Management strategy of umbilical artery aneurysm complicated by cardiac anomaly: case study and literature review

Abstract

Objective: Key considerations for managing an umbilical artery aneurysm (UAA) are a timely termination and the prevention of rupture of the UAA during delivery. Herein, we propose a treatment strategy based on our experience of UAA complicated by a fetal cardiac anomaly.

Case: A case of UAA was referred to our hospital at 23 weeks of gestation. The UAA increased its size to 6 cm. The blood reservoir within the UAA was presumed to be equivalent to the circulating blood volume of the fetus. At 28 weeks, small echogenic components suspected to be hematomas appeared in the umbilical vein, and the umbilical interstitial substance became edematous. An improvement in the fetus' condition could not be expected unless the UAA size was smaller. Thus, a cesarean delivery was performed at 30 weeks during which the UAA ruptured. The baby was anemic, disseminated intravascular coagulation (DIC) and later died.

Conclusion: We present an assessment of a large blood reservoir within an UAA that may indicate the likelihood of high-output cardiac failure of the fetus. Either a classical cesarean section or a transverse uterine fundal incision should be performed when the UAA size is greater than 5 cm to prevent rupture of the UAA.

Keywords: Aneurysm of umbilical artery; DIC; classical cesarean section; fetal anemia; middle cerebral artery peak systolic velocities (MCA PSV).