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Tonni G, Lituania M, Cecchi A, Carboni E, Resta S, Bonasoni MP, Ruano R. Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes. Healthcare (Basel) 2023; 11:2634. [PMID: 37830671 PMCID: PMC10572758 DOI: 10.3390/healthcare11192634] [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: 09/05/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Serena Resta
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vegata, 00133 Rome, Italy;
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy;
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Slack JC, Boyd TK, Carreon CK. Recurrent Second Trimester Fetal Demise Caused by Hypercoiled Umbilical Cords. Fetal Pediatr Pathol 2022; 42:492-497. [PMID: 36445244 DOI: 10.1080/15513815.2022.2142490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Umbilical cord flow impairment accounts for a majority of fetal vascular malperfusion (FVM). Hypercoiled umbilical cords are one cause of impaired fetal blood flow that may, in severe cases, result in intrauterine fetal demise (IUFD). Although the factors involved in umbilical cord patterning are incompletely understood, a limited number of reports have described recurrent intra-familial hypercoiling leading to death in the second trimester, suggesting a subset may have a genetic etiology. CASE REPORTS Herein, we report two additional cases of recurrent second trimester IUFD secondary to FVM due to umbilical cord hypercoiling and briefly discuss all published cases. CONCLUSION Our cases add to a small, but growing, body of literature that suggests a genetic etiology to a subset of hypercoiled umbilical cords.
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Affiliation(s)
- Jonathan C Slack
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Theonia K Boyd
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Chrystalle Katte Carreon
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Sherer DM, Al-Haddad S, Cheng R, Dalloul M. Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology. Int J Womens Health 2021; 13:939-971. [PMID: 34703323 PMCID: PMC8541738 DOI: 10.2147/ijwh.s278747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022] Open
Abstract
The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.
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Affiliation(s)
- David M Sherer
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sara Al-Haddad
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Regina Cheng
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mudar Dalloul
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
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Montaña-Jimenez LP, Lasalvia P, Diaz Puentes M, Olaya-C M. Congenital heart defects and umbilical cord abnormalities, an unknown association? J Neonatal Perinatal Med 2021; 15:81-88. [PMID: 34542034 DOI: 10.3233/npm-210799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Few studies exist that research the association between umbilical cord characteristics with cardiac malformations. In this study, we describe a population of newborns with congenital heart defects (CHD) and the frequency of presentation of umbilical cord (UC) alterations, based upon the hypothesis that the continuity of the cardio-placental circuit can be affected by similar noxas during early development. METHODS We carried out a descriptive study at a hospital in Bogota based on clinical records from newborns with congenital heart disease with placental and UC pathology results. Group analyses were done according to the major categories of the ICD-10. RESULTS We analyzed 122 cases and found that the most frequent alterations where hypercoiling (27.9%) and abnormal UC insertion (16.4%). Additionally, in almost every group of CHD, more than 65%of patients had some type of cord alteration. CONCLUSION We discovered a high frequency of UC alterations in patients with CHD. This outcome suggests that a possible association exists between the two phenomena, further research is needed.
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Affiliation(s)
- L P Montaña-Jimenez
- Hospital Universitario San Ignacio, Bogotá D.C, Colombia.,Pontificia Universidad Javeriana, Bogotá D.C, Colombia
| | | | | | - M Olaya-C
- Hospital Universitario San Ignacio, Bogotá D.C, Colombia.,Pontificia Universidad Javeriana, Bogotá D.C, Colombia
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Chen R, Yan J, Han Q, Zheng L. Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion. J Int Med Res 2021; 48:300060520905421. [PMID: 32223647 PMCID: PMC7133088 DOI: 10.1177/0300060520905421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study analyzed factors influencing umbilical cord torsion, measured the umbilical coiling index (UCI) postnatally, and analyzed the association of umbilical cord torsion with maternal and perinatal outcomes. Methods In total, 845 antenatal women who went into labor at the Fujian Provincial Maternity and Children’s Hospital from January 2016 to January 2017 were retrospectively studied. The patients were divided into those with and without umbilical cord torsion. Possible influencing factors and the UCI were noted, and maternal and perinatal outcomes were compared. Results Higher morbidity in the presence of umbilical cord torsion was affected by multiparous pregnancy and a long cord. The area under the curve was 0.666 for the UCI to predict fetal distress and 0.505 for the umbilical artery peak systolic to end diastolic flow velocity ratio (S/D ratio) to predict fetal distress. Umbilical cord torsion was associated with higher rates of fetal distress, forceps-assisted delivery, cesarean sections, fetal heart rate abnormalities, amniotic fluid meconium staining, neonatal intensive care unit admission, and small for gestational age. Conclusions Multiparous status and longer umbilical cord length were highly associated with umbilical cord torsion. The UCI is a better predictor of fetal distress than is the umbilical artery S/D ratio.
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Affiliation(s)
- Rongxin Chen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jianying Yan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Han
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lianghui Zheng
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Slack JC, Boyd TK. Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review. Pediatr Dev Pathol 2021; 24:12-18. [PMID: 32986509 DOI: 10.1177/1093526620962061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. METHODS Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. RESULTS All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. CONCLUSION Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.
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Affiliation(s)
- Jonathan C Slack
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Theonia K Boyd
- Department of Pathology, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Feist H, Hussein K, Blöcker T, Wohlschlaeger J. Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition. Pediatr Dev Pathol 2020; 23:107-114. [PMID: 31345137 DOI: 10.1177/1093526619865426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.
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Affiliation(s)
- Henning Feist
- Department of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - Kais Hussein
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Thordis Blöcker
- Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
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Bamberg C, Diemert A, Glosemeyer P, Tavares de Sousa M, Hecher K. Discordance of umbilical coiling index between recipients and donors in twin-twin transfusion syndrome. Placenta 2019; 76:19-22. [PMID: 30803710 DOI: 10.1016/j.placenta.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/04/2019] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To compare the intertwin umbilical cord coiling in twin-twin transfusion syndrome (TTTS) before fetoscopic laser treatment and to correlate these with Doppler findings in both twins. METHODS We performed a prospective study using three-dimensional (3D) ultrasound with color Doppler imaging of the umbilical cord in TTTS. Coiling index was measured as a reciprocal value of one complete vascular coil. Ultrasound hypocoiling was thus defined as < 0.2 coils/cm and hypercoiling as > 0.6 coils/cm, respectively. Umbilical artery pulsatility index (PI) and peak systolic velocity, middle cerebral artery peak systolic velocity and ductus venosus PI of flow-velocity waveformes of both twins were measured. RESULTS We included 65 women in the study. The average gestational age was 21.1 ± 2.7 weeks. In 65 recipients and 56 donors coiling index could be quantified. The median (interquartile range) coiling index of recipient twins was significantly higher than of donors, 0.55 (0.41-0.68) vs. 0.26 (0.2-0.5); P < 0.0001. The proportions of abnormal intertwin coiling were significantly (P = 0.0015) different. Out of 65 recipient with coiling indices evaluation, 1 (1.5%) showed hypocoiled and 27 (41.5%) hypercoiled cords. In contrast, 27 donor twins (48.2%) showed hypocoiled and 5 (8.9%) hypercoiled umbilical cords. There were no significant correlations between the fetal Doppler values and coiling indices. DISCUSSION Evaluation of umbilical cord coiling index using 3D color Doppler in both twins complicated by TTTS is feasible in both, donors and recipients. Coiling indices differ significantly between recipient and donor twins and do not correlate with Doppler findings.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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