
18. Kupferminc M.J. Thrombophilia and pregnancy //
Curr. Pharm. Des. 2005. V. 11. № 6. P. 735–748.
19. Marchetti D., Belviso M., Fulcheri E. A case of stillbirth: the importance of placental investigation in
medicolegal practice // Am. J. Forensic Med.
Pathol. 2009. V. 30. № 1. P. 64–68.
20. Redline R.W. Clinical and pathological umbilical
cord abnormalities in fetal thrombotic vasculopathy // Hum. Pathol. 2004. V. 35. № 12.
P. 1494–1498.
21. Kaplan C.G. Fetal and maternal vascular lesions //
Semin. Diagn. Pathol. 2007. V. 24. № 1. P. 14–22.
22. Ernst L.M., Grossman A.B., Ruchelli E.D. Familial
perinatal liver disease and fetal thrombotic vasculopathy // Pediatr. Dev. Pathol. 2008. V. 11. № 2.
P. 160–163.
23. Kofinas A., Kofinas G., Sutija V. The role of second
trimester ultrasound in the diagnosis of placental
hypoechoic lesions leading to poor pregnancy outcome // J. Matern. Fetal Neonatal Med. 2007.
V. 20. № 12. P. 859–866.
24. Gogia N., Machin G.A. Maternal thrombophilias
are associated with specific placental lesions //
Pediatr. Dev. Pathol. 2008. V. 11. № 6. P. 424–429.
25. LeistraLeistra M.J., Timmer A., van Spronsen F.J.
et al. Fetal thrombotic vasculopathy in the placenta:
a thrombophilic connection between pregnancy
complications and neonatal thrombosis? //
Placenta. 2004. V. 25. Suppl. A. P. S102–S105.
26. Ariel I., Anteby E., Hamani Y., Redline R.W.
Placental pathology in fetal thrombophilia // Hum.
Pathol. 2004. V. 35. № 6. P. 729–733.
27. Steffensen T.S., GilbertBarness E., Spellacy W.,
Quintero R.A. Placental pathology in trap
sequence: clinical and pathogenetic implications //
Fetal Pediatr. Pathol. 2008. V. 27. № 1. P. 13–29.
28. Ernst L.M., Chou D., Parry S. Fetal thrombotic vasculopathy in twin placentas with complete hydatidiform mole // Pediatr. Dev. Pathol. 2009. V. 12.
№1. P. 63–67.
29. Smorgick N., Herman A., Wiener Y. et al. Prenatal
thrombosis of the inferior vena cava and the renal
veins // Prenat. Diagn. 2007. V. 27. № 7.
P. 603–607.
30. Brenner B., Kupferminc M.J. Inherited thrombophilia and poor pregnancy outcome // Best Pract.
Res. Clin. Obstet. Gynaecol. 2003. V. 17. № 3.
P. 427–439.
31. Anteby E.Y., Musalam B., Milwidsky A. et al. Fetal
inherited thrombophilias influence the severity of
preeclampsia, IUGR and placental abruption //
Eur. J. Obstet. Gynecol. Reprod. Biol. 2004. V. 15.
№ 1. P. 31–35.
32. Livingston J.C., Barton J.R., Park V. et al. Maternal and fetal inherited thrombophilias are not related to the development of severe preeclampsia //
Am. J. Obstet. Gynecol. 2001. V. 185. № 1.
P. 153–157.
33. Salomon O., Seligsohn U., Steinberg D.M. et al. The
common prothrombotic factors in nulliparous
women do not compromise blood flow in the fetomaternal circulation and are not associated with
preeclampsia or intrauterine growth restriction //
Am. J. Obstet. Gynecol. 2004. V. 191. № 6.
P. 2002–2009.
34. Alfirevic Z., Mousa H.A., Martlew V. et al.
Postnatal screening for thrombophilia in women
with severe pregnancy complications // Obstet.
Gynecol. 2001. V. 97. № 5. P. 753–759.
35. Franchi F., Cetin I., Todros T. et al. Intrauterine
growth restriction and genetic predisposition to
thrombophilia // Haematologica. 2004. V. 89. № 4.
P. 444–449.
36. Gharavi A.E., Pierangeli S.S., Levy R.A., Harris E.N. Mechanisms of pregnancy loss in antiphospholipid syndrome // Clin. Obstet. Gynecol. 2001.
V. 44. № 1. P. 11–19.
37. Berceanu S., Patrascu A., Berceanu C. et al.
Morphopathological changes induced by the
Obstetrical Antiphospholipid Antibody Syndrome
in fetal adnexa and uterus // Rom. J. Morphol.
Embryol. 2008. V. 49. № 1. P. 47–52.
38. Weber M.A., Sau A., Maxwell D.J. et al. Third
trimester intrauterine fetal death caused by arterial aneurysm of the umbilical cord // Pediatr. Dev.
Pathol. 2007. V. 10. № 4. P. 305–308.
39. Viora E., Sciarrone A., Bastonero S. et al.
Anomalies of the fetal venous system: a report of
26 cases and review of the literature // Fetal Diagn.
Ther. 2004. V. 19. № 5. P. 440–447.
40. Clerici G., Koutras I., Luzietti R., Di Renzo G.C.
Multiple true umbilical knots: a silent risk for
intrauterine growth restriction with anomalous
hemodynamic pattern // Fetal Diagn. Ther. 2007.
V. 22. № 6. P. 440–443.
41. Gualandri G., Rivasi F., Santunione A.L., Silingardi E. Spontaneous umbilical cord hematoma: an
unusual cause of fetal mortality: a report of 3 cases
and review of the literature // Am. J. Forensic
Med. Pathol. 2008. V. 29. № 2. P. 185–190.
42. Hecht J.L., Allred E.N., Kliman H.J., Zambrano E.
Histological characteristics of singleton placentas
delivered before the 28th week of gestation //
Pathology. 2008. V. 40. № 4. P. 372–376.
43. Kita M., Kikuchi A., Miyashita S. et al. Umbilical
cord cysts of allantoic and omphalomesenteric remnants with progressive umbilical cord edema: a case
report // Fetal Diagn. Ther. 2009. V. 25. № 2.
P. 250–254.
44. Redline R.W. Villitis of unknown etiology: noninfectious chronic villitis in the placenta // Hum.
Pathol. 2007. V. 38. № 10. P. 1439–1446.
In the article 7 cases of umbilical artery spontaneous thrombosis and 3 cases of thrombosis associated with intrauterine intravascular hemotransfusion were described. 6 of 7 umbilical artery spontaneous thrombosis cases were confirmed morphologically. Umbilical artery thrombosis was accompanied by artery diameter decrease. With the lapse of time the umbilical artery have becoming hyperechoic or isoechoic to Wharton's jelly. In this case one of the arteries has “disappeared”. The diameter of another artery was increasing. Taking into consideration the embryogenesis peculiarities conclusions were made: it is necessary thoroughly investigate the umbilical root, free loops, umbilical ring region for well-timed umbilical blood flow disorders diagnosis.
Keywords:
prenatal ultrasound diagnosis, umbilical artery thrombosis, fetal dopplerography, intrauterine growth restriction, fetal thrombotic vasculopathy.