1
|
Hong J, Crawford K, Daly M, Clifton V, da Silva Costa F, Perkins AV, Matsika A, Lourie R, Kumar S. Utility of placental biomarkers and fetoplacental Dopplers in predicting likely placental pathology in early and late fetal growth restriction - A prospective study. Placenta 2024; 156:20-29. [PMID: 39232442 DOI: 10.1016/j.placenta.2024.08.016] [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] [Received: 07/05/2024] [Revised: 08/07/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the association between placental abnormalities, placental biomarkers, and fetoplacental Dopplers in a cohort of pregnancies complicated by fetal growth restriction (FGR). We also ascertained the risk of perinatal mortality, severe neurological morbidity, and severe non-neurological morbidity by type of placental abnormality. METHODS This was a prospective cohort study. Multivariable logistic regression was used to evaluate the effect of early vs. late FGR, placental biomarkers and fetoplacental Dopplers on Maternal Vascular Malperfusion (MVM) which was the commonest placental abnormality identified. RESULTS There were 161 (53.5 %) early FGR and 140 (46.5 %) late FGR cases. MVM abnormalities were present in 154 (51.2 %), VUE in 45 (14.6 %), FVM in 16 (5.3 %), DVM in 14 (4.7 %) and CHI in 4 (1.3 %) cases. The odds of MVM were higher in early compared to late FGR cohort (OR 1.89, 95%CI 1.14, 3.14, p = 0.01). Low maternal PlGF levels <100 ng/L (OR 2.34, 95%CI 1.27,4.31, p = 0.01), high sFlt-1 level (OR 2.13, 95%CI 1.35, 3.36, p = 0.001) or elevated sFlt-1/PlGF ratio (OR 3.48, 95%CI 1.36, 8.91, p = 0.01) were all associated with MVM. Increased UA PI > 95th centile (OR 2.91, 95%CI 1.71, 4.95, p=<0.001) and mean UtA PI z-score (OR 1.74, 95%CI 1.15, 2.64, p = 0.01) were associated with higher odds of MVM. Rates of severe non-neurological morbidity were highest in the MVM, FVM, and CHI cohorts (44.8 %, 50 %, and 50 % respectively). CONCLUSION MVM was the commonest placental abnormality in FGR, particularly in early-onset disease. Low maternal PlGF levels, high sFlt-1 levels, elevated sFlt-1/PlGF ratio, and abnormal fetoplacental Dopplers were also significantly associated with MVM. MVM, FVM, and CHI abnormalities were associated with lower median birthweight, higher rates of preterm birth, operative birth for non-reassuring fetal status, and severe neonatal non-neurological morbidity.
Collapse
Affiliation(s)
- Jesrine Hong
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kylie Crawford
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Matthew Daly
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Vicki Clifton
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Fabricio da Silva Costa
- School of Medicine and Dentistry, Griffith University and Maternal Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Anthony V Perkins
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Admire Matsika
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Rohan Lourie
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
| |
Collapse
|
2
|
Stanek J. Clinical Significance of the Large Fetal Vessel Lesions in Placental Fetal Vascular Malperfusion. J Transl Med 2024; 104:102089. [PMID: 38810837 DOI: 10.1016/j.labinv.2024.102089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/26/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
Fetal vascular malperfusion (FVM) is an important pattern of placental injury. Although the significance of distal villous FVM (clusters of sclerotic and/or mineralized chorionic villi) is well documented, the clinical significance of proximal (large vessel) lesions of FVM is less clear, which is the aim of this retrospective analysis. To evaluate the clinical significance and placental associations of single and coexisting categories of lesions of large vessel FVM, 24 clinical and 44 placental phenotypes of 804 consecutive placentas with at least 1 lesion of proximal vessel FVM from the second half of pregnancy, divided according to the type or category of the individual FVM lesion (fetal vascular ectasia, fetal vascular thrombi, intramural fibrin deposition, and stem vessel obliteration): 689, 341, 286, and 267 placentas, respectively (first analysis) and single or coexisting large fetal vessel lesions (1, 2, 3, and 4 coexisting categories of lesions: 276, 321, 162, and 45 placentas, respectively) were statistically compared (analysis of variance, χ2, univariate analysis). Because of multiple comparisons, Bonferroni-corrected P < .001 was used as a threshold of statistical significance. In this population of high-risk pregnancies dominated by fetal congenital anomalies, single individual or 1 to 2 coexisting categories of lesions of the large vessel FVM, including fetal vascular thrombi, did not consistently correlate with clinical or placental variables and were not prognostically useful, but the coexistence of 3 or 4 lesions was associated with the most advanced gestational age, fetal congenital anomalies, distal villous FVM, particularly high-grade, chorangioma or chorangiomatosis, hypercoiled umbilical cord, perivascular stem edema, and marginate or vallate placenta. Therefore, the finding of multiple lesions of the large vessel FVM not only merits a diligent search for the distal villous lesions including the CD34 immunostaining, but also justifies putting the large vessel (global) FVM on the final placental diagnosis line, which in the case of up to only 2 lesions may not be justified.
Collapse
Affiliation(s)
- Jerzy Stanek
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
3
|
Stanek J. Single Umbilical Artery Umbilical Cord Is Associated With High-Grade Distal Fetal Vascular Malperfusion. Pediatr Dev Pathol 2024; 27:52-58. [PMID: 37771135 DOI: 10.1177/10935266231200013] [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] [Indexed: 09/30/2023]
Abstract
PURPOSE AND CONTEXT Umbilical cord abnormalities with clinical signs of cord compromise are frequently associated with fetal vascular malperfusion (FVM). Single umbilical artery (SUA) has been reported to be associated with high-grade FVM in fetal growth restriction but not in an unselected population; our study aimed to address this issue. METHODS Clinical and placental phenotypes of 55 consecutive placentas with SUA (Group 1) were compared with those of 655 placentas with 3-vessel umbilical cord (Group 2) from patients who were in the second half of their pregnancy. The placentas were histologically examined using hematoxylin and eosin (H&E) staining and CD 34 immunostaining. KEY RESULTS Several umbilical cord phenotypes and high-grade distal FVM, based on H&E staining and endothelial fragmentation by CD34 were significantly more common in Group 1, whereas decidual clusters of multinucleate trophoblasts were more common in Group 2. Notably, H&E staining or CD34 immunostaining evaluated separately showed that high-grade distal FVM was more common in Group 1 than in Group 2, but the difference was not statistically significant. CONCLUSIONS SUA predisposes to remote, advanced, and recent high-grade distal villous FVM, with a pathogenesis partly different from that of stasis-induced FVM, likely related to fetal anomalies associated with SUA.
Collapse
Affiliation(s)
- Jerzy Stanek
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
4
|
Zhang D, Lindsey SE. Recasting Current Knowledge of Human Fetal Circulation: The Importance of Computational Models. J Cardiovasc Dev Dis 2023; 10:240. [PMID: 37367405 PMCID: PMC10299027 DOI: 10.3390/jcdd10060240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Computational hemodynamic simulations are becoming increasingly important for cardiovascular research and clinical practice, yet incorporating numerical simulations of human fetal circulation is relatively underutilized and underdeveloped. The fetus possesses unique vascular shunts to appropriately distribute oxygen and nutrients acquired from the placenta, adding complexity and adaptability to blood flow patterns within the fetal vascular network. Perturbations to fetal circulation compromise fetal growth and trigger the abnormal cardiovascular remodeling that underlies congenital heart defects. Computational modeling can be used to elucidate complex blood flow patterns in the fetal circulatory system for normal versus abnormal development. We present an overview of fetal cardiovascular physiology and its evolution from being investigated with invasive experiments and primitive imaging techniques to advanced imaging (4D MRI and ultrasound) and computational modeling. We introduce the theoretical backgrounds of both lumped-parameter networks and three-dimensional computational fluid dynamic simulations of the cardiovascular system. We subsequently summarize existing modeling studies of human fetal circulation along with their limitations and challenges. Finally, we highlight opportunities for improved fetal circulation models.
Collapse
Affiliation(s)
| | - Stephanie E. Lindsey
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, CA 92093, USA;
| |
Collapse
|
5
|
Lebas H, Boutigny A, Maupu C, Salfati J, Orset C, Mazighi M, Bonnin P, Boulaftali Y. Imaging Cerebral Arteries Tortuosity and Velocities by Transcranial Doppler Ultrasound Is a Reliable Assessment of Brain Aneurysm in Mouse Models. STROKE (HOBOKEN, N.J.) 2023; 3:e000476. [PMID: 37496732 PMCID: PMC10368188 DOI: 10.1161/svin.122.000476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 07/28/2023]
Abstract
Background During the past few decades, several pathophysiological processes contributing to intracranial aneurysm (IA) rupture have been identified, including irregular IA shape, altered hemodynamic stress within the IA, and vessel wall inflammation. The use of preclinical models of IA and imaging tools is paramount to better understand the underlying disease mechanisms. Methods We used 2 established mouse models of IA, and we analyzed the progression of the IA by magnetic resonance imaging, transcranial Doppler, and histology. Results In both models of IA, we observed, by transcranial Doppler, a significant decrease of the blood velocities and wall shear stress of the internal carotid arteries. We also observed the formation of tortuous arteries in both models that were correlated with the presence of an aneurysm as confirmed by magnetic resonance imaging and histology. A high grade of tortuosity is associated with a significant decrease of the mean blood flow velocities and a greater artery dilation. Conclusions Transcranial Doppler is a robust and convenient imaging method to evaluate the progression of IA. Detection of decreased blood flow velocities and increased tortuosity can be used as reliable indicators of IA.
Collapse
Affiliation(s)
- Héloïse Lebas
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
| | - Alexandre Boutigny
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
- Service de Physiologie Clinique Explorations FonctionnellesAP‐HPHôpital Lariboisière–F WidalParisFrance
| | - Clémence Maupu
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
| | - Jonas Salfati
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
| | - Cyrille Orset
- UMR‐S U1237 “Physiopathology and Imaging of Neurological Disorders,”Centre CYCERONCaenFrance
| | - Mikael Mazighi
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
- Département de Neuroradiologie Interventionnelle de la Fondation Rothschild et Département de NeurologieHôpital LariboisièreParisFrance
| | - Philippe Bonnin
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
- Service de Physiologie Clinique Explorations FonctionnellesAP‐HPHôpital Lariboisière–F WidalParisFrance
| | - Yacine Boulaftali
- INSERM U1148Laboratory for Vascular Translational ScienceUniversité de Paris and Université Sorbonne Paris NordParisFrance
| |
Collapse
|
6
|
Wu X, Wei C, Chen R, Yang L, Huang W, Huang L, Yan X, Deng X, Gou Z. Fetal umbilical artery thrombosis: prenatal diagnosis, treatment and follow-up. Orphanet J Rare Dis 2022; 17:414. [PMID: 36371215 PMCID: PMC9652808 DOI: 10.1186/s13023-022-02563-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To analyze the ultrasound imaging and clinical characteristics of fetuses with umbilical artery thrombosis (UAT), explore the potential causes of UAT and construct a prognostic prediction model to guide clinical practice. METHODS This was a retrospective cohort study of fetal UAT cases examined at two academic tertiary referral care centers from 2014 to 2020. The basic information of the participants was obtained by interview during follow-up, and data on clinical treatment, delivery conditions, diagnosis and confirmation were obtained through medical records. Probable causes of thrombosis were explored by comparative analysis of the UAT group to the control group and by further regression analysis. Multivariable logistic regression models were used to evaluate risk factors for adverse pregnancy outcomes. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the prognostic prediction model. RESULTS Thirty fetuses with UAT were included in this study. UAT occurred mostly in the third trimester of pregnancy, and there was an obvious predominance of right UAT. An abnormal pregnancy history (53.3%) was the most common comorbidity, followed by gestational diabetes mellitus (GDM) (20.0%). GDM and umbilical cord (UC) abnormalities were found to be independent risk factors for the development of UAT. After comprehensive decision-making, over two-thirds of the patients with UAT received urgent treatment, and less than one-third received expectant management. Surprisingly, there were no significant differences in fetal outcomes between the urgent treatment and expectant management groups. Multivariate logistic regression analysis showed that gestational age (GA) at clinical diagnosis and UC abnormalities were independent risk factors for adverse pregnancy outcomes (OR 0.781, p = 0.042; OR 16.779, p = 0.023, respectively). Based on this, we constructed a comprehensive prognostic prediction model. The area under the ROC curve (AUC) was 0.877 (95% CI 0.698-0.970; p < 0.001), which suggested that the combination of GA and UC abnormalities was a better predictor for fetal outcomes in our setting. CONCLUSION In summary, maternal GDM and fetal UC abnormalities are independent risk factors for UAT. UAT is more frequently observed on the right side. Moreover, poor clinical outcomes for fetuses with UAT are ascribed mainly to GA and UC abnormalities, which should be comprehensively evaluated to choose the appropriate treatment.
Collapse
Affiliation(s)
- Xiafang Wu
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Chenchen Wei
- grid.89957.3a0000 0000 9255 8984Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Ruifeng Chen
- grid.452210.0Department of Ultrasonography, Affiliated Changsha Central Hospital of South China University, Changsha, Hunan China
| | - Linxian Yang
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Weifei Huang
- grid.469636.8Department of Ultrasonography, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang China
| | - Liang Huang
- grid.513202.7Department of Ultrasonography, Tongren People’s Hospital, Tongren, Guizhou, China
| | - XinXin Yan
- grid.89957.3a0000 0000 9255 8984Department of Pharmacology, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Xuedong Deng
- grid.89957.3a0000 0000 9255 8984Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| | - Zhongshan Gou
- grid.89957.3a0000 0000 9255 8984Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, 242# Guangji Road, Suzhou, 215002 Jiangsu China
| |
Collapse
|
7
|
Naftali S, Ashkenazi YN, Ratnovsky A. A novel approach based on machine learning analysis of flow velocity waveforms to identify unseen abnormalities of the umbilical cord. Placenta 2022; 127:20-28. [DOI: 10.1016/j.placenta.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022]
|
8
|
van Willigen BG, van der Hout-van der Jagt MB, Huberts W, van de Vosse FN. A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system. Front Pediatr 2022; 10:915846. [PMID: 36210952 PMCID: PMC9532745 DOI: 10.3389/fped.2022.915846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preterm birth is the main cause of neonatal deaths with increasing mortality and morbidity rates with decreasing GA at time of birth. Currently, premature infants are treated in neonatal intensive care units to support further development. However, the organs of, especially, extremely premature infants (born before 28 weeks of GA) are not mature enough to function optimally outside the womb. This is seen as the main cause of the high morbidity and mortality rates in this group. A liquid-filled incubator, a so-called PLS system, could potentially improve these numbers for extremely premature infants, since this system is designed to mimic the environment of the natural womb. To support the development and implementation of such a complex system and to interpret vital signals of the fetus during a PLS system operation, a digital twin is proposed. This mathematical model is connected with a manikin representing the digital and physical twin of the real-life PLS system. Before developing a digital twin of a fetus in a PLS system, its functional and technical requirements are defined and existing mathematical models are evaluated. METHOD AND RESULTS This review summarizes existing 0D and 1D fetal circulatory models that potentially could be (partly) adopted for integration in a digital twin of a fetus in a PLS system based on predefined requirements. The 0D models typically describe hemodynamics and/or oxygen transport during specific events, such as the transition from fetus to neonate. Furthermore, these models can be used to find hemodynamic differences between healthy and pathological physiological states. Rather than giving a global description of an entire cardiovascular system, some studies focus on specific organs or vessels. In order to analyze pressure and flow wave profiles in the cardiovascular system, transmission line or 1D models are used. As for now, these models do not include oxygen transport. CONCLUSION This study shows that none of the models identified in literature meet all the requirements relevant for a digital twin of a fetus in a PLS system. Nevertheless, it does show the potential to develop this digital twin by integrating (parts) of models into a single model.
Collapse
Affiliation(s)
- Bettine G van Willigen
- Cardiovascular Biomechanics, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Cardiovascular Biomechanics, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands.,Signal Processing Systems, Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wouter Huberts
- Cardiovascular Biomechanics, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| |
Collapse
|
9
|
Saw SN, Dai Y, Yap CH. A Review of Biomechanics Analysis of the Umbilical-Placenta System With Regards to Diseases. Front Physiol 2021; 12:587635. [PMID: 34475826 PMCID: PMC8406807 DOI: 10.3389/fphys.2021.587635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Placenta is an important organ that is crucial for both fetal and maternal health. Abnormalities of the placenta, such as during intrauterine growth restriction (IUGR) and pre-eclampsia (PE) are common, and an improved understanding of these diseases is needed to improve medical care. Biomechanics analysis of the placenta is an under-explored area of investigation, which has demonstrated usefulness in contributing to our understanding of the placenta physiology. In this review, we introduce fundamental biomechanics concepts and discuss the findings of biomechanical analysis of the placenta and umbilical cord, including both tissue biomechanics and biofluid mechanics. The biomechanics of placenta ultrasound elastography and its potential in improving clinical detection of placenta diseases are also discussed. Finally, potential future work is listed.
Collapse
Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yichen Dai
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Estimating umbilical cord flow resistance from measurements of the whole cord. Placenta 2020; 103:180-187. [PMID: 33160251 DOI: 10.1016/j.placenta.2020.09.066] [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: 04/27/2020] [Revised: 09/09/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022]
Abstract
Measuring umbilical blood pressure in utero is challenging and for this reason non-invasive methods are required. However, the total vessel blood pressure drop can be estimated using numerical and empirical results by studying the mechanics of fluids in coiled and straight tubes. Two key findings emerge from such an analysis. Firstly, the total pressure drop along a vessel at a given blood flow-rate depends on both the tightness of the coils and the total cord length. Relatively short and straight cords exhibit low pressure, while long, tightly coiled cords with large width exhibit high pressure. It follows that an estimate of the pressure requires three measurements: the full cord length, its average width and number of coils. Using this result we propose two prototype indices for clinical testing that estimate umbilical cord flow resistance. The umbilical pressure index (PX) and flow index (QX) quantify the deviation of a cord geometry from defined typical conditions by considering the steady pressure drop and flow-rate, respectively. These indices can be quickly calculated, and require only a single additional measurement to the conventional umbilical coiling index (UCI); namely the cord coiling width. Unlike the UCI, these indices are derived from blood-flow properties and provide a measure of the relative flow-resistance inherent to a cord geometry. Furthermore, the pressure index can be applied to irregularities, including loose true knots, which we show must be accounted for.
Collapse
|
12
|
Kasiteropoulou D, Topalidou A, Downe S. A computational fluid dynamics modelling of maternal-fetal heat exchange and blood flow in the umbilical cord. PLoS One 2020; 15:e0231997. [PMID: 32722669 PMCID: PMC7386597 DOI: 10.1371/journal.pone.0231997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/18/2022] Open
Abstract
Human fetal thermoregulation, maternal-fetal heat exchange, and the role of the umbilical cord in these processes are not well understood. Ethical and technical limitations have restricted current knowledge to animal studies, that do not reflect human morphology. Here, we present the first 3-dimensional computational model of the human umbilical cord with finite element analysis, aiming to compute the maternal-fetal heat exchange. By modelling both the umbilical vein and the two umbilical arteries, we found that the coiled geometry of the umbilical artery, in comparison with the primarily straight umbilical vein, affects blood flow parameters such as velocity, pressure, temperature, shear strain rate and static entropy. Specifically, by enhancing the heat transfer coefficient, we have shown that the helical structure of the umbilical arteries plays a vital role in the temperature drop of the blood, along the arterial length from the fetal end to the placental end. This suggests the importance of the umbilical cord structure in maternal-fetal heat exchange and fetal heat loss, opening the way for future research with modified models and scenarios, as the basis for early detection of potential heat-transfer related complications, and/or assurance of fetal wellbeing.
Collapse
Affiliation(s)
| | - Anastasia Topalidou
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Sharzehee M, Fatemifar F, Han HC. Computational simulations of the helical buckling behavior of blood vessels. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3277. [PMID: 31680465 PMCID: PMC7286361 DOI: 10.1002/cnm.3277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 08/27/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
Tortuous vessels are often observed in vivo and could hinder or even disrupt blood flow to distal organs. Besides genetic and biological factors, the in vivo mechanical loading seems to play a role in the formation of tortuous vessels, but the mechanism for formation of helical vessel shape remains unclear. Accordingly, the aim of this study was to investigate the biomechanical loads that trigger the occurrence of helical buckling in blood vessels using finite element analysis. Porcine carotid arteries were modeled as thick-walled cylindrical tubes using generalized Fung and Holzapfel-Gasser-Ogden constitutive models. Physiological loadings, including axial tension, lumen pressure, and axial torque, were applied. Simulations of various geometric dimensions, different constitutive models and at various levels of axial stretch ratios, lumen pressures, and twist angles were performed to identify the mechanical factors that determine the helical stability. Our results demonstrated that axial torsion can cause wringing (twist buckling) that leads to kinking or helical coiling and even looping and winding. The specific buckling patterns depend on the combination of lumen pressure, axial torque, axial tension, and the dimensions of the vessels. This study elucidates the mechanism of how blood vessels buckle under various mechanical loads and how complex mechanical loads yield helical buckling.
Collapse
Affiliation(s)
- Mohammadali Sharzehee
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Fatemeh Fatemifar
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Hai-Chao Han
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- Biomedical Engineering Program, UTSA-UTHSCSA, San Antonio, TX
| |
Collapse
|
15
|
Brunelli R, De Spirito M, Giancotti A, Palmieri V, Parasassi T, Di Mascio D, Flammini G, D'Ambrosio V, Monti M, Boccaccio A, Pappalettere C, Ficarella E, Papi M, Lamberti L. The biomechanics of the umbilical cord Wharton Jelly: Roles in hemodynamic proficiency and resistance to compression. J Mech Behav Biomed Mater 2019; 100:103377. [PMID: 31398692 DOI: 10.1016/j.jmbbm.2019.103377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/21/2019] [Accepted: 07/30/2019] [Indexed: 11/15/2022]
Abstract
The umbilical cord is a complex structure containing three vessels, one straight vein and two coiled arteries, encased by the Wharton Jelly (WJ) a spongy structure made of collagen and hydrated macromolecules. Fetal blood reaches the placenta through the arteries and flows back to the fetus through the vein. The role of the WJ in maintaining cord circulation proficiency and the ultimate reason for arterial coiling still lack of reasonable mechanistic interpretations. We performed biaxial tension tests and evidenced significant differences in the mechanical properties of the core and peripheral WJ. The core region, located between the arteries and the vein, resulted rather stiffer close to the fetus. Finite element modelling and optimization based inverse method were used to create 2D and 3D models of the cord and to simulate stress distribution in different hemodynamic conditions, compressive loads and arterial coiling. We recorded a facilitated stress transmission from the arteries to the vein through the soft core of periplacental WJ. This condition generates a pressure gradient that boosts the venous backflow circulation towards the fetus. Peripheral WJ allows arteries to act as pressure buffering chambers during the cardiac diastole and helps to dissipate compressive forces away from vessels. Altered WJ biomechanics may represent the structural basis of cord vulnerability in many high-risk clinical conditions.
Collapse
Affiliation(s)
- R Brunelli
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - M De Spirito
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A Giancotti
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - V Palmieri
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - T Parasassi
- Istituto di Farmacologia Traslazionale, CNR, Roma, Italy
| | - D Di Mascio
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - G Flammini
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - V D'Ambrosio
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - M Monti
- Dipartimento Materno Infantile e Scienze Urologiche, Università Sapienza, Roma, Italy
| | - A Boccaccio
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, Bari, Italy
| | - C Pappalettere
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, Bari, Italy
| | - E Ficarella
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, Bari, Italy
| | - M Papi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - L Lamberti
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, Bari, Italy
| |
Collapse
|
16
|
Jensen OE, Chernyavsky IL. Blood flow and transport in the human placenta. ANNUAL REVIEW OF FLUID MECHANICS 2019; 51:25-47. [PMID: 38410641 PMCID: PMC7615669 DOI: 10.1146/annurev-fluid-010518-040219] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The placenta is a multi-functional organ that exchanges blood gases and nutrients between a mother and her developing fetus. In humans, fetal blood flows through intricate networks of vessels confined within villous trees, the branches of which are bathed in pools of maternal blood. Fluid mechanics and transport processes play a central role in understanding how these elaborate structures contribute to the function of the placenta, and how their disorganization may lead to disease. Recent advances in imaging and computation have spurred significant advances in simulations of fetal and maternal flows within the placenta, across a range of lengthscales. Models describe jets of maternal blood emerging from spiral arteries into a disordered and deformable porous medium, and solute uptake by fetal blood flowing through elaborate three-dimensional capillary networks. We survey recent developments and emerging challenges in modeling flow and transport in this complex organ.
Collapse
Affiliation(s)
| | - Igor L. Chernyavsky
- School of Mathematics, University of Manchester, UK
- Maternal and Fetal Health Research Centre, Division of Developmental
Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine
& Health, University of Manchester, UK
| |
Collapse
|
17
|
Advances in Human Placental Biomechanics. Comput Struct Biotechnol J 2018; 16:298-306. [PMID: 30181841 PMCID: PMC6120428 DOI: 10.1016/j.csbj.2018.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/21/2022] Open
Abstract
Pregnancy complications are a major clinical concern due to the related maternal and fetal morbidity. Many are caused through defective placentation, but research into placental function is difficult, principally because of the ethical limitations associated with the in-vivo organ and the difficulty of extrapolating animal models. Perfused by two separate circulations, the maternal and fetal bloodstreams, the placenta has a unique structure and performs multiple complex functions. Three-dimensional imaging and computational modelling are becoming popular tools to investigate the morphology and physiology of this organ. These techniques bear the potential for better understanding the aetiology and development of placental pathologies, however, their full potential is yet to be exploited. This review aims to summarize the recent insights into placental structure and function by employing these novel techniques.
Collapse
|
18
|
Wilke DJ, Denier JP, Khong TY, Mattner TW. Pressure and flow in the umbilical cord. J Biomech 2018; 79:78-87. [PMID: 30146174 DOI: 10.1016/j.jbiomech.2018.07.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
A fluid dynamic study of blood flow within the umbilical vessels of the human maternal-fetal circulatory system is considered. It is found that the umbilical coiling index (UCI) is unable to distinguish between cords of significantly varying pressure and flow characteristics, which are typically determined by the vessel curvature, torsion and length. Larger scale geometric non-uniformities superposed over the inherent coiling, including cords exhibiting width and/or local UCI variations as well as loose true knots, typically produce a small effect on the total pressure drop. Crucially, this implies that a helical geometry of mean coiling may be used to determine the steady vessel pressure drop through a more complex cord. The presence of vessel constriction, however, drastically increases the steady pressure drop and alters the flow profile. For pulsatile-flow within the arteries, the steady pressure approximates the time-averaged value with high accuracy over a wide range of cords. Furthermore, the relative peak systolic pressure measured over the period is virtually constant and approximately 25% below the equivalent straight-pipe value for a large range of non-straight vessels. Interestingly, this suggests that the presence of vessel helicity dampens extreme pressures within the arterial cycle and may provide another possible evolutionary benefit to the coiled structure of the cord.
Collapse
Affiliation(s)
- D J Wilke
- School of Mathematical Sciences, The University of Adelaide, Australia
| | - J P Denier
- Department of Mathematics, Macquarie University, Australia.
| | - T Y Khong
- School of Medicine, The University of Adelaide, Australia.
| | - T W Mattner
- School of Mathematical Sciences, The University of Adelaide, Australia.
| |
Collapse
|
19
|
Gemert MJCV, Wijngaard JPHMVD, Paarlberg KM, Gardiner HM, Nikkels PGJ. Acardiac twin pregnancies part IV: Acardiac onset from unequal embryonic splitting simulated by a fetoplacental resistance model. Birth Defects Res 2018; 109:211-223. [PMID: 27891739 DOI: 10.1002/bdra.23581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Benirschke postulated that acardiac twinning occurs when markedly unequal embryonic splitting combines with arterioarterial (AA) and venovenous placental anastomoses. We tested this hypothesis by model simulations and by comparison of outcomes with 18 "pseudo-" (twin fetus with beating heart but otherwise with clear signs of an acardiac) and 3 "normal" acardiac cases. METHODS The smaller/larger cell volume ratio at embryonic splitting becomes the smaller/larger embryonic/fetal blood volume ratio (a). From a, we derived nonpulsating blood pressures using normal values (larger twin) and normal values at an appropriate earlier gestational age (smaller twin). These unequal pressure sources were used in a linear resistance fetoplacental network to calculate umbilical venous diameter ratios. Acardiac onset occurs when the smaller twin has 50% left of its normal, singleton placenta. Comparison with clinical cases approximated a by crown-rump-length-ratio to the 3rd power. Input parameters are a and the AA-radius at 40 weeks. RESULTS Acardiacs can be small or large, can occur early or late, earlier at smaller a and larger AA, with larger umbilical venous diameter ratios at smaller a and smaller AA. Comparison with the 21 clinical cases was good, except for 2. CONCLUSION Our analysis supports Benirschke's hypothesis. The smaller twin has to share its placental perfusion with the larger twin, which is a novel finding. The AA size is essential for the future of both fetuses but complicates easy understanding of (pseudo-)acardiac clinical presentations. Late acardiac onset occurs infrequently. Using nonpulsating circulations may have caused our extensive predictions of late onset. An improved model requires including hypoxemia in the smaller twin from chronic placental hypoperfusion. Birth Defects Research 109:211-223, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Martin J C van Gemert
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen P H M van den Wijngaard
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - K Marieke Paarlberg
- Department of Obstetrics and Gynecology, Gelre Hospitals, location Apeldoorn, The Netherlands
| | - Helena M Gardiner
- The Fetal Center, McGovern Medical School at UTHealth, University of Texas, Houston, TX, USA
| | - Peter G J Nikkels
- Department of Pathology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
20
|
Xu P, Xie R, Liu Y, Luo G, Ding M, Liang Q. Bioinspired Microfibers with Embedded Perfusable Helical Channels. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2017; 29. [PMID: 28639435 DOI: 10.1002/adma.201701664] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/17/2017] [Indexed: 05/23/2023]
Abstract
Materials with microchannels have attracted increasing attention due to their promising perfusability and biomimetic geometry. However, the fabrication of microfibers with more geometrically complex channels in the micro- or nanoscale remains a big challenge. Here, a novel method for generating scalable microfibers with consecutive embedded helical channels is presented using an easily made coaxial microfluidic device. The characteristics of the helical channel can be accurately controlled by simply adjusting the flow rate ratio of the fluids. The mechanism of the helix formation process is theorized with newly proposed heterogenerated rope-coil effect, which enhances the tunability of helical patterns and promotes the comprehension of this abnormal phenomenon. Based on this effect, microfibers with embedded Janus channels and even double helical channels are generated in situ by changing the design of the device. The uniqueness and potential applications of these tubular microfibers are also demonstrated by biomimetic supercoiling structures as well as the perfusable and permeable spiral vessel.
Collapse
Affiliation(s)
- Peidi Xu
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Ruoxiao Xie
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Yupeng Liu
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Guoan Luo
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Mingyu Ding
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Qionglin Liang
- Key Laboratory of Chemical Biology (Ministry of Education), Beijing Key Laboratory of Microanalytical Methods & Instrumentation, Department of Chemistry, Tsinghua University, Beijing, 100084, China
| |
Collapse
|
21
|
Shah RG, Girardi T, Merz G, Necaise P, Salafia CM. Hemodynamic analysis of blood flow in umbilical artery using computational modeling. Placenta 2017; 57:9-12. [PMID: 28864024 DOI: 10.1016/j.placenta.2017.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/16/2017] [Accepted: 05/27/2017] [Indexed: 11/27/2022]
Abstract
The umbilical cord is the crucial pathway for blood flow between the fetus and the placenta. Umbilical coiling and length have been separately linked to adverse clinical outcomes; however, the effects of variations of these parameters on umbilical arterial blood flow are not well understood. Using 3D computational model, we studied the individual and combined effects of umbilical coiling index, cord length and arterial diameter on umbilical artery hemodynamics. We found that specific combinations of umbilical coiling index, cord length and arterial diameter yielded pressure and flow drops incompatible with fetal life. Such models are useful as hypothesis-developing tools.
Collapse
Affiliation(s)
| | | | - George Merz
- Institute for Basic Research, Staten Island, NY, USA
| | | | - Carolyn M Salafia
- Placental Analytics, LLC, New Rochelle, NY, USA; Institute for Basic Research, Staten Island, NY, USA.
| |
Collapse
|
22
|
Saw SN, Dawn C, Biswas A, Mattar CNZ, Yap CH. Characterization of the in vivo wall shear stress environment of human fetus umbilical arteries and veins. Biomech Model Mechanobiol 2016; 16:197-211. [DOI: 10.1007/s10237-016-0810-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
|
23
|
Sugimoto M, Panuccio G, Bisdas T, Berekoven B, Torsello G, Austermann M. Tortuosity is the Significant Predictive Factor for Renal Branch Occlusion after Branched Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2016; 51:350-7. [DOI: 10.1016/j.ejvs.2015.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/12/2015] [Indexed: 11/24/2022]
|
24
|
Effects of Vessel Tortuosity on Coronary Hemodynamics: An Idealized and Patient-Specific Computational Study. Ann Biomed Eng 2015; 44:2228-39. [PMID: 26498931 DOI: 10.1007/s10439-015-1492-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
Abstract
Although coronary tortuosity can influence the hemodynamics of coronary arteries, the relationship between tortuosity and flow has not been thoroughly investigated partly due to the absence of a widely accepted definition of tortuosity and the lack of patient-specific studies that analyze complete coronary trees. Using a computational approach we investigated the effects of tortuosity on coronary flow parameters including pressure drop, wall shear stress, and helical flow strength as measured by helicity intensity. Our analysis considered idealized and patient-specific geometries. Overall results indicate that perfusion pressure decreases with increased tortuosity, but the patient-specific results show that more tortuous vessels have higher physiological wall shear stress values. Differences between the idealized and patient-specific results reveal that an accurate representation of coronary tortuosity must account for all relevant geometric aspects, including curvature imposed by the heart shape. The patient-specific results exhibit a strong correlation between tortuosity and helicity intensity, and the corresponding helical flow contributes directly to the observed increase in wall shear stress. Therefore, helicity intensity may prove helpful in developing a universal parameter to describe tortuosity and assess its impact on patient health. Our data suggest that increased tortuosity could have a deleterious impact via a reduction in coronary perfusion pressure, but the attendant increase in wall shear stress could afford protection against atherosclerosis.
Collapse
|
25
|
Serov AS, Salafia C, Grebenkov DS, Filoche M. The role of morphology in mathematical models of placental gas exchange. J Appl Physiol (1985) 2015; 120:17-28. [PMID: 26494446 DOI: 10.1152/japplphysiol.00543.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023] Open
Abstract
The performance of the placenta as a gas exchanger has a direct impact on the future health of the newborn. To provide accurate estimates of respiratory gas exchange rates, placenta models need to account for both the physiology of exchange and the organ morphology. While the former has been extensively studied, accounting for the latter is still a challenge. The geometrical complexity of placental structure requires use of carefully crafted approximations. We present here the state of the art of respiratory gas exchange placenta modeling and demonstrate the influence of the morphology description on model predictions. Advantages and shortcomings of various classes of models are discussed, and experimental techniques that may be used for model validation are summarized. Several directions for future development are suggested.
Collapse
Affiliation(s)
- A S Serov
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
| | - C Salafia
- Placental Analytics, LLC, Larchmont, New York
| | - D S Grebenkov
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
| | - M Filoche
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
| |
Collapse
|
26
|
Abstract
Cases of unexplained intrauterine fetal death (IUFD) can be reduced by full placental examination, with or without autopsy. Determination of the umbilical coiling index (UCI) is considered to be a part of full placental examination. Umbilical hypercoiling (UCI above 0.30 coils/cm) is associated with IUFD. In a large retrospective study, we found an incidence of 18% umbilical hypercoiling in IUFD. We explored the association between umbilical hypercoiling and 2nd- and 3rd-trimester IUFD in 77 cases. There was a significant negative correlation between the UCI and gestational age of IUFD (P<0.001). More severe cases of hypercoiling were observed in the categories of IUFD at a younger age and with a longer duration. Signs of fetal thrombosis were significantly more present in IUFDs with umbilical hypercoiling. An umbilical cord stricture and hypercoiling seem to be significantly more common in IUFD. The severity of hypercoiling was of no influence on the presence or absence of an umbilical cord stricture. Furthermore, there was no significant difference in signs of cardiac failure between the groups of IUFD with and without umbilical hypercoiling. Our findings may be explained by the theory that hypercoiling leads to a disturbed fetal-placental circulation. Therefore, determination of the UCI should be part of the routine placental examination of cases of IUFD.
Collapse
Affiliation(s)
- Annemiek C Dutman
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
27
|
Abstract
INTRODUCTION The aim of this study was to analyze abnormalities of umbilical coiling index (UCI) in twin gestation to test whether the coiling is genetically influenced by zygosity. METHODS Data retrieved comprised gestational age (GA), chorionicity, fetal gender, and UCI. RESULTS The mean UCI of hypercoiled cords in monochorionic placentas was 0.55 coils/cm and 0.49 coils/cm in dichorionic placentas with discordant fetal gender (P = 0.2629). DISCUSSION In conclusion, no significant statistical difference between UCI in monochorionic and dichorionic twin placentas with discordant fetal gender was identified, suggesting that zygosity does not play a role in umbilical coiling induction.
Collapse
Affiliation(s)
- André Joannou Coetzee
- a Department of Histopathology , Sheffield Children's Hospital , Western Bank , United Kingdom
| | - Eumenia Castro
- b Department of Pathology and Immunology , Texas Childrens Hospital , Houston , Texas , USA
| | - Luiz Cesar Peres
- a Department of Histopathology , Sheffield Children's Hospital , Western Bank , United Kingdom
| |
Collapse
|
28
|
Gross patterns of umbilical cord coiling: Correlations with placental histology and stillbirth. Placenta 2013; 34:583-8. [DOI: 10.1016/j.placenta.2013.04.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/21/2022]
|
29
|
Abstract
Arteries are under significant mechanical loads from blood pressure, flow, tissue tethering, and body movement. It is critical that arteries remain patent and stable under these loads. This review summarizes the common forms of buckling that occur in blood vessels including cross-sectional collapse, longitudinal twist buckling, and bent buckling. The phenomena, model analyses, experimental measurements, effects on blood flow, and clinical relevance are discussed. It is concluded that mechanical buckling is an important issue for vasculature, in addition to wall stiffness and strength, and requires further studies to address the challenges. Studies of vessel buckling not only enrich vascular biomechanics but also have important clinical applications.
Collapse
|
30
|
Patterns of placental pathology in preterm infants with a periventricular haemorrhagic infarction: Association with time of onset and clinical presentation. Placenta 2012; 33:839-44. [DOI: 10.1016/j.placenta.2012.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/04/2012] [Accepted: 06/19/2012] [Indexed: 11/22/2022]
|
31
|
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.
Collapse
Affiliation(s)
- T Y Khong
- SA Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
| |
Collapse
|
32
|
Langer HE, Birth U. [Patient education in chronic polyarthritis. 3. Intermediate results of a prospective, controlled study of the effectiveness and side effects of patient seminars for polyarthritis patients]. Z Rheumatol 1988; 49:185-97. [PMID: 3369246 DOI: 10.1159/000335123] [Citation(s) in RCA: 301] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/11/2011] [Indexed: 01/13/2023]
Abstract
Efficacy and possible negative side effects of a patient education program for rheumatoid arthritis were evaluated in a controlled, prospective study over 3 months. 34 outpatients were educated over a total of 8 h in three groups within a patient-centred design. Before the program the knowledge of the disease depended only on the formal grade of education but not on disease-related variables such as disease duration or disability. Probably due to its individualizing method, the program improved the knowledge of all patients to the same extent, regardless of their intellectual and social prerequisites. The increased cognitive knowledge did not result in negative side effects like increased pain or depression. The pain score remained unchanged. Depression decreased after the education. The group sessions made us suppose that the participants may have represented a selected group of active, psychologically stable patients, who cope well with rheumatoid arthritis. In contrast, we felt that non-participation was the response of the inactive, fatalistic patients with rheumatoid arthritis, who live in social isolation and especially need our care. Therefore, future efforts must particularly focus on the problem of motivation and on an increase in the rate of participation.
Collapse
Affiliation(s)
- H E Langer
- Abteilung Krankheiten der Bewegungsorgane und des Stoffwechsels, Medizinischen Hochschule Hannover
| | | |
Collapse
|
33
|
Scull SA, Dow MB, Athreya BH. Physical and occupational therapy for children with rheumatic diseases. J Biomech Eng 1986; 133:121004. [PMID: 3489919 DOI: 10.1115/1.4005478] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Total management of rheumatic disorders of children includes antiinflammatory drugs, active therapy, maintenance of ADLs, and attention to the psychosocial development of the child. This article focuses on the role that physical and occupational therapists play in the management of children with arthritis. The complexity of the problems of these children necessitates a multidisciplinary team approach, with professionals who are committed to helping the child lead as normal a life as possible. This objective can be accomplished only by teaching families and school personnel how to manage the child's daily therapeutic needs.
Collapse
|