1
|
Dehner LP. The Placenta and Neonatal Encephalopathy with a Focus on Hypoxic-Ischemic Encephalopathy. Fetal Pediatr Pathol 2023; 42:950-971. [PMID: 37766587 DOI: 10.1080/15513815.2023.2261051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Background: Placental examination is important for its diagnostic immediacy to correlate with maternal and/or fetal complications and parturitional difficulties. In a broader context, clinicopathologic studies of the placenta have addressed a range of pathogenetic questions that have led to conclusive and inconclusive results and interpretations. Methods: Recent standardized morphologic criteria and terminology of placental lesions have facilitated the ability to compare findings from studies that have focused on complications and outcomes of pregnancy. This review is an evaluation of recent studies on placental lesions associated with hypoxic-ischemic encephalopathy (HIE). Conclusion: No apparent consensus exists on whether it is fetal inflammation with the release of cytokines or chronic maternal and/or fetal vascular malperfusion is responsible for HIE with a lowering of the threshold for hypoxic ischemia. The counter argument is that HIE occurs solely as an intrapartum event. Additional investigation is necessary.
Collapse
Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, State of Washington University in St. Louis Medical Center, St. Louis, MO, USA
| |
Collapse
|
2
|
Ward S, Sun Z, Maresse S. Current practice of placental cord insertion documentation in Australia - A sonographer survey. Australas J Ultrasound Med 2023; 26:157-168. [PMID: 37701770 PMCID: PMC10493351 DOI: 10.1002/ajum.12360] [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: 09/14/2023] Open
Abstract
Introduction During pregnancy, the umbilical cord attaches to the placenta in a central, eccentric, marginal or velamentous location. Maternal and fetal complications are associated with marginal and velamentous cord insertions, the most clinically significant being perinatal mortality due to undiagnosed vasa praevia. Current literature describes a wide variation regarding regulation of placental cord insertion (PCI) documentation during antenatal ultrasound examinations. This prospective cross-sectional study aimed to assess the current practice of antenatal PCI documentation in Australia. Methods Members of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022. Results Four hundred ninety sonographers met the inclusion criteria for the study of which 330 (67.3%) have more than 10 years' experience as a sonographer and 375 (76.5%) are employed primarily in a public or private setting offering general ultrasound. Most respondents (89.6%) indicated documentation of the PCI site is departmental protocol at the second trimester anatomy scan (17-22 weeks gestation), but PCI documentation is protocol in less than 50% of other obstetric ultrasound examinations listed in the survey. The PCI site is included in the formal ultrasound report at a rate significantly less than inclusion in the departmental protocol and the sonographer's worksheet. Conclusions Considering the potential maternal and fetal complications associated with abnormal PCI and the ease at which the PCI site is identified in the first and second trimesters, we believe that standard inclusion of the PCI site in departmental protocol and in the formal ultrasound report from 11 weeks gestation, regardless of whether it is normal or abnormal, would prove invaluable.
Collapse
Affiliation(s)
- Samantha Ward
- Discipline of Medical Radiation Science, Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
| | - Sharon Maresse
- Discipline of Medical Radiation Science, Curtin Medical SchoolCurtin UniversityPerthWestern AustraliaAustralia
| |
Collapse
|
3
|
Pradipta GA, Wardoyo R, Musdholifah A, Sanjaya INH. Machine learning model for umbilical cord classification using combination coiling index and texture feature based on 2-D Doppler ultrasound images. Health Informatics J 2022; 28:14604582221084211. [DOI: 10.1177/14604582221084211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The umbilical cord is an organ that circulates oxygen and nutrition from mother to fetus during pregnancy. This study aims to classify the umbilical cord based on ultrasound images. The similarity of shape and coil between each class becomes a challenge. Therefore, it requires feature values that are relevant to the characteristics of these three classes. The condition of imbalanced data sets in this study is also an obstacle that causes the classifier’s performance to degrade on minority classes. Therefore, this study proposes a machine learning model capable of properly dealing with imbalanced data sets and recognizing the umbilical cord class. Furthermore, this study proposes a new feature extraction method, namely, the umbilical coiling index (UCI), which directly adopts obstetricians’ knowledge. The proposed model consists of five stages: image preprocessing, feature extraction, feature selection, oversampling data using SMOTE, and Classification. Machine learning method observations were carried out comprehensively on five based classifiers: Random Forest, KNN, Decision tree, SVM, Naïve Bayes, and Multiclassifier. The results showed that the Random forest and Multiclassifier methods provide the highest accuracy, precision, recall, and F-measure performance in imbalanced data sets.
Collapse
Affiliation(s)
- Gede A. Pradipta
- Doctoral Program Department of Computer Science and Electronics, Faculty of Mathematics and Natural Science, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Information Technology, Faculty Computer and Informatics, Institut Teknologi Dan Bisnis STIKOM Bali, Bali, Indonesia
| | | | - Aina Musdholifah
- Department of Computer Science and Electronics, Faculty of Mathematics and Natural Science, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - I Nyoman H. Sanjaya
- Department of Obstetrics and Gynecology, Faculty of Medicine Udayana University/Sanglah General Hospital, Bali, Indonesia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Chandran AR, Agrawal S, Hobson SR, Windrim RC, Parks T, Kingdom JC. Stillbirth Following Normal Ultrasound Findings and Maternal Placental Growth Factor Levels. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1426-1428. [PMID: 34411727 DOI: 10.1016/j.jogc.2021.07.019] [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: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Attempts to reduce the current rate of antepartum stillbirth in the late third trimester have largely focused on the accurate identification of fetal growth restriction. Universal ultrasound significantly increases detection, especially when combined with maternal angiogenic growth factors, but this screening strategy is not well suited to identify umbilical cord pathology. While this poses unique challenges to pregnancy care, the recurrence risk of cord obstruction is low in comparison with many intrinsic placental diseases. CASE A 30-year-old woman with normal uterine artery Doppler waveforms, fetal growth ultrasounds, and circulating placental growth factor experienced an unexpected third-trimester stillbirth. Placental pathology demonstrated fetal vascular malperfusion and cord hyper-coiling. CONCLUSION Despite normal placental function, the otherwise healthy fetus is at risk of antepartum stillbirth due to cord-related pathology.
Collapse
Affiliation(s)
| | - Swati Agrawal
- Maternal Fetal Medicine, Sinai Health System, Toronto, ON
| | | | - Rory C Windrim
- Maternal Fetal Medicine, Sinai Health System, Toronto, ON
| | - Tony Parks
- Department of Pathology, Sinai Health System, Toronto, ON
| | - John C Kingdom
- Maternal Fetal Medicine, Sinai Health System, Toronto, ON
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Haghighi L, Jahanshahi F, Dini P. Two knots in an umbilical cord with seventy centimeter length: A case report. Clin Case Rep 2020; 8:1579-1581. [PMID: 32884799 PMCID: PMC7455404 DOI: 10.1002/ccr3.2919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/15/2020] [Accepted: 04/21/2020] [Indexed: 12/02/2022] Open
Abstract
Our case was a newborn with two umbilical knots that delivered 39 weeks gastation and did not experience any developmental disruptions. The risk factors of fetus for true knot formation in the umbilical cord were gender and the umbilical cord size.
Collapse
Affiliation(s)
- Ladan Haghighi
- Department of Obstetrics and GynecologySchool of MedicinesIran University of Medical SciencesTehranIran
| | - Fatemeh Jahanshahi
- Student Research Committee, Faculty of MedicineIran University of Medical SciencesTehranIran
| | - Parisa Dini
- Department of Obstetrics and GynecologySchool of MedicinesIran University of Medical SciencesTehranIran
| |
Collapse
|
8
|
Olaya-C M, Vargas W, Martinez RA, Peñaloza IF, Sanchez M, Madariaga I, Aldana S, Bernal JE. Impact of umbilical cord length on fetal circulatory system by Doppler assessment. J Ultrasound 2020; 23:585-592. [PMID: 32654041 DOI: 10.1007/s40477-020-00495-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Numerous studies have revealed the impact of umbilical cord (UC) length on fetal perfusion; abundant data implicate abnormal UC length to neurological delay and subsequent poor prognoses for fetuses and newborns. Indeed, our group previously developed theoretical approximations that contributed to formulas capable of explaining the impact of UC length on cardiac output. METHODS We performed an observational study that measured the pulsatility index and flow velocity in umbilical arteries. A special Doppler measured proximal and distal indexes in both arteries. After birth, medical staff measured complete UC length. We obtained maternal and neonatal outcomes from clinical records. RESULTS Our study enrolled 20 pregnant mothers. We found that flow velocities in the two edges were different: fetal edges exhibited greater velocity in the majority of cases; but, when we compared pressure differentials (ΔP), the pulsatility index was significantly related to umbilical cord length. CONCLUSIONS Fetal perfusion, welfare, and viability are related to UC function as the conveyor of all fetal volemia. Excessive UC length affects cardiac dynamics and increases peripheral vascular resistance. Further studies could validate routine use of the differential proximal and distal measurements proposed in this article, and their implications in in utero fetal heart function. We also hope that early diagnosis or UC alterations could alert neonatologists and obstetricians to clinical conditions of the fetus.
Collapse
Affiliation(s)
- Mercedes Olaya-C
- Pathology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia. .,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia.
| | - William Vargas
- Forensic Physics Group, Instituto Nacional de Medicina Legal y Ciencias Forenses, Bogota, Colombia
| | - Rodolfo Andres Martinez
- Obstetrics and Gynecology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia.,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia
| | - Ivan Felipe Peñaloza
- Pontificia Universidad Javeriana, Bogota, Colombia.,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia
| | - Melissa Sanchez
- Pontificia Universidad Javeriana, Bogota, Colombia.,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia
| | - Ithzayana Madariaga
- Pontificia Universidad Javeriana, Bogota, Colombia.,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia
| | - Sergio Aldana
- Pontificia Universidad Javeriana, Bogota, Colombia.,Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia
| | - Jaime E Bernal
- Instituto de Genetica Humana, Pontificia Universidad Javeriana, Bogota, Colombia
| |
Collapse
|
9
|
Olaya-C M, Michael F, Fabian G, Silva JL, Bernal JE, Garzon AL. Role of VEGF in the differential growth between the fetal and placental ends of the umbilical cord. J Neonatal Perinatal Med 2019; 12:47-56. [PMID: 30149476 DOI: 10.3233/npm-1795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The umbilical cord (UC) is a vital structure; its alterations affect the newborn and neurological impact can be permanent. Paradoxically, factors that determine it remain unknown. We explore the differential VEGF protein expression in the UC's proximal and distal portions in relation to the hypothesis that the UC has differential growth and that VEGF plays a role in it. METHODS An observational analytical study was performed. One UC segment was taken proximal to fetus and another distal; both were randomly processed; VEGF immunohistochemical analysis was performed; two blinded pathologists read results. RESULTS Forty-eight newborns were included. Protein expression between the two edges of the umbilical cord, in any kind of cells, was interpreted. Endothelium, amnion, and stromal cells expressed VEGF; the first two were not different between opposite ends. Stromal cells had differential expression: higher in the proximal to the fetus portion. CONCLUSION Knowledge of molecular factors is necessary. UC cells widely expressed VEGF, possibly contributing to UC growth. Even though stromal cell expression was different, the interaction with activity close to the fetus must be explored.
Collapse
Affiliation(s)
- M Olaya-C
- Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | - F Michael
- Department of Pathology, Perinatal Division, Northwestern Medical Group, Chicago, IL, USA
| | - G Fabian
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Luis Silva
- Department of Obstetrics and Gynecology, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | - J E Bernal
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana and Universidad Tecnológica de Bolivar, Cartagena de Indias, Colombia
| | | | - A L Garzon
- Pathology Residency Program, Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
10
|
Olaya-C M, Garrido M, Hernandez-Losa J, Sesé M, Ayala-Ramirez P, Somoza R, Vargas MJ, Ramón Y Cajal S. The umbilical cord, preeclampsia and the VEGF family. Int J Womens Health 2018; 10:783-795. [PMID: 30568515 PMCID: PMC6276640 DOI: 10.2147/ijwh.s174734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The VEGF family has been identified as abnormal in preeclampsia (PE). Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal morbidity and mortality worldwide; likewise, umbilical cord anatomical abnormalities (UCAA) are linked to poor neonatal outcomes. Based on the relationship described between PE and UCAA and the role of the VEGF family in PE, this study explored VEGF expression in placental and UC tissued from patients with PE and with UCAA. Methods We performed an observational, analytical study on placentas, comparing protein and mRNA expression in four groups: patients with PE, patients with UC abnormalities, patients with both, and patients with none of them. Using immunohistochemistry, we studied VEGF A, VEGF R1 (FLT1), MMP1, and PLGF. With quantitative reverse transcription polymerase chain reaction we described mRNA expression of PLGF, VEGF and sFLT1, and sFLT1/PLGF ratio. Results Forty newborns were included. Sixty-seven percent of mothers and 45% of newborns developed no complications. Immunohistochemistry was performed on UC and placental disc paraffin-embedded tissue; in the latter, the mRNA of the VEGF family was also measured. Statistically significant differences were observed among different expressions in both HDP and UCAA groups. Interestingly, the UCAA group exhibited lower levels of sFLT1 and VEGF-A in comparison with other groups, with significant P-value for sFLT1 (P=0000.1). Conclusion The origin of UCAA abnormalities and their relation with HDP are still unknown. VEGF family alterations could be involved in both. This study provides the first approach related to molecules linked to UCAA.
Collapse
Affiliation(s)
- Mercedes Olaya-C
- Department of Pathology, Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia,
| | - Marta Garrido
- Pathology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Javier Hernandez-Losa
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Marta Sesé
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Paola Ayala-Ramirez
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Rosa Somoza
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Magda Jimena Vargas
- Department of Pathology, The Medical School, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia
| | - Santiago Ramón Y Cajal
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| |
Collapse
|