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Al Qasem M, Meyyazhagan A, Tsibizova V, Clerici G, Arduini M, Khader M, M Alkarabsheh A, Di Renzo GC. Knots of the umbilical cord: Incidence, diagnosis, and management. Int J Gynaecol Obstet 2024. [PMID: 38264935 DOI: 10.1002/ijgo.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
Knot(s) of the umbilical cord have received emphasis because the clinical assessments and sonographic literature show a crucial role in fetal outcomes. The true umbilical cord knot could be a knot in a singleton pregnancy or an entanglement of two umbilical cords in monoamniotic twins. Clinical manifestations are almost silent, which can raise clinical challenges. They worsen outcomes, and the pathology can be easily missed during prenatal visits because ultrasonographers do not pay attention to the cord during an obstetric ultrasound scan. However, most medical centers now have ultrasound machines that improve fetal assessment. The umbilical cord should be routinely evaluated during a fetal assessment, and suspicion of an umbilical cord knot can be more frequently diagnosed and is detected only incidentally. Clinical outcome is usually good but depends on the knot's characteristics and if it is tight or loose. In this review, we discuss pathophysiology, the theories on formation, the main risk factors, ultrasound signs and findings, different opinions in the management, and features of pregnancy outcomes feature.
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Affiliation(s)
- Malek Al Qasem
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Arun Meyyazhagan
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
- PREIS International School, Firenze, Italy
| | - Valentina Tsibizova
- PREIS International School, Firenze, Italy
- CEMER, European Centre for Medical Research, Perugia, Italy
| | - Graziano Clerici
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- CEMER, European Centre for Medical Research, Perugia, Italy
| | - Maurizio Arduini
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Mohammed Khader
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Ahlam M Alkarabsheh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- PREIS International School, Firenze, Italy
- Department of Obstetrics, Gynecology and Perinatology, IE Sechenov First State University, Moscow, Russian Federation
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de Graaff E, Bartlett K, Sadler L, Lakhdhir H, Simon-Kumar R, Peiris-John R, Burgess W, Cronin R, McCowan L, Anderson N. Placental pathology findings in perinatal deaths from 28 weeks gestation in Aotearoa New Zealand. Placenta 2023; 138:97-108. [PMID: 37245428 DOI: 10.1016/j.placenta.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Women of South Asian ethnicity are overrepresented in adverse pregnancy outcome across high-income countries, including those related to placental dysfunction. It has been hypothesised that placental aging occurs at earlier gestation in South Asian pregnancies. We aimed to identify differences in placental pathology among perinatal deaths ≥28 weeks gestation, between South Asian, Māori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. METHODS Placental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded, and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. RESULTS 790 of 1161 placental pathology reports, 346 preterm (28+0 to 36+6 weeks) and 444 term (≥37+0 weeks) deaths, met the inclusion criteria. Among preterm deaths, South Asian women had higher rates of maternal vascular malperfusion compared with Māori (aOR 4.16, 95%CI 1.55-11.15) and NZ European (aOR 2.60, 95%CI 1.10-6.16). Among term deaths, South Asian women had higher rates of abnormal villous morphology compared with Māori (aOR 2.19, 95%CI 1.04-4.62) and NZ European (aOR 2.12, 95%CI 1.14-3.94), mostly due to increased rates of chorangiosis (36.7%, compared to 23.3% and 21.7%, respectively). DISCUSSION Differences in placental pathology by ethnicity were observed among preterm and term perinatal deaths. While we suspect differing underlying causal pathways, these deaths may be associated with maternal diabetic and red blood cell disorders among South Asian women, leading to a hypoxic state in-utero.
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Affiliation(s)
- Esti de Graaff
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Kate Bartlett
- Auckland District Health Board LabPlus, Auckland City Hospital, Building 31, Gate 4 Grafton Road, Grafton, Auckland, 1148, New Zealand.
| | - Lynn Sadler
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand; Te Toka Tumai Auckland, Te Whatu Ora Health, 2 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Heena Lakhdhir
- Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health, 100 Hospital Road, Ōtāhuhu, Auckland, 2025, New Zealand.
| | - Rachel Simon-Kumar
- The University of Auckland School of Population Health, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Roshini Peiris-John
- The University of Auckland Section of Epidemiology and Biostatistics, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Wendy Burgess
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Robin Cronin
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand; Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health, 100 Hospital Road, Ōtāhuhu, Auckland, 2025, New Zealand.
| | - Lesley McCowan
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Ngaire Anderson
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
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Subashini G, Anitha C, Gopinath G, Ramyathangam K. A Longitudinal Analytical Study on Umbilical Cord Coiling Index as a Predictor of Pregnancy Outcome. Cureus 2023; 15:e35680. [PMID: 37012952 PMCID: PMC10066625 DOI: 10.7759/cureus.35680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background The umbilical cord coiling index (UCI) is usually measured sonographically during antenatal follow-up and can be used to determine the fetuses at risk of adverse outcomes. Methodology UCI measured antenatally and postnatally whose correlation is studied along with the association of abnormal UCI with the adverse outcomes in terms of gestational age, intrauterine growth restriction (IUGR), intra-uterine death, birth weight, sex, neonatal intensive care unit (NICU) admission, the color of the liquor, Amniotic Fluid Index (AFI), Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at one min and five mins and mode of delivery. All parameters are tested for significant differences among UCI and a p-value < 0.05 is considered significant. The correlation of UCI measured antenatally and postnatally is tested using the spearman correlation coefficient. Results A strong correlation is found between antenatal UCI and postnatal UCI with rs 0.9. The majority of the population had normo coiling. Hyper and hypo coiling are associated risks of emergency lower segment cesarean section (LSCS). Low birth weight is seen in 88.89% of hypo coiled patients with a p-value < 0.01. The coiling index among sex is found to be insignificant with a p-value of 0.81. Meconium-Stained Liquor (MSL) is seen in 78.5% of hyper coiled patients. IUGR is found to be associated with hypo coiling as seen in 59.2% of patients with significant p-value (< 0.01). Age, gestational age, and birth weight are found to be statistically significant between various coiling indexes with p-value < 0.05. Conclusion Antenatal UCI correlates with postnatal UCI and any abnormal index found can be used as a predictor of adverse perinatal outcomes and help obstetricians to monitor continuously and put the patients at risk on prophylactic measures.
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Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord. Medicina (B Aires) 2022; 58:medicina58121754. [PMID: 36556956 PMCID: PMC9782481 DOI: 10.3390/medicina58121754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton's jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.
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Najafi L, Honardoost M, Khajavi A, Cheraghi S, Kadivar M, Khamseh ME. The association of umbilical coiling and angiogenesis markers: Impact assessment of gestational diabetes. Placenta 2022; 129:70-76. [PMID: 36252320 DOI: 10.1016/j.placenta.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the association between the postnatal umbilical coiling index (pUCI) and vascular endothelial growth factor A (VEGFA) and its receptor (VEGFR2) in parturients with and without gestational diabetes mellitus (GDM). METHODS Within 24 h following birth, the umbilical cord and pUCI of 29 newborns with GDM and 28 neonates with non-GDM parturients were prospectively examined. Real-time PCR tests were used to determine the expression levels of the VEGFA and VEGFR2 genes, measured from the umbilical cord. The Mann-Whitney and Chi-squared tests were used to compare continuous and discrete variables with and without GDM. RESULTS The median (IQR) of maternal age was 30 (26-34) years. There were no differences in demographic features between GDM and non-GDM parturients. While there was a marginal difference in VEGFA expression levels between the GDM and non-GDM groups (P-values = 0.07), no difference was detected for VEGFR2 (P-values = 0.75). Comparing hyper- and hypocoiling cords revealed a small difference in VEGFA levels (P-values = 0.05), but no change in VEGFR2 (P-values = 0.50). Furthermore, in both GDM and non-GDM parturients, down-regulated VEGFA was the general rule among abnormal pUCIs. DISCUSSION The GDM and coiling state both are associated with the amount of VEGFA expression, but neither is related to VEGFR2. Furthermore, regardless of whether the patient has GDM or not, the abnormal coiling pattern appears to be related to the VEGFA down-regulation.
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Affiliation(s)
- Laily Najafi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Honardoost
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Alireza Khajavi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Cheraghi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Kadivar
- Department of Pathology, Hazrat-e- Rasool Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Loverro MT, Di Naro E, Nicolardi V, Resta L, Mastrolia SA, Schettini F, Capozza M, Loverro M, Loverro G, Laforgia N. Pregnancy Complications, Correlation With Placental Pathology and Neonatal Outcomes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:807192. [PMID: 36994339 PMCID: PMC10012052 DOI: 10.3389/fcdhc.2021.807192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
PurposeWe aimed to clarify and contribute to a better comprehension of associations and correlations between placental histological findings, pregnancy evolution, and neonatal outcomes.Study DesignThis is a longitudinal and prospective observational study, performed between May 2015 and May 2019, on 506 pregnant women. Clinical data related to pregnancy outcome, neonatal health status, and placental histology were primarily collected. Twin pregnancies or malformed newborns were excluded and therefore the study was conducted on 439 cases. These cases have been then subdivided into the following study groups: (a) 282 placentas from pathological pregnancies; and, (b) a control group of 157 pregnancies over 33 weeks of gestational age, defined as physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies, most of which had undergone elective cesarean section for maternal or fetal indication.ResultsA normal placenta was present in 57.5% of normal pregnancies and in 42.5% of pathological pregnancies. In contrast, placental pathology was present in 26.2% of normal pregnancies and 73.8% of pathological pregnancies. Comparison of the neonatal health status with the pregnancy outcome showed that, among the 191 newborns classified as normal, 98 (51.3%) were born from a normal pregnancy, while 93 (48.7%) were born from mothers with a pathological pregnancy. Among the 248 pathological infants, 59 (23.8%) were born from a mother with a normal pregnancy, while 189 (76.2%) were born from pregnancies defined as pathological.ConclusionPlacental histology must be better understood in the context of natural history of disease. Retrospective awareness of placental damage is useful in prevention in successive pregnancy, but their early identification in the evolving pregnancy could help in association with biological markers or more sophisticated instruments for early diagnosis.
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Affiliation(s)
- Maria Teresa Loverro
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Edoardo Di Naro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Vittorio Nicolardi
- Department of Economics and Finance University of Bari “Aldo Moro”, Bari, Italy
| | - Leonardo Resta
- Department Emergency and Organ Transplantation, Institute of Pathology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Ospedale dei Bambini “Vittore Buzzi”, University of Milan, Milan, Italy
- *Correspondence: Salvatore Andrea Mastrolia,
| | - Federico Schettini
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Matteo Loverro
- Department of Women and Child Health, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giuseppe Loverro
- Department Interdisciplinary Medicine, Unit of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
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Bohîlțea RE, Dima V, Ducu I, Iordache AM, Mihai BM, Munteanu O, Grigoriu C, Veduță A, Pelinescu-Onciul D, Vlădăreanu R. Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology. Diagnostics (Basel) 2022; 12:diagnostics12020236. [PMID: 35204327 PMCID: PMC8871173 DOI: 10.3390/diagnostics12020236] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/10/2022] Open
Abstract
Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies.
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Affiliation(s)
- Roxana Elena Bohîlțea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Vlad Dima
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Ioniță Ducu
- Department of Obstetrics and Gynecology, University Emergency Hospital, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania;
| | - Ana Maria Iordache
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Bianca Margareta Mihai
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
| | - Octavian Munteanu
- Department of Anatomy, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania;
| | - Corina Grigoriu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania;
- Correspondence: (R.E.B.); (V.D.); (A.M.I.); (C.G.)
| | - Alina Veduță
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11–13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania; (B.M.M.); (A.V.)
| | - Dimitrie Pelinescu-Onciul
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
| | - Radu Vlădăreanu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (D.P.-O.); (R.V.)
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Elgendy MM, Puthuraya S, LoPiccolo C, Liu W, Aly H, Karnati S. Neonatal stroke: Clinical characteristics and neurodevelopmental outcomes. Pediatr Neonatol 2022; 63:41-47. [PMID: 34509386 DOI: 10.1016/j.pedneo.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Neonatal stroke can potentially result in significant neurological sequelae in affected infants. Studies on neurodevelopmental outcomes and the need for rehabilitation therapies in the first two years are limited. We aimed to describe the clinical characteristics, diagnostic evaluation, and neurodevelopmental outcomes of a cohort of infants with neonatal stroke. METHODS A retrospective cohort study of infants with neonatal stroke, from 2011 to 2020. Maternal and infant characteristics were described. Placental pathology, echocardiogram results, and prothrombotic evaluations were reported. The neurodevelopmental outcomes using Bayley scale of infant development (BSID III), rates of epilepsy and cerebral palsy, and the need for rehabilitation therapies at two years were described. RESULTS During the study period, 55 infants had neonatal stroke. Majority (93%) were term or late preterm infants. Maternal chorioamnionitis and perinatal HIE were diagnosed in about a third of the infants. Most (66%) of the infants presented with seizures. On brain MRI, the lesions were unilateral in 76% and arterial in origin in 86% of the infants. Meconium exposure (42%), intrauterine inflammation/infection (37%) and fetal vascular malperfusion (16%) were seen on placental histopathology. At two-year BSID III assessment, median (min, max) composite cognitive, language, and motor scores were 100 (55-145), 97 (47-124), and 100 (46-141), respectively. Among this cohort, epilepsy (27%), cerebral palsy (16%) and the need for rehabilitation therapies (physical -24%, occupational -18%, speech -21%) were reported at two years. CONCLUSION Neonatal stroke presented commonly in term or late preterm infants with seizures. It was unilateral and arterial in origin in most infants. Maternal chorioamnionitis and perinatal HIE were the most commonly associated conditions at birth. About one-fifth of the infants had mild or severe developmental delays at two years. Epilepsy, cerebral palsy, and need for rehabilitation therapies were noted in a significant proportion of infants at two years.
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Affiliation(s)
- Marwa M Elgendy
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Carmela LoPiccolo
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OHio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA.
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Mavedatnia D, Tran J, Oltean I, Bijelić V, Moretti F, Lawrence S, El Demellawy D. Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes. J Clin Med 2021; 10:5693. [PMID: 34884395 PMCID: PMC8658381 DOI: 10.3390/jcm10235693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28-4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12-2.75) and through birthweight OR 2.12 (95% CI 1.40-3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28-21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.
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Affiliation(s)
- Dorsa Mavedatnia
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Irina Oltean
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
| | - Felipe Moretti
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Sarah Lawrence
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Dina El Demellawy
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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10
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Åmark H, Westgren M, Sirotkina M, Hulthén Varli I, Persson M, Papadogiannakis N. Maternal obesity and stillbirth at term; placental pathology-A case control study. PLoS One 2021; 16:e0250983. [PMID: 33930082 PMCID: PMC8087010 DOI: 10.1371/journal.pone.0250983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim was to explore the potential role of the placenta for the risk of stillbirth at term in pregnancies of obese women. METHODS This was a case-control study comparing placental findings from term stillbirths with placental findings from live born infants. Cases were singleton term stillbirths to normal weight or obese women, identified in the Stockholm stillbirth database, n = 264 and n = 87, respectively. Controls were term singletons born alive to normal weight or obese women, delivered between 2002-2005 and between 2018-2019. Placentas were compared between women with stillborn and live-born infants, using logistic regression analyses. RESULTS A long and hyper coiled cord, cord thrombosis and velamentous cord insertion were stronger risk factors for stillbirth in obese women compared to normal weight women. When these variables were adjusted for in the logistic regression analysis, also adjusted for potential confounders, the odds ratio for stillbirth in obese women decreased from 1.89 (CI 1.24-2.89) to 1.63 (CI 1.04-2.56). CONCLUSION Approximately one fourth of the effect of obesity on the risk of stillbirth in term pregnancies is explained by umbilical cord associated pathology.
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Affiliation(s)
- Hanna Åmark
- Dept of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Magnus Westgren
- Dept of Clinical Sciences, Intervention & Technology, Karolinska Institute, Stockholm, Sweden
| | - Meeli Sirotkina
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
| | - Ingela Hulthén Varli
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Martina Persson
- Dep of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Stockholm, Sweden
- Dept of Clinical Science and Education, Unit of Pediatrics, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Dep of Laboratory Medicine, Karolinska University Hospital Huddinge, Huddinge, Sweden
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11
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Nikkels PG, Evers AC, Schuit E, Brouwers HA, Bruinse HW, Bont L, Houben ML, Kwee A. Placenta Pathology From Term Born Neonates With Normal or Adverse Outcome. Pediatr Dev Pathol 2021; 24:121-130. [PMID: 33470918 DOI: 10.1177/1093526620980608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The incidence of umbilical cord or placental parenchyma abnormalities associated with mortality or morbidity of term infants is lacking. METHODS Placentas of 55 antepartum stillbirths (APD), 21 intrapartum stillbirths (IPD), 12 neonatal deaths (ND), and 80 admissions to a level 3 neonatal intensive care unit (NS) were studied and compared with 439 placentas from neonates from normal term pregnancies and normal outcome after vaginal delivery (NPVD) and with 105 placentas after an elective caesarian sections (NPEC). RESULTS NPVD and NPEC placentas showed no or one abnormality in 70% and placentas from stillbirth showed two or more abnormalities in 80% of cases. APD placentas more frequently had a low weight and less formation of terminal villi. Hypercoiling was more often present in all study groups. Severe chronic villitis was almost exclusively present in APD placentas. Chorioamnionitis was significantly more frequent in APD, IPD and NS placentas and funisitis was more often observed in IPD and NS placentas. CONCLUSION Multiple placental abnormalities are significantly more frequent in placentas from term neonates with severe perinatal morbidity and mortality. These placental abnormalities are thought to be associated with disturbed oxygen transfer or with inflammation.
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Affiliation(s)
- Peter Gj Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke Cc Evers
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hens Aa Brouwers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hein W Bruinse
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Louis Bont
- Department of Pediatrics, Utrecht University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L Houben
- Department of Pediatrics, Utrecht University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Pergialiotis V, Kotrogianni P, Koutaki D, Christopoulos-Timogiannakis E, Papantoniou N, Daskalakis G. Umbilical cord coiling index for the prediction of adverse pregnancy outcomes: a meta-analysis and sequential analysis. J Matern Fetal Neonatal Med 2020; 33:4022-4029. [PMID: 30870055 DOI: 10.1080/14767058.2019.1594187] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: To evaluate the potential association of abnormal cord coiling with adverse pregnancy outcomes.Materials and methods: We used the Medline (1966-2018), Scopus (2004-2018), Clinicaltrials.gov (2008-2018), Embase (1980-2018), Cochrane Central Register of Controlled Trials CENTRAL (1999-2018), and Google Scholar (2004-2018) databases. The date of last search was set on 31 May 2018. Language, country, or date restrictions were not applied during the literature research to prevent bias. All observational (both prospective and retrospective) studies that reported maternal and neonatal antenatal and perinatal outcomes based on the umbilical coiling index (UCI) status were considered as eligible for inclusion. Meta-analysis of the risk ratio (RR) and mean differences (MD) among hypocoiled/hypercoiled and normocoiled cases was performed with RevMan 5.3 software. Univariate metaregression and leave-one-out meta-analysis was performed with Open Meta-Analyst statistical software. Trial sequential analysis was performed with the trial sequential analysis (TSA) software.Results: Twenty four studies were finally included that involved 9553 pregnant women. Umbilical cord coiling was evaluated with the use of the umbilical coiling index (UCI). Values of the UCI below the 10th percentile were evaluated as hypocoiled and above the 90th percentile as hypercoiled. Hypocoiled cords were significantly associated with increased prevalence of preterm birth < 37 weeks, need for interventional delivery due to fetal distress, meconium stained liquor, Apgar scores < 7 at 5 min, small for gestational age (SGA) neonates, fetal anomalies, need for admission in the neonatal intensive care unit (NICU), fetal heart rate abnormalities, and fetal death. Hypercoiled cords were significantly associated with increased prevalence of preterm birth < 37 weeks, need for interventional delivery due to fetal distress, meconium stained liquor, Apgar scores < 7 at 5 min, small for gestational age (SGA) neonates, fetal anomalies, fetal growth restriction fetal heart rate abnormalities, fetal acidosis, and fetal death.Conclusions: The findings of our meta-analysis underline the correlation of UCI abnormalities with antenatal and perinatal pathology. More studies are needed, however, to elucidate whether antenatal assessment of the UCI can be used as routine in clinical practice as well as its value in uncomplicated pregnancies.
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Affiliation(s)
- Vasilios Pergialiotis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Kotrogianni
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamanto Koutaki
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Papantoniou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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13
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Hayes DJL, Warland J, Parast MM, Bendon RW, Hasegawa J, Banks J, Clapham L, Heazell AEP. Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One 2020; 15:e0239630. [PMID: 32970750 PMCID: PMC7514048 DOI: 10.1371/journal.pone.0239630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/09/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes. Methods MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks’ gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA. Results This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37). Conclusions True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.
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Affiliation(s)
- Dexter J. L. Hayes
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Jane Warland
- University of South Australia, Adelaide, Australia
| | - Mana M. Parast
- University of California, San Diego, CL, United States of America
| | - Robert W. Bendon
- Retired from Norton Children’s Hospital, Louisville, Kentucky, United States of America
| | | | - Julia Banks
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
| | - Laura Clapham
- Tommy’s Stillbirth Research Centre, University of Manchester, Manchester, United Kingdom
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Abstract
OBJECTIVE Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors. METHODS The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index. RESULTS Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16-23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non-umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords. CONCLUSION Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
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Kadivar M, Khamseh ME, Malek M, Khajavi A, Noohi AH, Najafi L. Histomorphological changes of the placenta and umbilical cord in pregnancies complicated by gestational diabetes mellitus. Placenta 2020; 97:71-78. [PMID: 32792068 DOI: 10.1016/j.placenta.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/30/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The objective of this study was to compare the histomorphological changes of placenta and umbilical cord (UC), between gestational diabetes mellitus (GDM) and non- GDM pregnancies. METHODS In this prospective study, 222 parturients were recruited (117 GDM and 105 non-GDM). GDM was confirmed at 24-28 weeks of gestation, using one-step strategy. A full record of demographic, laboratory, histologic and gross morphology data of placenta and UC was extracted and analyzed. RESULTS Overall, 222 placentas/UCs met inclusion criteria. The mean (SD) of gestational age of GDM diagnosis was 20.68 (10.02) and the GDM duration was 16.76 (8.98) weeks. The mean HbA1C was 6.03 (0.41) % in the GDM group. The gross morphology findings including UC diameter and thick edematous UC differed significantly between two groups and more presented in GDM group, 1.41 (0.03) vs. 1.28 (0.03) centimeters; p-value = 0.006 and 34.19% vs. 16.19%; p-value = 0.002, respectively. The umbilical coiling index (UCI) was similar in two groups (p-value = 0.61). In the histological evaluation, persistence of central vessels differed significantly between two groups, more detected in non-GDM (47.62% vs. 32.97%; p-value = 0.04). No other significant histomorphological changes were detected between two groups. DISCUSSION This study showed that gross morphologic features such as UC diameter increment and thick edematous UC happened more frequently, among the GDM parturients. Due to early diagnosis, diagnosis strategy, and optimal glycemic control, the histomorphological changes were less in GDM comparing of non-GDM group.
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Affiliation(s)
- Maryam Kadivar
- Department of Pathology, Hazrat-e- Rasool Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hussein Noohi
- Pediatric Department, Bahonar Teaching Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Laily Najafi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
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16
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Excessive umbilical cord coiling confers risk of elevated nocturnal blood pressure and severe/early-onset preeclampsia. J Hypertens 2020; 37:187-196. [PMID: 30015757 DOI: 10.1097/hjh.0000000000001849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The associations between umbilical cord coiling, feto-placental vascular resistance and maternal blood pressure (BP) are not well understood. METHOD We retrospectively analyzed 502 pregnant women suspected of hypertensive disorders in the third trimester from a hospital-based cohort, who underwent ambulatory BP monitoring and umbilical artery Doppler velocimetry examinations within 14 days before delivery. By applying quantile regression, a significant quantile-dependent positive association between umbilical cord coiling index and umbilical artery pulsatility index (UAPIMOM; converted to multiples of median) was observed from above 0.75th quantiles for each parameter. RESULTS Using the cutoffs both at the 0.75th quantile to define high umbilical cord coiling (≥0.28 coils/cm) and high UAPIMOM (≥1.30), respectively, a graded increase in BP level was observed from patients with both low, either high and both high categories. Multivariate linear and quantile regression revealed that the high umbilical cord coiling/high UAPIMOM interaction was significantly correlated with night-time mean DBP level. Moreover, umbilical cord hypercoiling (≥0.3 coils/cm) was significantly correlated with night-time DBP with an average increase of ∼5 mmHg from the 0.05th to 0.70th quantiles and independently predicted the occurrence of severe (odds ratio 2.32, 95% confidence interval: 1.22-4.41) and early-onset (odds ratio 2.43, 95% confidence interval: 1.18-4.97) preeclampsia after adjusting for covariates. Further mediation analysis showed that elevated high UAPIMOM (≥1.30) could explain 11.4% of the umbilical cord hypercoiling → high night-time DBP association. CONCLUSION Therefore, this retrospective study identifies excessive umbilical cord coiling, and its interaction with increased feto-placental vascular resistance, as novel risk factors for nocturnal BP elevation and preeclampsia.
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Hasegawa J, Furuya N, Doi M, Sasaki T, Takagi M, Suzuki N. Sono-embryological assessments of a true knot that developed into a hypercoiled cord and circumvallate placenta. J Matern Fetal Neonatal Med 2019; 34:4162-4166. [PMID: 31885291 DOI: 10.1080/14767058.2019.1704247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Longitudinal investigations using ultrasound during pregnancy can be used to clarify the mechanisms and pathophysiology of abnormal fetal and placental development. In this report, we presented a case of a true knot that appeared to develop into a hypercoiled cord and circumvallate placenta, which we found through longitudinal ultrasound investigations during pregnancy. In the present case, ultrasonography proved that the true knot had existed at least 16 weeks of gestation. The true knot was presumed to develop into a hypercoiled cord based on the hypothesis of differential umbilical vascular growth rates.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Furuya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masatomo Doi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takamichi Sasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
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Ochshorn Y, Ascher Landsberg J, Many A, Maslovitz S, Rimon E, Yogev Y. Fetal gender and umbilical cord characteristics at birth. J Matern Fetal Neonatal Med 2019; 34:2454-2457. [PMID: 31510828 DOI: 10.1080/14767058.2019.1667328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine fetal gender on umbilical cord parameters. METHODS Umbilical cords were prospectively collected from uncomplicated, singleton, term pregnancies, which ended either by elective cesarean section or spontaneous vaginal delivery. Data regarding obstetrical history and pregnancy outcome were collected. Various cord parameters were examined including, length, number of coils, umbilical cord index (UCI), which demonstrate the ratio between number of coils and cord length, site of placental insertion, direction of coiling and the presence of true knots. RESULTS Overall, 154 umbilical cords were collected, of them 84 from male and 70 from female newborns. No differences were found regarding obstetrical history parameters or pregnancy outcome between the groups. The umbilical coiling index was significantly higher in female compared to male newborns (0.183 coils/cm versus 0.157 coils/cm, p=.006) due to higher number of cord coils (12.25 ± 5.31 vs. 10.17 ± 3.96, p=.007), with no difference in cord length (66.48 vs. 64.61 cm, p=.372). These differences remained statistically significant even after correction for gravidity, parity and gestational age using multiple linear regression analysis. CONCLUSION Female newborns having higher umbilical cord index, compared to male as a result of more coils, with no length dissimilarity.
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Affiliation(s)
- Yifat Ochshorn
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Jessica Ascher Landsberg
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Maslovitz
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rimon
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel
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Najafi L, Abedini A, Kadivar M, Khajavi A, Bordbar A, Noohi AH, Mashak B, Hashemnejad M, Khamseh ME, Malek M. Gestational diabetes mellitus: the correlation between umbilical coiling index, and intrapartum as well as neonatal outcomes. J Diabetes Metab Disord 2019; 18:51-57. [PMID: 31275874 DOI: 10.1007/s40200-019-00389-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/24/2019] [Indexed: 11/26/2022]
Abstract
Objectives The objective of this study was to investigate the relationship between the postnatal umbilical coiling index (pUCI), and intrapartum and neonatal outcomes in parturients with gestational diabetes mellitus (GDM) and non-GDM. Methods An evaluation of the umbilical cords and pUCI of 117 neonates of GDM and 105 of non-GDM parturients were prospectively studied within 24 h after delivery. Furthermore, obstetric history, intrapartum and neonatal data were recorded. Results Premature rupture of membrane (PROM) (p = 0.001), emergency cesarean delivery (p = 0.01), spontaneous preterm delivery (p = 0.006), duration of hospital admission (p < 0.001), and congenital malformations (p = 0.03) were significantly higher in the GDM group. Moreover, pUCI had a significant association with large for gestational age (LGA) (p = 0.009), and meconium-stained amniotic fluid (p = 0.04) in the GDM group. In addition, increment of pUCI had significant association with spontaneous preterm delivery in both groups (p = 0.002) (OR = 1.23). Conclusions GDM is associated with spontaneous preterm delivery, PROM, emergency cesarean delivery, duration of hospital admission, and congenital malformations. Increase in pUCI could increase the rate of spontaneous preterm delivery in normal pregnancy and pregnancy complicated by GDM, as well as, the rate of LGA and meconium-stained amniotic fluid in GDM.
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Affiliation(s)
- Laily Najafi
- 1Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Abedini
- 2Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Maryam Kadivar
- 3Department of Pathology, Hazrat-e- Rasool Akram General Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Khajavi
- 4Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Bordbar
- 5Department of neonatology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Amir Hussein Noohi
- 2Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Banafsheh Mashak
- 2Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Maryam Hashemnejad
- 2Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Mohammad E Khamseh
- 1Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mojtaba Malek
- 6Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq, Tehran, 15937-16615 Iran
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20
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Najafi L, Khamseh ME, Kashanian M, Younesi L, Abedini A, Valojerdi AE, Amoei Z, Khashe Heiran EN, Keshtkar AA, Malek M. Antenatal umbilical coiling index in gestational diabetes mellitus and non-gestational diabetes pregnancy. Taiwan J Obstet Gynecol 2018; 57:487-492. [PMID: 30122566 DOI: 10.1016/j.tjog.2018.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Umbilical cord abnormalities increase fetal morbidity and mortality. This study was designed to compare antenatal umbilical coiling index (aUCI) in gestational diabetes mellitus (GDM) and non-gestational diabetes mellitus (non-GDM) pregnancy, considering uncertainties about the best time to perform antenatal ultrasonography scan. MATERIALS AND METHODS In this prospective study, 246 parturients were included, 123 with GDM and 123 with non-GDM pregnancy. Gestational diabetes was confirmed at 24-28 weeks of gestation (WG) using one-step strategy. An anatomical ultrasound survey of placenta and umbilical cord was performed at 18-23 as well as 37-41 weeks of gestational age. RESULTS At 18-23 WG, the frequency distribution (10th, 90th percentiles, mean ± SD) of the aUCI in the GDM and non-GDM groups were (0.13,0.66,0.32 ± 0.19) and (0.18,0.74, 0.4 ± 0.31) respectively. These values were (0.12,0.4, 0.25 ± 0.11) in the GDM group at 37-41 WG and (0.17,0.43, 0.29 ± 0.11) in the non-GDM group. A significant relationship was detected between UCI value and GDM/non-GDM groups at both antenatal evaluations (18-23 WG; P = 0.002, 37-41WG; P < 0.001). A significant association at 18-23 WG was found between GDM/non-GDM groups and aUCI categorization (hypocoiling <10th, normocoiling 10th-90th and hypercoiling >90th) (P = 0.001). However, hypocoiling were significantly more frequent in GDM than non-GDM in both antenatal evaluations (P < 0.001, P = 0.006). CONCLUSION Antenatal UCI in pregnancy complicated by GDM were lower in comparison with non-GDM pregnancy. The most abnormal pattern of coiling in gestational diabetes was hypocoiling in both trimesters. In addition, 18-23 WG is the best time to perform ultrasound scan to detect aUCI and umbilical cord pattern.
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Affiliation(s)
- Laily Najafi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, 15937-16615 Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, 15937-16615 Iran
| | - Maryam Kashanian
- Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences (IUMS), Tehran, 1168743514 Iran
| | - Ladan Younesi
- Akbarabadi Teaching Hospital, Iran University of Medical Sciences (IUMS), Tehran, 1168743514 Iran
| | - Azadeh Abedini
- Kamali Teaching Hospital, Alborz University of Medical Sciences, Karaj, 3134877179 Iran
| | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, 15937-16615 Iran
| | - Zahra Amoei
- Kamali Teaching Hospital, Alborz University of Medical Sciences, Karaj, 3134877179 Iran
| | - Elmira Nouri Khashe Heiran
- Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences (IUMS), Tehran, 1168743514 Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, Tehran University of Medical Sciences, Tehran, 3439123900 Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, 15937-16615 Iran.
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Steinl GK, Gandelman JS, Katzman PJ, Ru Y, Guillet R, Pressman E, Cooper EM, O'Brien KO. Umbilical Cord Coiling in High-risk Pregnancies: Associations With Determinants of Adverse Birth Outcomes and Iron Status. Pediatr Dev Pathol 2018; 21:537-547. [PMID: 29652240 DOI: 10.1177/1093526618770318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes, but the etiology of these findings remains poorly characterized. This study was undertaken to examine associations between cord coiling and maternal iron (Fe) status and to identify potential determinants of hypo- and hypercoiling in 2 higher risk obstetric groups: pregnant adolescents (≤18 years, n = 92) and adult women carrying twins (n = 49), triplets (n = 11), or quadruplets (n = 1). Umbilical cords were classified as hypo-, normo-, or hypercoiled using digital photographs to assess gross appearance. Hypocoiling and hypercoiling were observed in 44% (n = 86/195) and 13% (n = 26/195) of the combined study population. The prevalence of hypocoiling among women carrying multiples was over 3-fold higher than the prevalence in singleton pregnancies based on the published data. Within the entire study population, hypocoiling was associated with a lower gestational age at birth when compared to normocoiling and hypercoiling (36.3 ± 3.6 weeks [n = 86] vs 37.8 ± 2.7 [n = 83], P < .01, and 38.2 ± 2.6 [n = 26], P < .01, respectively), whereas hypercoiling was associated with significantly lower serum ferritin when compared to normocoiling ( P < .01) and hypocoiling ( P < .001). In the multiples cohort only, hypercoiling was significantly associated with multiparity ( P < .01) and lower birth weight ( P < .05). Further studies are needed to identify the determinants and consequences of cord coiling.
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Affiliation(s)
- Gabrielle K Steinl
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | | | - Philip J Katzman
- 2 School of Medicine, University of Rochester, Rochester, New York
| | - Yuan Ru
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Ronnie Guillet
- 2 School of Medicine, University of Rochester, Rochester, New York
| | - Eva Pressman
- 2 School of Medicine, University of Rochester, Rochester, New York
| | | | - Kimberly O O'Brien
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Ma'ayeh M, McClennen E, Chamchad D, Geary M, Brest N, Gerson A. Hypercoiling of the umbilical cord in uncomplicated singleton pregnancies. J Perinat Med 2018; 46:593-598. [PMID: 28672757 DOI: 10.1515/jpm-2017-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/26/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The umbilical coiling index (UCI) is a measure of the number of coils in the umbilical cord in relation to its length. Hypercoiled cords with a UCI of >0.3 coils/cm have been associated with adverse fetal and neonatal outcomes. AIMS The primary aim is to determine the accuracy of UCI measured on second trimester ultrasound in predicting UCI at birth. The secondary outcome is to investigate the association between hypercoiling of the umbilical cord on prenatal ultrasound and adverse maternal, fetal and neonatal outcomes. METHODS This was a prospective cohort study of uncomplicated singleton pregnancies. Seventy two patients were included in the study. UCI was measured in the second trimester ultrasound, and compared to UCI measured postnatally. Outcomes of patients with hypercoiled cords on ultrasound were compared to outcomes of patients with normocoiled cords. RESULTS Our results failed to show a strong correlation between the UCI determined with ultrasound, and the UCI determined with examination of the umbilical cord after delivery. We also did not demonstrate that measurement of the UCI on second trimester ultrasound is able to predict adverse maternal, fetal or neonatal outcomes. CONCLUSION This study suggests that measurement of the umbilical coiling index should not be part of routine second trimester sonography in patients with uncomplicated singleton pregnancies, with no other medical or surgical comorbidities.
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Affiliation(s)
- Marwan Ma'ayeh
- Department of Obstetrics and Gynecology, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA, Tel.: +1-484-476-4650, Fax: +1-484-476-2422
| | - Evan McClennen
- Department of Obstetrics and Gynecology, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Dmitri Chamchad
- Department of Obstetrics and Gynecology, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Michael Geary
- Department of Obstetrics and Gynecology, St Michael's Hospital 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Norman Brest
- Department of Obstetrics and Gynecology, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Andrew Gerson
- Department of Obstetrics and Gynecology, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
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Turowski G, Tony Parks W, Arbuckle S, Jacobsen AF, Heazell A. The structure and utility of the placental pathology report. APMIS 2018; 126:638-646. [PMID: 30129133 DOI: 10.1111/apm.12842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023]
Abstract
The placenta is one of the most exciting organs. It is dynamic; its morphology and function continuously develop and adjust over its brief life span. It mediates the physiology of two distinct yet highly interconnected individuals. The pathology that develops in the placenta, and the adaptations the placenta undergoes to mitigate this pathology, may influence the later life health of the mother and baby (Circ Res, 116, 2015, 715; Hum Reprod Update, 17, 2011, 397; Nutr Rev 71, 2013, S88; Placenta, 36, 2015, S20). Pathological placenta examination may reveal macroscopic and microscopic patterns that provide valuable information to the obstetricians, neonatologists, and pediatricians caring for the family. The placenta often plays a key role in understanding adverse fetal outcomes such as hypoxic brain injury, cerebral palsy, fetal growth restriction, stillbirth, and neonatal death (Placenta, 35, 2014, 552; Placenta, 52, 2017, 58; Placenta, 30, 2009, 700; Obstet Gynecol, 114, 2009, 809; Clin Perinatol, 33, 2006, 503; Pediatr Dev Pathol, 11, 2008, 456; Arch Pathol Lab Med, 124, 2000, 1785). Moreover, it may help to understand the pathophysiology of pregnancy, improve management of subsequent pregnancies, and assist in medicolegal assessment. Placental pathologic examination may even provide evidence of susceptibility to adult-onset diseases such as diabetes (Pediatr Dev Pathol, 6, 2003, 54; Diabetes Metab, 36, 2010, 682; BJOG, 113, 2006, 1126; Int J Gynaecol Obstet, 104, 2009, S25; Zentralbl Gynakol, 97, 1975, 875). Pathologic examination of the placenta may thus be of tremendous value, particularly for those women experiencing an adverse pregnancy outcome. However, this potential utility may be entirely wasted, if the findings are not communicated in an effective manner to the appropriate clinicians. An optimized, readily understandable report of pathological findings is essential for clinical utility.
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Affiliation(s)
- Gitta Turowski
- Department of Pathology, Paediatric and Pregnancy Related Pathology, Oslo University Hospital, Oslo, Norway
| | - W Tony Parks
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Susan Arbuckle
- Department of Anatomical Pathology, The Children's Hospital, Westmead, NSW, Australia
| | - Anne F Jacobsen
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alexander Heazell
- Faculty of Biological, Medical and Human Sciences, School of Medical Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Ayala NK, Ernst LM, Miller ES. Is umbilical coiling genetically determined? J Perinatol 2018; 38:653-657. [PMID: 29467518 DOI: 10.1038/s41372-018-0078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Abnormal umbilical cord coiling is associated with adverse perinatal outcomes; however, the etiology of the umbilical coiling pattern is poorly understood. STUDY DESIGN Retrospective cohort of all twin deliveries >20 weeks in 2014. Pregnancies were dichotomized by chorionicity and the umbilical coiling index (UCI) and placental cord insertion location were compared. In cases with one or both cords hypercoiled, the direction and pattern of coiling were compared by chorionicity. A similar analysis was performed stratified by zygosity. RESULTS Three hundred sisty two twin pairs were included; 26 (7.2%) monochorionic and 174 (87.0%) definitively dizygotic. Concordance in the UCI and coiling category were similar between dichorionic and monochorionic as well as dizygous and monozygous gestations, (73.2% vs 80.8%, p = 0.399 and 71.4% vs 80.8%, p = 0.399, respectively). Analyses of the coiling direction and pattern also demonstrated no difference by chorionicity or zygosity. CONCLUSION These data do not support a genetic basis for umbilical cord coiling.
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Affiliation(s)
- Nina K Ayala
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA.
| | - Linda M Ernst
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Emily S Miller
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chicago, IL, USA
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Mariella J, Iacono E, Lanci A, Merlo B, Palermo C, Morris L, Castagnetti C. Macroscopic characteristics of the umbilical cord in Standardbred, Thoroughbred and Warmblood horses. Theriogenology 2018; 113:166-170. [DOI: 10.1016/j.theriogenology.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022]
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26
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Hasegawa J. Ultrasound screening of umbilical cord abnormalities and delivery management. Placenta 2018; 62:66-78. [DOI: 10.1016/j.placenta.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/26/2022]
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Namli Kalem M, Kalem Z, Akgun N, Yuce E, Aktas H. Investigation of possible maternal and fetal factors which affect umbilical coiling index. J Matern Fetal Neonatal Med 2017; 32:954-960. [DOI: 10.1080/14767058.2017.1396311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | - Hatice Aktas
- Department of Biostatistics, Yildirim Beyazit Universitesi, Ankara, Turkey
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28
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Um-Bergström M, Papadogiannakis N, Westgren M, Vinnars MT. Antenatal corticosteroid treatment and placental pathology, with a focus on villous maturation. Acta Obstet Gynecol Scand 2017; 97:74-81. [DOI: 10.1111/aogs.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Miranda Um-Bergström
- Department of Clinical Sciences, Intervention and Technology (CLINTEC); Karolinska Institute; Stockholm Sweden
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| | - Magnus Westgren
- Department of Clinical Sciences, Intervention and Technology (CLINTEC); Karolinska Institute; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| | - Marie-Therese Vinnars
- Department of Clinical Sciences, Intervention and Technology (CLINTEC); Karolinska Institute; Stockholm Sweden
- Örnsköldsviks Hospital; Örnsköldsvik Sweden
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Risk Factors Affecting the Severity of Full-Term Neonatal Retinal Hemorrhage. J Ophthalmol 2017; 2017:4231489. [PMID: 28804645 PMCID: PMC5540476 DOI: 10.1155/2017/4231489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/16/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to explore the underlying clinical factors associated with the degree of retinal hemorrhage (RH) in full-term newborns. Methods A total of 3054 full-term infants were included in this study. Eye examinations were performed with RetCamIII within one week of birth for all infants. Maternal, obstetric, and neonatal parameters were compared between newborns with RH and controls. The RH group was divided into three sections (I, II, and III) based on the degree of RH. Results RH was observed in 1202 of 3054 infants (39.36%) in this study. The quantity and proportion of newborns in groups I, II, and III were 408 (13.36%), 610 (19.97%), and 184 (6.03%), respectively. Spontaneous vaginal delivery (SVD), prolonged duration of second stage of labor, advanced maternal age, and neonatal intracranial hemorrhage positively correlated with aggravation of the degree of RH in newborns. Conversely, cesarean section was protective against the incidence of RH. Conclusions SVD, prolonged duration of second stage of labor, advanced maternal age, and neonatal intracranial hemorrhage were potential risk factors for aggravation of the degree of RH in full-term infants. Accordingly, infants with these risk factors may require greater attention with respect to RH development.
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30
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Takita H, Hasegawa J, Arakaki T, Nakamura M, Tokunaka M, Oba T, Sekizawa A. Antenatal ultrasound screening using check list before delivery for predicting a non-reassuring fetal status during labor. J Matern Fetal Neonatal Med 2017; 31:1-6. [DOI: 10.1080/14767058.2016.1176137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Tokunaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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31
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Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia. J Perinatol 2016; 36:977-984. [PMID: 27537858 DOI: 10.1038/jp.2016.110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/27/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the relationship between placental pathology, pattern of brain injury and neurodevelopmental outcome in term infants with perinatal asphyxia receiving therapeutic hypothermia. STUDY DESIGN Studies were performed in 76 infants. Death or survival with impairments at 18 to 24 months was used as a composite adverse outcome. Multivariable analysis was performed. RESULTS Among the 75 infants analyzed, the predominant pattern of brain injury was: no injury (n=27), a white matter/watershed pattern (n=14), basal-ganglia-thalamic injury (n=13) or near-total brain injury (n=21). An adverse outcome was seen in 35 of the 76 infants. Elevated nucleated red blood cells were associated with white matter involvement. Small placental infarcts were more common among infants without brain injury. All other placental abnormalities were not related to both outcome measures. CONCLUSION In our population of term infants receiving therapeutic hypothermia, no type of placental pathology was related to extensive brain injury or adverse neurodevelopmental outcome.
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Ohno Y, Terauchi M, Tamakoshi K. Perinatal outcomes of abnormal umbilical coiling according to a modified umbilical coiling index. J Obstet Gynaecol Res 2016; 42:1457-1463. [PMID: 27527823 DOI: 10.1111/jog.13092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/04/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to determine the relation between perinatal outcomes and umbilical cord coiling as evaluated by a modified umbilical coiling index. METHODS In this retrospective study, 200 consecutive umbilical cords were examined. An umbilical venous and arterial coiling index was calculated by dividing the total number of umbilical venous and arterial coils by the length of cord individually. Umbilical cords with umbilical venous coiling indices in the lowest decile, the highest decile, and the remaining deciles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. The perinatal outcomes of the subjects with hypocoiled and hypercoiled umbilical cords were compared with those with normocoiled umbilical cords. RESULTS In 69.5% of subjects, a difference in the degree of coiling was detected between the umbilical veins and arteries. While all umbilical venous twisting demonstrated the same direction, the direction of the arterial twisting reversed at a certain point along the umbilical cord in 19.0% of the subjects. The arteriovenous coiling difference was small in the hypercoiled group and large in the hypocoiled group. A hypocoiled umbilical cord evaluated by umbilical venous coiling index was found to be associated with prolonged deceleration (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.54-11.38), operative delivery (OR, 2.67; 95%CI, 1.01-7.09), and nuchal cord entanglement (OR, 3.21; 95%CI, 1.23-8.33). CONCLUSION Umbilical coiling abnormalities were investigated using a novel umbilical venous coiling index. A hypocoiled umbilical cord evaluated by umbilical venous coiling index was found to be associated with fetal heart rate abnormalities, operative delivery, and nuchal cord entanglement.
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Affiliation(s)
| | | | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Khong TY, Mooney EE, Ariel I, Balmus NCM, Boyd TK, Brundler MA, Derricott H, Evans MJ, Faye-Petersen OM, Gillan JE, Heazell AEP, Heller DS, Jacques SM, Keating S, Kelehan P, Maes A, McKay EM, Morgan TK, Nikkels PGJ, Parks WT, Redline RW, Scheimberg I, Schoots MH, Sebire NJ, Timmer A, Turowski G, van der Voorn JP, van Lijnschoten I, Gordijn SJ. Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med 2016; 140:698-713. [PMID: 27223167 DOI: 10.5858/arpa.2015-0225-cc] [Citation(s) in RCA: 952] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -The value of placental examination in investigations of adverse pregnancy outcomes may be compromised by sampling and definition differences between laboratories. OBJECTIVE -To establish an agreed-upon protocol for sampling the placenta, and for diagnostic criteria for placental lesions. Recommendations would cover reporting placentas in tertiary centers as well as in community hospitals and district general hospitals, and are also relevant to the scientific research community. DATA SOURCES -Areas of controversy or uncertainty were explored prior to a 1-day meeting where placental and perinatal pathologists, and maternal-fetal medicine specialists discussed available evidence and subsequently reached consensus where possible. CONCLUSIONS -The group agreed on sets of uniform sampling criteria, placental gross descriptors, pathologic terminologies, and diagnostic criteria. The terminology and microscopic descriptions for maternal vascular malperfusion, fetal vascular malperfusion, delayed villous maturation, patterns of ascending intrauterine infection, and villitis of unknown etiology were agreed upon. Topics requiring further discussion were highlighted. Ongoing developments in our understanding of the pathology of the placenta, scientific bases of the maternofetoplacental triad, and evolution of the clinical significance of defined lesions may necessitate further refinements of these consensus guidelines. The proposed structure will assist in international comparability of clinicopathologic and scientific studies and assist in refining the significance of lesions associated with adverse pregnancy and later health outcomes.
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Affiliation(s)
- T Yee Khong
- From SA Pathology, Women's and Children's Hospital, University of Adelaide, North Adelaide, Australia (Dr Khong); the Department of Pathology, National Maternity Hospital, Dublin, Ireland (Drs Mooney and Kelehan); the Department of Pathology, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (Dr Ariel); the Department of Pathology, Kennemer Gasthuis, Haarlem, the Netherlands (Dr Balmus); the Department of Pathology, Boston Children's Hospital, and the Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Boyd); the Departments of Pathology and Laboratory Medicine, and Pediatrics, University of Calgary, Calgary, Alberta, Canada (Dr Brundler); the Maternal & Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom (Ms Derricott); the Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Dr Evans); the Department of Pathology, University of Alabama at Birmingham, (Dr Faye-Petersen); the Department of Pathology, Rotunda Hospital, Dublin, Ireland (Dr Gillan); the Institute of Human Development, Faculty of Medical and Human Sciences
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Three new families with recurrent male miscarriages and hypercoiled umbilical cord. Clin Dysmorphol 2015; 24:128-31. [DOI: 10.1097/mcd.0000000000000084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roescher AM, Timmer A, van der Laan ME, Erwich JJHM, Bos AF, Kooi EMW, Verhagen EA. In preterm infants, ascending intrauterine infection is associated with lower cerebral tissue oxygen saturation and higher oxygen extraction. Pediatr Res 2015; 77:688-95. [PMID: 25665059 DOI: 10.1038/pr.2015.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/20/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Placental lesions are associated with neurological morbidity but the mechanism leading to morbidity is unclear. To provide insight into such a possible mechanism, we determined whether placental lesions were associated with regional cerebral tissue oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE) in preterm infants during their first 5 d after birth. We hypothesized that as a result of cerebral hypoperfusion, rcSO2 would be lower and FTOE would be higher. METHOD In a prospective, observational study of 42 preterm infants (gestational age <32 wk), the infants' placentas were examined for histopathology. We measured rcSO2 and transcutaneous arterial oxygen saturation (SpO2) on days 1-5. FTOE was calculated as FTOE = (transcutaneous SpO2 - rcSO2)/transcutaneous SpO2. RESULTS Only three placentas showed no pathology. Ascending intrauterine infection (AIUI) (n = 16) was associated with lower rcSO2 and higher FTOE values on days 2, 3, and 4 (P ≤ 0.05). Other placental lesions were not associated with rcSO2 and FTOE. CONCLUSION AIUI is associated with lower rcSO2, and higher FTOE shortly after birth. The effect it has on cerebral oxygenation might be the mechanism leading to neurodevelopmental problems.
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Affiliation(s)
- Annemiek M Roescher
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albertus Timmer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michelle E van der Laan
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise A Verhagen
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hafeziahmadi M, Yousefi A, Ghavam S, Alizadeh S. Thin Cord Syndrome in a Thirty-year-old Pregnant Woman. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14122. [PMID: 25389479 PMCID: PMC4222005 DOI: 10.5812/ircmj.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/12/2013] [Accepted: 01/16/2014] [Indexed: 12/03/2022]
Abstract
Introduction: The umbilical cord anomalies directly effect on the life quality of the fetus. It can lead to fetal death or many problems during pregnancy and delivery. Early detection of these abnormalities is of particular importance. Case Presentation: We report a case of thin cord syndrome (TCS) in a 30-year-old pregnant woman with suprapubic pain. After termination of pregnancy, histopathologic assessment confirmed the TCS. Conclusions: In all cases with suspected abortion, the umbilical cord disorder should be considered.
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Affiliation(s)
| | - Atefeh Yousefi
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Samiramis Ghavam
- Department of Cardiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Sajjad Alizadeh
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding Author: Sajjad Alizadeh, Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-9187467005, Fax: +98-8412227136, E-mail:
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Mittal A, Nanda S, Sen J. Antenatal umbilical coiling index as a predictor of perinatal outcome. Arch Gynecol Obstet 2014; 291:763-8. [PMID: 25209352 DOI: 10.1007/s00404-014-3456-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the relationship between sonographic measurements of umbilical cord coiling index during late second trimester of pregnancy and perinatal outcome. METHODS This prospective study was conducted on two hundred pregnant women with uncomplicated, singleton pregnancy between 20 to 24 weeks of gestation. The antenatal umbilical coiling index (UCI) was calculated by doing a transabdominal ultrasound at the time of induction into the study as the reciprocal of the pitch of one complete vascular coil. The patients were followed up till delivery and any adverse antenatal and/or perinatal event was noted. RESULTS The mean value for the UCI was noted to be 0.36 + 0.07 coils/cm with a 95% CI of 0.35-0.37. The values for the 10th and the 90th percentile were 0.26 and 0.46 coils/cm respectively. Accordingly the cases were divided into three groups- hypocoiled (UCI <10th percentile)-18, normocoiled (UCI between 10th-90th percentile)-162 and hypercoiled (UCI >90th percentile)-20. Hypocoiling was observed to be significantly associated with preterm labour pains (P value 0.0344), oligohydramnios (P value 0.0021), intrapartum foetal heart rate abnormalities (P value 0.0012), instrumental vaginal delivery (P value 0.0275) and low birth weight (P value 0.0344). Hypercoiling was found to be significantly associated with intrauterine growth restriction (P value 0.0323), foetal heart rate abnormalities during labour (0.0399) and low birth weight (P value 0.0095). CONCLUSION Abnormal umbilical coiling index in the form of either hypo- or hypercoiling is associated with several adverse antenatal and neonatal outcomes.
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Affiliation(s)
- Ankita Mittal
- Department of Obstetrics and Gynecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, 124001, Haryana, India,
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Roescher AM, Timmer A, Erwich JJHM, Bos AF. Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review. PLoS One 2014; 9:e89419. [PMID: 24586764 PMCID: PMC3934891 DOI: 10.1371/journal.pone.0089419] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The placenta plays a crucial role during pregnancy for growth and development of the fetus. Less than optimal placental performance may result in morbidity or even mortality of both mother and fetus. Awareness among pediatricians, however, of the benefit of placental findings for neonatal care, is limited. OBJECTIVES To provide a systematic overview of the relation between placental lesions and neonatal outcome. DATA SOURCES Pubmed database, reference lists of selected publications and important research groups in the field. STUDY APPRAISAL AND SYNTHESIS METHODS We systematically searched the Pubmed database for literature on the relation between placental lesions and fetal and neonatal mortality, neonatal morbidity and neurological outcome. We conducted three separate searches starting with a search for placental pathology and fetal and neonatal mortality, followed by placental pathology and neonatal morbidity, and finally placental pathology and neurological development. We limited our search to full-text articles published in English from January 1995 to October 2013. We refined our search results by selecting the appropriate articles from the ones found during the initial searches. The first selection was based on the title, the second on the abstract, and the third on the full article. The quality of the selected articles was determined by using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Placental lesions are one of the main causes of fetal death, where placental lesions consistent with maternal vascular underperfusion are most important. Several neonatal problems are also associated with placental lesions, whereby ascending intrauterine infection (with a fetal component) and fetal thrombotic vasculopathy constitute the greatest problem. CONCLUSIONS The placenta plays a key role in fetal and neonatal mortality, morbidity, and outcome. Pediatricians should make an effort to obtain the results of placental examinations.
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Affiliation(s)
- Annemiek M. Roescher
- Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Albert Timmer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Jan Jaap H. M. Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Arend F. Bos
- Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, the Netherlands
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Jessop FA, Lees CC, Pathak S, Hook CE, Sebire NJ. Umbilical cord coiling: clinical outcomes in an unselected population and systematic review. Virchows Arch 2013; 464:105-12. [PMID: 24259031 DOI: 10.1007/s00428-013-1513-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/04/2013] [Accepted: 11/07/2013] [Indexed: 11/26/2022]
Abstract
This study was conducted to determine the frequency of pre-defined clinical outcomes in relation to umbilical cord coiling indices >90th percentile and <10th percentile in an unselected population of >1,000 women with a singleton pregnancy resulting in livebirth delivering at or near term and to report these findings in the context of a systematic review. Placentas of consecutive deliveries from an unselected low-risk population with >15 cm attached umbilical cords were included in the study. Clinical outcomes included interventional delivery, birthweight <10th percentile, Apgar score <7 at 1 min, neonatal acidosis (pH<7.2) and admission to neonatal special care. Standard MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines were observed for the systematic review. Umbilical coiling index was determined for 1,082 placentas. Mean maternal age was 30.7 years (standard deviation [SD] =5.7) and 519 women (48 %) were primiparous. Mean cord length was 43 cm (SD=13) and mean cord coiling index 0.20 (SD=0.09). A total of 866 cords were normally coiled, and 108 cases were hypercoiled (>90th centile) and 108 cases were undercoiled (<10th percentile). There were no differences between cases of overcoiled, normally coiled or undercoiled cords for any clinical outcome studied. The systematic review yielded a small number of clinical studies which were too statistically and clinically heterogenous to permit meta-analysis. There is insufficient evidence either from this unselected cohort study or from a systematic review to support the previous suggestion that cord coiling index >90th centile or <10th centile is associated with adverse clinical outcome in an unselected population. Previous studies that draw a link between abnormal cord coiling and clinical outcome are generally too small and/or selective to allow meaningful conclusions or applicability to low-risk populations.
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Affiliation(s)
- F A Jessop
- Department of Paediatric Pathology, Addenbrookes Hospital, Cambridge, UK
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Verkleij CPM, van Oppen ACC, Mulder EJH, de Laat MWM, Sikkel E, Koster MPH, van der Tweel I, Franx A, Visser GHA. Evaluation of antenatal umbilical coiling index at 16-21 weeks of gestation as a predictor of trisomy 21 and other chromosomal defects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:545-552. [PMID: 23436607 DOI: 10.1002/uog.12443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/28/2013] [Accepted: 02/13/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether there is an association between sonographically assessed hyper- or hypocoiling of the umbilical cord and the presence of trisomy 21, to provide reference values for the antenatal umbilical coiling index (aUCI) at a gestational age of 16-21 weeks and to determine whether these measurements are reliable and reproducible. METHODS This was a prospective study of 737 pregnancies in which the aUCI was measured between 16 and 21 weeks of gestation by ultrasound at the time of amniocentesis. The aUCI was calculated as the reciprocal value of the mean length of one complete coil in centimeters. We created reference curves and studied the relationship with trisomy 21 and other chromosomal defects. In 30 pregnancies we studied the intra- and interobserver variation in measurements using Bland-Altman plots with associated 95% limits of agreement and intraclass correlation coefficients. RESULTS aUCI was found to be non-linearly related to gestational age at 16-21 weeks and reference curves were created for the mean aUCI and the 2.3(rd) , 10(th) , 90(th) and 97.7(th) percentiles. There was no significant difference in aUCI values between the reference group (n = 714) and cases with trisomy 21 (n = 16) or other aneuploidies (n = 7) (one-way ANOVA, P = 0.716). There was good intra- and interobserver agreement in aUCI measurements. CONCLUSIONS The aUCI can be measured reliably and varies according to gestational age at 16-21 weeks. The aUCI was not significantly associated with trisomy 21 or other chromosomal defects.
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Affiliation(s)
- C P M Verkleij
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Schmid A, Jacquemyn Y, Loor JD. Intrauterine growth restriction associated with excessively long umbilical cord. Clin Pract 2013; 3:e23. [PMID: 24765511 PMCID: PMC3981270 DOI: 10.4081/cp.2013.e23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/16/2013] [Accepted: 04/24/2013] [Indexed: 12/02/2022] Open
Abstract
We present a 37-week female baby, known with intrauterine growth restriction since 25 weeks of pregnancy, born with a placenta with an excessive long umbilical cord (ELUC), without any other abnormalities. ELUC is mostly an incidental finding after delivery, but represents a potentially detectable intrauterine cause of growth restriction. A system that allows ultrasound measurement of the length of the umbilical cord could highly increase antenatal diagnosis of ELUC.
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Affiliation(s)
- Ann Schmid
- Zaaldenrode 2, 2640 Mortsel, Belgium. +32.486229364.
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A case report of umbilical ring constriction with application of amnioinfusion. J Med Ultrason (2001) 2013; 40:257-60. [PMID: 27277245 DOI: 10.1007/s10396-013-0451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 10/01/2012] [Indexed: 10/26/2022]
Abstract
This is a case report of a pregnant 38-year-old primigravida woman. Due to severe fetal growth restriction and oligohydramnios, she was referred to our tertiary perinatal center at 24 weeks' gestation. To rule out chromosomal abnormalities and facilitate ultrasound evaluation of fetal morphology, we performed amniocentesis and subsequent amnioinfusion. Thereafter, a precise ultrasound examination revealed no obvious fetal morphological abnormalities except for a hyper-coiled cord and marginal placenta previa. During expectant management, the amount of amniotic fluid was maintained at 20-26 mm for a few days; however, the pregnancy resulted in intrauterine fetal death after 26 weeks + 5 days of gestation. The stillborn infant weighed 530 g (-3.3 SD) and had no obvious external abnormalities apart from umbilical ring constriction. Although a postmortem autopsy was not performed, it is suspected that the fetal growth restriction and the intrauterine fetal death were associated with the hyper-coiled cord and the umbilical ring constriction. It is thought that umbilical ring constriction might therefore be an irreversible fatal condition in cases with a hyper-coiled cord.
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Marton T, Hargitai B, Bowen C, Cox PM. Elevated brain weight/liver weight ratio in normal body weight centile term perinatal deaths: an indicator of terminal intrauterine malnourishment. Pediatr Dev Pathol 2013; 16:267-71. [PMID: 23570414 DOI: 10.2350/12-11-1278-oa.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A proportion of antepartum/intrapartum intrauterine deaths (IUDs) with normal or elevated body weight (BW) centile also show an elevated brain weight/liver weight (BLR) ratio. We postulate that this may be an indication of intrauterine malnourishment/incipient intrauterine growth restriction (IUGR), which may have a bearing on the cause of death. Searching our departmental postmortem database, we identified 331 IUD/intrapartum deaths (254; 77%) or early neonatal deaths (77; 23%), ≥37/40 weeks gestation in a 4-year period. The customized BW centile, BLR, brain weight/thymus weight ratio (BTR), fetus weight/placenta weight ratio (FPR), and maternal body mass index were calculated. A BLR >4.0 and a BTR >60 were regarded as abnormal. Of the 331 cases, the BLR was >4.0 in 71 (21.4%). Nineteen (26.7%) of the 71 had a BW above the 25th centile, and these were all IUDs. Eight deaths were explained. In the 11 unexplained deaths, the BTR was raised in 5 and FPR was elevated in 7. Three of these 11 mothers had impaired glucose tolerance, and 7 were overweight or obese. In the absence of a definitive cause, a raised BLR in an IUD with a normal BW centile is likely to indicate nutritional impairment/incipient IUGR. The majority of these deaths are associated with maternal obesity, with or without impaired glucose tolerance. Recognition of features of IUGR in IUDs of normal BW may help us understand the death. In these cases, placental growth may be insufficient to support a macrosomic fetus, leading to late nutritional impairment and death.
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Affiliation(s)
- Tamas Marton
- Department of Cellular Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK.
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Hung TH, Hsieh TT, Lo LM, Chiu TH, Hsieh CC, Hsu JJ. Risk factors and perinatal outcomes associated with idiopathic small for gestational age Taiwanese newborns. Int J Gynaecol Obstet 2013; 122:212-5. [PMID: 23796255 DOI: 10.1016/j.ijgo.2013.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/01/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine risk factors and perinatal outcomes associated with small for gestational age (SGA) neonates among healthy pregnant women. METHODS A retrospective cohort study was conducted of 49 945 women who gave birth at Chang Gung Memorial Hospital, Taipei, Taiwan, after 24weeks of pregnancy. Idiopathic SGA newborns (n=3398) were characterized by a birth weight below the 10th percentile for mean weight corrected for GA and fetal sex. RESULTS Risk factors for idiopathic SGA newborns included hypercoiling of the umbilical cord (adjusted odds ratio [aOR], 3.3; 95% confidence interval [CI], 1.6-7.0); prior fetal death (aOR, 2.8; 95% CI, 2.0-3.9); primiparity (aOR, 1.5; 95% CI, 1.4-1.7); adolescent pregnancy (aOR, 1.5; 95% CI, 1.2-2.0), low prepregnancy weight (aOR, 1.6; 95% CI, 1.5-1.8), low prepregnancy body mass index (aOR, 1.1; 95% CI, 1.0-1.3); short stature (aOR, 1.3; 95% CI, 1.1-1.4); and entangled umbilical cord (aOR, 1.1; 95% CI, 1.0-1.3). Idiopathic SGA newborns correlated with increased risk of adverse perinatal outcomes, including fetal death, low Apgar scores, oligohydramnios, placental abruption, and admission to the neonatal intensive care unit. CONCLUSION Some risk factors for idiopathic SGA newborns were modifiable, suggesting potential implications for public health.
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Affiliation(s)
- Tai-Ho Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan.
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Hasegawa J, Nakamura M, Hamada S, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. Relationship between the umbilical cord coiling index and the umbilical blood flow at 11-13 weeks of gestation. Prenat Diagn 2013; 33:764-9. [DOI: 10.1002/pd.4122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Masamitsu Nakamura
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Shoko Hamada
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Ryu Matsuoka
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Akihiko Sekizawa
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
| | - Takashi Okai
- Department of Obstetrics, Gynecology; Showa University School of Medicine; Tokyo; Japan
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Association of umbilical coiling index by colour Doppler ultrasonography at 18-22 weeks of gestation and perinatal outcome. J Obstet Gynaecol India 2012; 62:650-4. [PMID: 24293842 DOI: 10.1007/s13224-012-0230-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 06/14/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To study the association between antenatal umbilical coiling index (aUCI) and perinatal outcome. METHODS 600 primigravidas with uncomplicated singleton pregnancies had an ultrasonography between 18 and 22 weeks of gestation for aUCI by colour Doppler. The aUCI was calculated as the reciprocal of the distance between a pair of coils. It was then correlated with the following pregnancy outcomes: birth weight, mode of delivery, meconium staining of liquor, Apgar scores and gestational age. The results were statistically analysed by χ(2)-test. RESULTS The mean aUCI was 0.41. Undercoiling was associated with spontaneous preterm delivery (47.87 %), low Apgar score (52.13 %), LBW (52.59 %), FGR (21.28 %) and NICU admission (76.34 %). Overcoiling was associated with preterm deliveries (65.38 %), increased caesarean sections (61.54 %), meconium staining of liquor (67.31 %), low Apgar score (63.46 %) and NICU admission (72.55 %). There was a positive strong correlation between aUCI and birth weight (r = +0.426). CONCLUSIONS Abnormal coiling is strongly correlated with low birth weight.
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Umbilical coiling index & the perinatal outcome. J Obstet Gynaecol India 2012; 62:43-6. [PMID: 23372289 DOI: 10.1007/s13224-012-0158-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/17/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To correlate the perinatal outcome by noting the umbilical coiling index. METHODS The umbilical cords of the babies born to 100 women, who delivered either vaginally or by lower segment cesarean section, were examined and umbilical coiling index was calculated. RESULTS There was significant correlation (p value 0.003) between the hypercoiled cords (UCI >90th percentile) and intrauterine growth restriction of the babies. Apgar score at 1 min <4 and 5 min <7 was highly significant (p < 0.001) with hypocoiled cords. Meconium staining was significantly (p value 0.001) associated with the hypocoiled cords (UCI <10th percentile) in the present study. CONCLUSION The hypocoiled cords or UCI <10th percentile is associated with the meconium staining, Apgar score at 1 min <4 and Apgar score at 5 min <7. The hypercoiled cord or UCI >10th percentile is associated with intra uterine growth restriction.
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Chitra T, Sushanth YS, Raghavan S. Umbilical coiling index as a marker of perinatal outcome: an analytical study. Obstet Gynecol Int 2012; 2012:213689. [PMID: 22496697 PMCID: PMC3307016 DOI: 10.1155/2012/213689] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/30/2011] [Indexed: 11/23/2022] Open
Abstract
Objectives. To measure umbilical coiling index (UCI) postnatally and to study the association of normocoiling, hypocoiling and hypercoiling to maternal and perinatal outcome. Method(s). One thousand antenatal women who went into labour were studied and umbilical coiling index calculated at the time of delivery. UCI was determined by dividing the total number of coils by the total umbilical cord length in centimeters. Its association with various maternal and perinatal risk factors were noted. The statistical tests were the Chi-square test and assessed with SPSS version 13.0 software and statistically analyzed. P value of less than 0.05 was regarded as statistically significant. Results. The mean umbilical coiling index was found to be 0.24 ± 0.09. Hypocoiling (<0.12) was found to be significantly associated with hypertensive disorders, abruptio placentae, preterm labour, oligohydramnios, and fetal heart rate abnormalities. Hypercoiling (>0.36) was found to be associated with diabetes mellitus, polyhydramnios, cesarean delivery, congenital anomalies, and respiratory distress of the newborn. Conclusion. Abnormal umbilical coiling index is associated with several antenatal and perinatal adverse features.
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Affiliation(s)
- T. Chitra
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, No.3, E-Type Quarters, JIPMER Campus, India
| | - Y. S. Sushanth
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, No.3, E-Type Quarters, JIPMER Campus, India
| | - S. Raghavan
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, No.3, E-Type Quarters, JIPMER Campus, India
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Placental pathology is associated with illness severity in preterm infants in the first twenty-four hours after birth. Early Hum Dev 2011; 87:315-9. [PMID: 21333470 DOI: 10.1016/j.earlhumdev.2011.01.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/29/2010] [Accepted: 01/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Placental pathology is associated with long-term neurological morbidity. Little is known about the association of placental pathology and illness severity directly after birth in preterm infants. OBJECTIVE To determine the association between placental pathology and illness severity in preterm infants during the first 24 h after birth. STUDY DESIGN Placentas of 40 preterm infants, born after singleton pregnancies (gestational age 25.4-31.7 weeks, birth weight 560-2250 g) were assessed for histopathology. Illness severity was measured using the Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE). A high SNAPPE reflects high illness severity. RESULTS Examination of the 40 placentas revealed: pathology consistent with maternal vascular underperfusion (MVU) (n=24), ascending intrauterine infection (AIUI) (n=17), villitis of unknown aetiology (VUE) (n=6), foetal thrombotic vasculopathy (FTV) (n=6), elevated nucleated red blood cells (NRBCs) (n=6), and chronic deciduitis (n=10). SNAPPE ranged from 1 to 53 (median 10). Infants with elevated NRBCs had a higher SNAPPE than infants without elevated NRBCs (median 30 vs. 10, p=0.014). The same was found for the presence of FTV (median 30 vs. 10, p=0.019). No relation existed between SNAPPE and the other placental pathologies. CONCLUSIONS Elevated NRBCs and FTV were associated with higher illness severity during the first 24 h after birth in preterm infants. Ascending intrauterine infection was not associated with high illness severity.
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Abstract
The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.
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Affiliation(s)
- T Y Khong
- SA Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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