Purpose Analysis of prenatal ultrasound features and pregnancy outcomes of umbilical artery occlusion combined with excessive twisting of the umbilical cord.Methods Selecting 6 cases of fetuses diagnosed with umbilical artery occlusion combined with excessive twisting of the umbilical cord in our hospital, analyze their general conditions, prenatal ultrasound features, pregnancy outcomes, and umbilical cord pathology examination data.Results Prenatal ultrasound features: In the 6 cases, the fetuses all had two normal umbilical arteries in the past, but one of the arteries later became occluded and the umbilical cord experienced excessive twisting. Before the occlusion of the umbilical artery, the gestational age of the fetuses on ultrasound matched the clinical gestational age, but after occlusion, 3 cases had a gestational age on ultrasound that was less than the clinical gestational age. 5 cases had thickened placentas, and 1 case had polyhydramnios. The pulsatility index (MCA-PI) and umbilical artery pulsatility index (UA-PI) of all fetuses were lower than the normal reference values, while the umbilical artery systolic/diastolic peak velocity ratio (UA-S/D) showed no abnormalities compared to the normal reference values. Pregnancy outcomes: Among the 6 fetuses, there was one intrauterine fetal death and 5 live births. All 5 live births were delivered by cesarean section due to abnormal fetal heart monitoring. Of the 5 live births, 3 were premature, 4 had low birth weight, and 2 were small for gestational age. Umbilical cord pathology examination: All fetuses had excessively twisted umbilical cords with umbilical artery thrombosis. The umbilical cord of the stillborn fetus showed thinning and necrosis in the cord wheel area.Conclusion When umbilical artery occlusion is combined with excessive twisting of the umbilical cord, prenatal ultrasound often shows a decreased MCA-PI in the fetus. Active intervention, combined with fetal heart monitoring, can help prevent adverse pregnancy outcomes from occurring.