# Hypercoiling and Single Umbilical Artery Associated With Fetal Placental Malperfusion and Growth Restriction: A Case Report

## TL;DR

A case report shows that hypercoiling and a single umbilical artery can lead to fetal growth restriction and require emergency delivery.

## Contribution

The paper reports a rare case where hypercoiling and a single umbilical artery coexist, leading to fetal growth restriction.

## Key findings

- Hypercoiling and single umbilical artery were linked to fetal vascular malperfusion and growth restriction.
- Placental histopathology showed hyalinized villi and thrombotic occlusion in the umbilical artery.
- The case highlights the need for close monitoring and timely delivery in such anomalies.

## Abstract

Hypercoiling of the umbilical cord can lead to fetal growth restriction and stillbirth because the cord is vulnerable to blood flow disturbances caused by external forces. A single umbilical artery (SUA) is a relatively common abnormality; however, isolated SUA is associated with fetal growth restriction and stillbirth. We report a case of fetal growth restriction with both SUA and hypercoiling. A 27‐year‐old primigravida was evaluated at 37 weeks of gestation. Prenatal ultrasonography revealed a small‐for‐gestational‐age fetus with a single umbilical artery and a hypercoiled umbilical cord. Continuous fetal monitoring was initiated upon admission. Cardiotocography demonstrated recurrent prolonged decelerations, necessitating an emergency cesarean section. Placental histopathology revealed fetal vascular malperfusion with hyalinized avascular villi and thrombotic occlusion of one umbilical artery, indicating disturbed fetoplacental circulation likely related to SUA and hypercoiling. The coexistence of hypercoiling and a single umbilical artery was associated with the risk of fetal vascular malperfusion and growth restriction. Careful antenatal surveillance and timely delivery are essential to prevent adverse perinatal outcomes in multiple umbilical cord anomalies.

Although single umbilical artery and hypercoiling are relatively common cord abnormalities, their coexistence was associated with fetal growth restriction and distress requiring close monitoring and emergency cesarean delivery. Overlapping umbilical cord anomalies can markedly increase perinatal risk, highlighting the need for intensive antenatal surveillance and timely intervention.