{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T01:02:20Z","timestamp":1781917340424,"version":"3.54.5"},"reference-count":11,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_crpm-2024-0017_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Umbilical artery thrombosis (UAT) is a rare and severe condition associated with grave perinatal outcomes, including intrauterine fetal death. This case report presents the case of a 38-year-old woman (gravida 3, para 1) of Japanese ethnicity, with a history of one spontaneous miscarriage, who conceived through micro-insemination and blastocyst transfer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_crpm-2024-0017_abs_002\">\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>Initial patient screening at 30\u00a0weeks and 6\u00a0days of gestation revealed normal fetal development, with two umbilical arteries and one umbilical vein. However, at 34\u00a0weeks and 5\u00a0days of gestation, we observed reduced fetal movements and the absence of accelerations on cardiotocography. Subsequent color Doppler examination revealed cessation of blood flow across a broad area in\u00a0one umbilical artery and a strongly curved umbilical vein\u00a0surrounding the blood flow of the other artery. These\u00a0formed the \u2018orange grab sign,\u2019 suggestive of UAT. Evaluations of blood flow in other areas revealed unremarkable findings. We performed an emergency cesarean section owing to fetal distress. The mother and newborn were healthy and discharged as healthy. The 1-month check-up revealed no abnormalities in the child. Pathological examination of the umbilical cord revealed fibrin-based thrombus formation along the length of one artery, confirmed to be an umbilical artery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_crpm-2024-0017_abs_003\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the present case report, we presented the diagnostic challenges of UAT. Furthermore, we highlighted the need for timely intervention by comparing the number of umbilical vessels among previous ultrasound findings and\u00a0verifying the presence of the \u2018orange grab sign.\u2019<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/crpm-2024-0017","type":"journal-article","created":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T05:12:00Z","timestamp":1726117920000},"source":"Crossref","is-referenced-by-count":2,"title":["Umbilical artery thrombosis diagnosed by fetal ultrasound"],"prefix":"10.1515","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0845-320X","authenticated-orcid":false,"given":"Yushi","family":"Abe","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , Saitama City Hospital , Saitama , Japan"},{"name":"Department of Obstetrics and Gynecology , Keio University School of Medicine , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Ueno","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Saitama City Hospital , Saitama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Saitama City Hospital , Saitama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruko","family":"Ariga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Saitama City Hospital , Saitama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Miyauchi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology , Saitama City Hospital , Saitama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Saitama City Hospital , Saitama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2024,9,12]]},"reference":[{"key":"2024112712452158804_j_crpm-2024-0017_ref_001","doi-asserted-by":"crossref","unstructured":"Tanaka, K, Tanigaki, S, Matsushima, M, Miyazaki, N, Hashimoto, R, Izawa, T, et al.. Prenatal diagnosis of umbilical artery thrombosis. Fetal Diagn Ther 2014;35:148\u201350. https:\/\/doi.org\/10.1159\/000355601.","DOI":"10.1159\/000355601"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_002","doi-asserted-by":"crossref","unstructured":"Heifetz, SA. Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Pediatr Pathol 1988;8:37\u201354. https:\/\/doi.org\/10.3109\/15513818809022278.","DOI":"10.3109\/15513818809022278"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_003","doi-asserted-by":"crossref","unstructured":"Avagliano, L, Marconi, AM, Candiani, M, Barbera, A, Bulfamante, G. Thrombosis of the umbilical vessels revisited. An observational study of 317 consecutive autopsies at a single institution. Hum Pathol 2010;41:971\u20139. https:\/\/doi.org\/10.1016\/j.humpath.2009.07.026.","DOI":"10.1016\/j.humpath.2009.07.026"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_004","doi-asserted-by":"crossref","unstructured":"Klaritsch, P, Haeusler, M, Karpf, E, Schlembach, D, Lang, U. Spontaneous intrauterine umbilical artery thrombosis leading to severe fetal growth restriction. Placenta 2008;29:374\u20137. https:\/\/doi.org\/10.1016\/j.placenta.2008.01.004.","DOI":"10.1016\/j.placenta.2008.01.004"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_005","doi-asserted-by":"crossref","unstructured":"Persutte, WH, Hobbins, J. Single umbilical artery: a clinical enigma in modern prenatal diagnosis. Ultrasound Obstet Gynecol 1995;6:216\u201329. https:\/\/doi.org\/10.1046\/j.1469-0705.1995.06030216.x.","DOI":"10.1046\/j.1469-0705.1995.06030216.x"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_006","doi-asserted-by":"crossref","unstructured":"Rembouskos, G, Cicero, S, Longo, D, Sacchini, C, Nicolaides, KH. Single umbilical artery at 11\u201314\u00a0weeks\u2019 gestation: relation to chromosomal defects. Ultrasound Obstet Gynecol 2003;22:567\u201370. https:\/\/doi.org\/10.1002\/uog.901.","DOI":"10.1002\/uog.901"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_007","doi-asserted-by":"crossref","unstructured":"Zhu, JF, Luo, JL. Pregnant woman with abnormal umbilical cord blood flow. Ann Emerg Med 2022;80:84\u201390. https:\/\/doi.org\/10.1016\/j.annemergmed.2022.01.012.","DOI":"10.1016\/j.annemergmed.2022.01.012"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_008","doi-asserted-by":"crossref","unstructured":"Li, X, Chen, W, Liu, T, Cai, J, Wei, S, Du, Y, et al.. Umbilical artery thrombosis and maternal positive autoimmune antibodies: two case reports and a literature review. Front Med 2023;10:1187492. https:\/\/doi.org\/10.3389\/fmed.2023.1187492.","DOI":"10.3389\/fmed.2023.1187492"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_009","doi-asserted-by":"crossref","unstructured":"Raio, L, Ghezzi, F, di Naro, E, Franchi, M, Balestreri, D, D\u00fcrig, P, et al.. In-utero characterization of the blood flow in the Hyrtl anastomosis. Placenta 2001;22:597\u2013601. https:\/\/doi.org\/10.1053\/plac.2001.0685.","DOI":"10.1053\/plac.2001.0685"},{"key":"2024112712452158804_j_crpm-2024-0017_ref_010","unstructured":"Hyrtl, J. Die Blutgef\u00e4sse der menschlichen Nachgeburt in normalen und abnormen Verh\u00e4ltnissen. Vienna: Braum\u00fcller Verlag; 1870."},{"key":"2024112712452158804_j_crpm-2024-0017_ref_011","doi-asserted-by":"crossref","unstructured":"Ullberg, U, Sandstedt, B, Lingman, G. Hyrtl\u2019s anastomosis, the only connection between the two umbilical arteries. A study in full term placentas from AGA infants with normal umbilical artery blood flow. 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