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Hanna M, Martini N, Deeb Y, Mahmoud W, Issa SY. A misdiagnosed case of a 150-cm umbilical cord coiled twice around the fetal neck with a true cord knot: A rare Syrian case report. SAGE Open Med Case Rep 2023; 11:2050313X231164858. [PMID: 37032995 PMCID: PMC10074614 DOI: 10.1177/2050313x231164858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
The normal umbilical cord is a crucial component during pregnancy, but sometimes it could become compromised due to some abnormalities such as excessive long umbilical cord, and though they usually end up with a healthy baby, they may lead to severe consequences. Excessive long umbilical cords are found in 4% of pregnancies and represent a risk factor for nuchal cords and true knots. We report a case of a 37-year-old Syrian pregnant woman who presented to the hospital at 37 weeks of gestation asking for a C-section for a fear of ambiguous ultrasound findings that have been interpreted as fetal malformation. At delivery, a healthy baby was born with a 150-cm umbilical cord, a true knot, and double-looped nuchal cords; the formation of the loops and the knot had been attributed to the elongated cord. Besides, ultrasound imaging could sometimes be deceptive and lead to unnecessary interventions; therefore, cord anomalies should always be kept in mind because they do not always represent a justification for a C-section.
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Affiliation(s)
- Majd Hanna
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
- Faculty of Medicine, University of Damascus, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
- Faculty of Medicine, University of Damascus, Damascus, Syrian Arab Republic
| | - Yara Deeb
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
- Al Andalus University, Qadmus, Syrian Arab Republic
| | - Wissam Mahmoud
- Tishreen Military Hospital, Damascus, Syrian Arab Republic
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2
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Taweevisit M, Thorner PS. Placental Findings Contributing to Perinatal Death: A 15-Year Retrospective Review from a Teaching Hospital in Thailand. Fetal Pediatr Pathol 2022; 41:18-28. [PMID: 32238079 DOI: 10.1080/15513815.2020.1747121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The placenta is infrequently examined in developing countries. This study examined the role of placental pathology in perinatal deaths at Chulalongkorn University Hospital, Bangkok. Methods: Included were singleton intrauterine deaths after gestational week 20 and live-born infants up to 1 week old, over a 15-year period. Placental lesions were classified as: inflammatory-immune, maternal stromal-vascular, fetal stromal-vascular, umbilical cord complications and other. Results: 208 such cases had the placenta available. A placental cause of death was found in 96 (46%), non-placental causes in 28% and the cause of death was unknown in 26%. Of those 96 placentas, 44% were categorized as inflammatory-immune, 30% maternal stromal-vascular, 13% fetal stromal-vascular, 7% umbilical cord complications and 6% other. Conclusions: Placental causes of death were less common than in many Western studies, but inflammatory-immune processes more common. These differences may relate to how cases were accrued, and/or local socioeconomic factors, and warrant further study.
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Affiliation(s)
- Mana Taweevisit
- Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paul Scott Thorner
- Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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3
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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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Habek D, Miletić IA, Živković K, Prka M. Extremely Long, 190-cm Umbilical Cord Wrapped Six Times around the Neck. Z Geburtshilfe Neonatol 2021; 225:188. [PMID: 33873232 DOI: 10.1055/a-1395-7933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Catholic University of Croatia,Zagreb
| | - Ivan Antonio Miletić
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Catholic University of Croatia,Zagreb
| | - Krešimir Živković
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Catholic University of Croatia,Zagreb
| | - Matija Prka
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Catholic University of Croatia,Zagreb
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Sánchez Gutiérrez JF, Olaya-C M, Franco JA, Guevara J, Garzón-Alvarado DA, Gutiérrez Gómez ML. Effect of umbilical cord length on early fetal biomechanics. Comput Methods Biomech Biomed Engin 2020; 24:91-100. [PMID: 32845161 DOI: 10.1080/10255842.2020.1811980] [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: 10/23/2022]
Abstract
The umbilical cord suspends the fetus within the amniotic cavity, where fetal dynamics is one of its many functions. Hence, the umbilical cord is a viable index in determining fetal activity. Fetal movements result in mechanical loads that are fundamental for fetal growth. At present, mechanical environment during early human fetal development is still largely unknown. To determine early fetal movement dynamics at given physiological (0.060 m) and pathological umbilical cord lengths (0.030 m, 0.020 m, 0.017 m and 0.014 m) a 2D computational model was created to simulate dynamic movement conditions. Main findings of this computational model revealed the shortest umbilical cord length (0.014 m) with a 6(10-6)N, twitch force amplitude had a two-fold increase on linear velocity (0.12 m/s) in comparison with other lengths (0.05m/s). Moreover, umbilical cord length effect presented an increasing exponential tension on the fetus body wall from longest to shortest, from 0 N in the control length to 0.05 N for the shortest umbilical cord. Last, tension was always present over a period of time for the shortest cord (0.03 N to 0.08 N). Collectively, for all variables evaluated the shortest umbilical cord (0.014 m) presented remarkable differences with other lengths in particular with the second shortest umbilical cord (0.017 m), suggesting a 0.003 m difference represents a greater biomechanical effect. In conclusion, this computational model brings new insights required by clinicians, where the magnitude of these loads could be associated with different pathologies found in the clinic.
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Affiliation(s)
| | - Mercedes Olaya-C
- Hospital Universitario San Ignacio - Pontificia Universidad Javeriana,Bogota, Colombia.,Instituto de Biotecnología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge Andrés Franco
- Department of Morphological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Johana Guevara
- Institute for the Study of Inborn Errors of Metabolism, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - María Lucía Gutiérrez Gómez
- Department of Morphological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Institute for Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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7
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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.
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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
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Bilateral Renal Vein and Inferior Vena Cava Thrombosis Associated With Fetal Vascular Malperfusion and Maternal Diabetes. Can J Diabetes 2019; 43:550-553. [PMID: 31548113 DOI: 10.1016/j.jcjd.2019.07.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022]
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Katsura D, Takahashi Y, Shimizu T, Watanabe Y, Iwagaki S, Murakami T, Kawabata I. Prenatal measurement of umbilical cord length using magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2018; 231:142-146. [PMID: 30388608 DOI: 10.1016/j.ejogrb.2018.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility of prenatal measurement of umbilical cord length using magnetic resonance imaging (MRI) in comparison with that of postnatal visual measurement. STUDY DESIGN Patients who underwent MRI pelvimetry to rule out cephalopelvic disproportion were recruited. We compared the umbilical cord length measured prenatally using the three-dimensional image of the umbilical cord constructed by AZE virtual place system (AZE®, Japan) on MRI (M-length) and measured postnatally using the actual length (R-length). The time interval between MRI scan and birth was set within 4 weeks. Patients were divided into normal, long (>90th centile), and short (<10th centile) groups based on the umbilical cord length. RESULTS A total of 106 pregnancies were analyzed. MRI was performed at a mean gestational age of 37.4 (34.1-41.7) weeks; the mean gestational age at delivery was 39.4 (36.0-41.8) weeks. M-length and R-length were 67.9 ± 13.6 [mean ± standard deviation] and 57.2 ± 12.7 cm, respectively. The correlation coefficient was larger in the long and short groups than in the normal group. The intraclass correlation coefficient showed high agreement, and Pearson's correlation coefficient revealed correlation inspection as r = 0.702. Bland-Altman analysis indicated non-agreement, and the bias and upper and lower limits of agreement were 10.6 cm and -6.0 and 27.3 cm, respectively. CONCLUSIONS Short and long umbilical cord lengths are associated with perinatal mortality and morbidity. Prenatal measurement of umbilical cord length using MRI is feasible for daily clinical use to distinguish short or long umbilical cords. Further research is needed for more precise clinical application and technical reduction of overestimation errors.
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Affiliation(s)
- Daisuke Katsura
- Department of Fetal-Maternal Medicine, Nagara Medical Center, 1300-7, Nagara, Gifu, Japan.
| | - Yuichiro Takahashi
- Department of Fetal-Maternal Medicine, Nagara Medical Center, 1300-7, Nagara, Gifu, Japan
| | - Toshihiro Shimizu
- Department of Radiology, Nagara Medical Center, 1300-7, Nagara, Gifu, Japan
| | - Yoshihiro Watanabe
- Department of Radiology, Nagara Medical Center, 1300-7, Nagara, Gifu, Japan
| | - Shigenori Iwagaki
- Department of Fetal-Maternal Medicine, Nagara Medical Center, 1300-7, Nagara, Gifu, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science Hospital, Tsukinowa-cho, Seta, Otsu, Shiga, Japan
| | - Ichiro Kawabata
- Department of Obstetrics and Gynecology, Matsunami General Hospital, 185-1, Dendai, Kasamatsu-cho, Hashima-gun, Gifu, Japan
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10
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Extreme umbilical cord lengths, cord knot and entanglement: Risk factors and risk of adverse outcomes, a population-based study. PLoS One 2018; 13:e0194814. [PMID: 29584790 PMCID: PMC5870981 DOI: 10.1371/journal.pone.0194814] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/09/2018] [Indexed: 01/17/2023] Open
Abstract
Objectives To determine risk factors for short and long umbilical cord, entanglement and knot. Explore their associated risks of adverse maternal and perinatal outcome, including risk of recurrence in a subsequent pregnancy. To provide population based gestational age and sex and parity specific reference ranges for cord length. Design Population based registry study. Setting Medical Birth Registry of Norway 1999–2013. Population All singleton births (gestational age>22weeks<45 weeks) (n = 856 300). Methods Descriptive statistics and odds ratios of risk factors for extreme cord length and adverse outcomes based on logistic regression adjusted for confounders. Main outcome measures Short or long cord (<10th or >90th percentile), cord knot and entanglement, adverse pregnancy outcomes including perinatal and intrauterine death. Results Increasing parity, maternal height and body mass index, and diabetes were associated with increased risk of a long cord. Large placental and birth weight, and fetal male sex were factors for a long cord, which again was associated with a doubled risk of intrauterine and perinatal death, and increased risk of adverse neonatal outcome. Anomalous cord insertion, female sex, and a small placenta were associated with a short cord, which was associated with increased risk of fetal malformations, placental complications, caesarean delivery, non-cephalic presentation, perinatal and intrauterine death. At term, cord knot was associated with a quadrupled risk of perinatal death. The combination of a cord knot and entanglement had a more than additive effect to the association to perinatal death. There was a more than doubled risk of recurrence of a long or short cord, knot and entanglement in a subsequent pregnancy of the same woman. Conclusion Cord length is influenced both by maternal and fetal factors, and there is increased risk of recurrence. Extreme cord length, entanglement and cord knot are associated with increased risk of adverse outcomes including perinatal death. We provide population based reference ranges for umbilical cord length.
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11
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Peleja AB, Martinelli S, Ribeiro RL, Bittar RE, Schultz R, Francisco RPV. Fetal thrombotic vasculopathy: A case report and literature review. Rev Assoc Med Bras (1992) 2016; 62:687-690. [DOI: 10.1590/1806-9282.62.07.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/27/2015] [Indexed: 11/22/2022] Open
Abstract
Summary Introduction: Fetal thrombotic vasculopathy is a recently described placental alteration with varying degrees of involvement and often associated with adverse perinatal outcomes. The diagnosis is made histologically and therefore is postnatal, which makes it a challenge in clinical practice. Method: Case report and review of literature on the subject. Results: The present case refers to a pregnant woman presenting fetal growth restriction, with poor obstetrical past, and sent late to our service. Even with weekly assessments of fetal vitality (fetal biophysical profile and Doppler velocimetry) and prenatal care, the patient progressed with fetal death at 36 weeks and 1 day. There was no association with inherited and acquired thrombophilia. Pathological examination of the placenta revealed fetal thrombotic vasculopathy. Conclusion: The fetal thrombotic vasculopathy may be associated with adverse perinatal outcomes including fetal death, but much remains to be studied regarding its pathogenesis. Diagnosis during pregnancy is not possible and there is still no proven treatment for this condition. Future studies are needed so that strategies can be developed to minimize the impact of fetal thrombotic vasculopathy.
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12
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Ernst LM, Rand CM, Bao R, Andrade J, Linn RL, Minturn L, Zhang C, Kang W, Weese-Mayer DE. Stillbirth: Genome-wide copy number variation profiling in archived placental umbilical cord samples with pathologic and clinical correlation. Placenta 2015; 36:783-9. [PMID: 26094028 DOI: 10.1016/j.placenta.2015.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/30/2015] [Accepted: 04/25/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Stillbirth remains a devastating health issue with 26,000 stillbirths occurring annually in the United States. Formalin-fixed, paraffin-embedded (FFPE) umbilical cord samples are available for many stillbirths. Our aim was to validate the use of these samples in identifying genetic variations in stillbirth through microarray analysis. METHODS This is a retrospective case-control study from a single institution of stillbirths ≥ 23 weeks gestational age and control liveborn infants. Fetal genomic DNA was extracted from FFPE umbilical cord samples of stillborn and control placentas, and genotyping was performed using the Illumina HumanOmniExpresss-12v1 Beadchip. Array results were verified with qPCR. RESULTS 31 case-specific CNVs (17 deletions and 14 amplifications) with an average size of 294 kb for amplifications and 74 kb for deletions were identified among 94 FFPE samples (86 cases; 8 controls). In total 38 (44%) of the stillbirth samples had a CNV detected. Validation of a subset of microarray findings with qPCR confirmed deletions on 1p (2 cases), 11q (4 cases) and amplifications on 18 (1 case). Placental underperfusion changes were seen in stillborns with deletions on 1p, a region containing complement regulatory genes which have been shown to play a role in preeclampsia. DISCUSSION This study validated the use of archived FFPE umbilical cord samples for genome-wide copy number profiling in stillbirths, and demonstrates specific CNV deletions and amplifications. Microarray analysis in an expanded cohort of stillbirth FFPE samples has the potential to identify biomarkers involved in stillbirth pathogenesis.
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Affiliation(s)
- L M Ernst
- Northwestern University, Feinberg School of Medicine, Department of Pathology, USA.
| | - C M Rand
- Ann & Robert H. Lurie Children's Hospital of Chicago, Center for Autonomic Medicine in Pediatrics (CAMP) and Stanley Manne Children's Research Institute, USA
| | - R Bao
- University of Chicago, Center for Research Informatics, USA
| | - J Andrade
- University of Chicago, Center for Research Informatics, USA
| | - R L Linn
- Northwestern University, Feinberg School of Medicine, Department of Pathology, USA
| | - L Minturn
- Northwestern University, Feinberg School of Medicine, Department of Pathology, USA
| | - C Zhang
- University of Chicago, Center for Research Informatics, USA
| | - W Kang
- University of Chicago, Center for Research Informatics, USA
| | - D E Weese-Mayer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Center for Autonomic Medicine in Pediatrics (CAMP) and Stanley Manne Children's Research Institute, USA; Northwestern University, Feinberg School of Medicine, Department of Pediatrics, USA
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13
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Abstract
Intrauterine factors important for cognitive development, such as birth weight, chorionicity and umbilical cord characteristics were investigated. A total of 663 twin pairs completed the Wechsler Intelligence Scale for Children-Revised and scores were available for Performance, Verbal and Total Intelligence Quotient (IQ). The intrauterine factors examined were birth weight, placental weight and morphology, cord knots, cord length and cord insertion. IQ scores for the varying levels of the intrauterine markers adjusting for gender and gestational age were calculated. The heritability of IQ and the association between IQ and intrauterine environment were examined. Twins with lower birth weight and cord knots had lower IQ scores. The aetiology of IQ is largely distinct from that of birth weight and cord knots, and non-shared environment may influence the observed relationships.
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14
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Schmid A, Jacquemyn Y, Loor JD. Intrauterine growth restriction associated with excessively long umbilical cord. Clin Pract 2013; 3:e23. [PMID: 24765511 PMCID: PMC3981270 DOI: 10.4081/cp.2013.e23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/16/2013] [Accepted: 04/24/2013] [Indexed: 12/02/2022] Open
Abstract
We present a 37-week female baby, known with intrauterine growth restriction since 25 weeks of pregnancy, born with a placenta with an excessive long umbilical cord (ELUC), without any other abnormalities. ELUC is mostly an incidental finding after delivery, but represents a potentially detectable intrauterine cause of growth restriction. A system that allows ultrasound measurement of the length of the umbilical cord could highly increase antenatal diagnosis of ELUC.
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Affiliation(s)
- Ann Schmid
- Zaaldenrode 2, 2640 Mortsel, Belgium. +32.486229364.
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15
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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]
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16
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17
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Stanek J. Utility of diagnosing various histological patterns of diffuse chronic hypoxic placental injury. Pediatr Dev Pathol 2012; 15:13-23. [PMID: 21864121 DOI: 10.2350/11-03-1000-oa.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To examine the clinicopathologic correlations of three histological patterns of diffuse chronic hypoxic placental injury (preuterine [PR], uterine [UH], and postuterine [PU]), a retrospective statistical analysis of a large 14-year placental database was performed. Of 5097 placentas between 20 and 43 weeks of gestation examined consecutively, 4413 did not feature histological chronic placental hypoxia, while 684 did. In the latter, maternal hypertensive disorders, diabetes mellitus, abnormal cardiotocography and Dopplers, cesarean sections, inductions of labor, and fetal growth restriction, as well as other placental hypoxic lesions and decidual arteriolopathy, were statistically significantly more common than in the remaining placental material. Two hundred eighty-nine PR cases featured the most advanced gestational age and meconium staining; 237 UH cases featured severe preeclampsia, decidual arteriolopathy, villous infarction, membrane laminar necrosis, microscopic chorionic pseudocysts, excessive extravillous trophoblasts, and maternal floor multinucleate trophoblastic giant cells; and 158 PU cases featured the lowest placental weight and the highest prevalence of abnormal Dopplers, umbilical cord compromise, fetal growth restriction, cesarean section rate, and complicated 3rd stage of labor. The specificity of chronic hypoxic patterns of placental injury was much higher than the sensitivity, with the highest specificity for an excessive amount of extravillous trophoblasts. Diagnosing various hypoxic patterns of placental injury by histology may help to clarify the etiopathogenesis of a significant proportion of complications of pregnancy and abnormal fetal or neonatal outcomes. The patterns should help to retrospectively diagnose placental hypoxia, even in clinically unsuspected cases.
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Affiliation(s)
- Jerzy Stanek
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Antoniou EE, Derom C, Thiery E, Fowler T, Southwood TR, Zeegers MP. The Influence of Genetic and Environmental Factors on the Etiology of the Human Umbilical Cord: The East Flanders Prospective Twin Survey1. Biol Reprod 2011; 85:137-43. [DOI: 10.1095/biolreprod.110.088807] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Placental fetal thrombotic vasculopathy in severe congenital anomalies prompting EXIT procedure. Placenta 2011; 32:373-9. [DOI: 10.1016/j.placenta.2011.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 11/18/2022]
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