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Todtenhaupt P, Kuipers TB, Dijkstra KL, Voortman LM, Franken LA, Spekman JA, Jonkman TH, Groene SG, Roest AA, Haak MC, Verweij EJT, van Pel M, Lopriore E, Heijmans BT, van der Meeren LE. Twisting the theory on the origin of human umbilical cord coiling featuring monozygotic twins. Life Sci Alliance 2024; 7:e202302543. [PMID: 38830769 PMCID: PMC11147950 DOI: 10.26508/lsa.202302543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
The human umbilical cord (hUC) is the lifeline that connects the fetus to the mother. Hypercoiling of the hUC is associated with pre- and perinatal morbidity and mortality. We investigated the origin of hUC hypercoiling using state-of-the-art imaging and omics approaches. Macroscopic inspection of the hUC revealed the helices to originate from the arteries rather than other components of the hUC. Digital reconstruction of the hUC arteries showed the dynamic alignment of two layers of muscle fibers in the tunica media aligning in opposing directions. We observed that genetically identical twins can be discordant for hUC coiling, excluding genetic, many environmental, and parental origins of hUC coiling. Comparing the transcriptomic and DNA methylation profile of the hUC arteries of four twin pairs with discordant cord coiling, we detected 28 differentially expressed genes, but no differentially methylated CpGs. These genes play a role in vascular development, cell-cell interaction, and axis formation and may account for the increased number of hUC helices. When combined, our results provide a novel framework to understand the origin of hUC helices in fetal development.
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Affiliation(s)
- Pia Todtenhaupt
- https://ror.org/05xvt9f17 Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas B Kuipers
- https://ror.org/05xvt9f17 Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
- https://ror.org/05xvt9f17 Sequencing Analysis Support Core, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Kyra L Dijkstra
- https://ror.org/05xvt9f17 Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Lenard M Voortman
- https://ror.org/05xvt9f17 Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Laura A Franken
- https://ror.org/05xvt9f17 Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Jip A Spekman
- https://ror.org/05xvt9f17 Neonatology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas H Jonkman
- https://ror.org/05xvt9f17 Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Sophie G Groene
- https://ror.org/05xvt9f17 Neonatology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arno Aw Roest
- https://ror.org/05xvt9f17 Pediatric Cardiology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Monique C Haak
- https://ror.org/05xvt9f17 Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - EJoanne T Verweij
- https://ror.org/05xvt9f17 Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Melissa van Pel
- NecstGen, Leiden, Netherlands
- https://ror.org/05xvt9f17 Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- https://ror.org/05xvt9f17 Neonatology, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Bastiaan T Heijmans
- https://ror.org/05xvt9f17 Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte E van der Meeren
- https://ror.org/05xvt9f17 Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
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Singireddy N, Chugh A, Bal H, Jadhav S. Re-evaluation of umbilical cord coiling index in adverse pregnancy outcome - Does it have role in obstetric management? Eur J Obstet Gynecol Reprod Biol X 2024; 21:100265. [PMID: 38099232 PMCID: PMC10716745 DOI: 10.1016/j.eurox.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction The placenta with the umbilical cord is a vital link between the mother and fetus. Umbilical cord supplies water, nutrients and oxygen from the mother to the fetus. The most unique character of the umbilical cord is its coiling, where the contents of the cord course in a coiled helical fashion. The umbilical coiling index(UCI) can be measured antenatally using ultrasonography. In the present study we have attempted to assess the UCI antenatally by ultrasound screening and correlate abnormal antenatal UCI with the adverse maternal and neonatal outcome of pregnancy. Aims To study umbilical coiling index ultrasonographically and to correlate it with pregnancy outcome. Methodology 150 antenatal cases in the second trimester of pregnancy between 22 and 28weeks of gestation attending the outpatient department were included for the study in a continuous manner and subjected to antenatal UCI measurement. The cases were followed up till delivery and various factors were noted. Results We confirmed that maternal medical comorbidities ( gestational hypertension and anemia) have a significant correlation with abnormal umbilical cord coiling index, either hyper-coiling or hypo-coiling or both.Some studies have shown a particular adverse effect being manifested in both hypo and hypercoiling. In the present study significant correlation of abnormal coiling has been found with only anaemia and hypertension in pregnancy. The question, therefore, arises:"Does abnormal UCI have any significant role in prediction of adverse outcome in pregnancy or is it just a random association?" This study does not reflect any significant role of abnormal UCI in the prediction of adverse perinatal outcome. Hence efforts to monitor UCI in the antenatal period may not have any justification in the present scenario. The latest edition of William's Obstetrics also makes a similar comment. A population based larger study to generate cut offs for hypo and hyper coiling and finding any association between abnormal coiling and perinatal outcome may throw more light on the utility of UCI as a predictor of adverse outcome in pregnancy.
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Affiliation(s)
- Nikhila Singireddy
- Department of Obstetrics and Gynecology, Dr. DY Patil Vidyapeeth, Pune 411018, India
| | - Amey Chugh
- Department of Obstetrics and Gynecology, Dr. DY Patil Vidyapeeth, Pune 411018, India
| | - Himadri Bal
- Department of Obstetrics and Gynecology, Dr. DY Patil Vidyapeeth, Pune 411018, India
| | - S.L. Jadhav
- Department of PSM, Dr. DY Patil Vidyapeeth, Pune 411018, India
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Tonni G, Lituania M, Cecchi A, Carboni E, Resta S, Bonasoni MP, Ruano R. Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes. Healthcare (Basel) 2023; 11:2634. [PMID: 37830671 PMCID: PMC10572758 DOI: 10.3390/healthcare11192634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Serena Resta
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vegata, 00133 Rome, Italy;
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy;
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Manjee K, Price E, Ernst LM. Comparison of the Autopsy and Placental Findings in Second vs Third Trimester Stillbirth. Pediatr Dev Pathol 2023; 26:345-351. [PMID: 37082921 DOI: 10.1177/10935266231165854] [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: 04/22/2023]
Abstract
BACKGROUND The pathology of second trimester fetal loss is not well-characterized due to lack of comprehensive autopsy studies. The purpose of this study is to compare autopsy pathology of second trimester and third trimester stillbirth. METHODS In this retrospective cohort study, fetal autopsies performed in-house with complete placental examination were included. From autopsy reports, maternal demographics, gestational age, sex, body and placental weight, congenital anomalies, and cause of death (COD) were obtained. Immediate COD was coded "probable" or "possible" according to Initial Causes of Fetal Death (INCODE). RESULTS Among 68 second trimester and 54 third trimester fetal autopsies, at least 1 probable COD was identified in 59/68 (87%) second trimester and 44/54 (81%) third trimester cases. 42/68 (62%) second trimester and 28/54 (52%) third trimester fetuses had probable COD secondary to placental pathology. Among placental causes, 29/42 (69%) second trimester and 14/28 (50%) third trimester stillbirths were related to compromised fetal microcirculation with umbilical cord abnormality. CONCLUSIONS Among stillborn first and second trimester fetuses who undergo autopsy, the most prevalent COD is pathologic placental conditions, particularly those associated with umbilical cord obstruction. This study stresses the importance of placenta examination for establishing COD in both second and third trimester fetuses.
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Affiliation(s)
- Kiran Manjee
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erica Price
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Proteomic analysis of the umbilical cord in fetal growth restriction and preeclampsia. PLoS One 2022; 17:e0262041. [PMID: 35213550 PMCID: PMC8880394 DOI: 10.1371/journal.pone.0262041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Fetal growth restriction (FGR) is associated with adverse perinatal outcomes. Pre-eclampsia (PreE) increases the associated perinatal morbidity and mortality. The structure of the umbilical cord in the setting of FGR and PreE is understudied. This study aimed to examine changes in the umbilical cord (UC) composition in pregnancies complicated by FGR and FGR with PreE. UC from gestational age-matched pregnancies with isolated FGR (n = 5), FGR+PreE (n = 5) and controls (n = 5) were collected, and a portion of the UC was processed for histologic and proteomic analysis. Manual segmentation analysis was performed to measure cross-section analysis of umbilical cord regions. Wharton’s Jelly samples were analyzed on a tims-TOF Pro. Spectral count and ion abundance data were analyzed, creating an intersection dataset from multiple mass spectrometry search and inference engines. UCs from FGR and FGR with PreE had lower cross-sectional area and Wharton’s Jelly area compared with control (p = 0.03). When comparing FGR to control, 28 proteins were significantly different in abundance analysis and 34 in spectral count analysis (p < 0.05). Differential expression analysis between PreE with FGR vs controls demonstrated that 48 proteins were significantly different in abundance and 5 in spectral count. The majority of changes occurred in proteins associated with extracellular matrix, cellular process, inflammatory, and angiogenesis pathways. The structure and composition of the UC is altered in pregnancies with FGR and FGR with PreE. Future work in validating these proteomic differences will enable identification of therapeutic targets for FGR and FGR with PreE.
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Nikkels PG, Evers AC, Schuit E, Brouwers HA, Bruinse HW, Bont L, Houben ML, Kwee A. Placenta Pathology From Term Born Neonates With Normal or Adverse Outcome. Pediatr Dev Pathol 2021; 24:121-130. [PMID: 33470918 DOI: 10.1177/1093526620980608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The incidence of umbilical cord or placental parenchyma abnormalities associated with mortality or morbidity of term infants is lacking. METHODS Placentas of 55 antepartum stillbirths (APD), 21 intrapartum stillbirths (IPD), 12 neonatal deaths (ND), and 80 admissions to a level 3 neonatal intensive care unit (NS) were studied and compared with 439 placentas from neonates from normal term pregnancies and normal outcome after vaginal delivery (NPVD) and with 105 placentas after an elective caesarian sections (NPEC). RESULTS NPVD and NPEC placentas showed no or one abnormality in 70% and placentas from stillbirth showed two or more abnormalities in 80% of cases. APD placentas more frequently had a low weight and less formation of terminal villi. Hypercoiling was more often present in all study groups. Severe chronic villitis was almost exclusively present in APD placentas. Chorioamnionitis was significantly more frequent in APD, IPD and NS placentas and funisitis was more often observed in IPD and NS placentas. CONCLUSION Multiple placental abnormalities are significantly more frequent in placentas from term neonates with severe perinatal morbidity and mortality. These placental abnormalities are thought to be associated with disturbed oxygen transfer or with inflammation.
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Affiliation(s)
- Peter Gj Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke Cc Evers
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hens Aa Brouwers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hein W Bruinse
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Louis Bont
- Department of Pediatrics, Utrecht University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L Houben
- Department of Pediatrics, Utrecht University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
OBJECTIVE Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors. METHODS The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index. RESULTS Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16-23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non-umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords. CONCLUSION Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
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Feist H, Hussein K, Blöcker T, Wohlschlaeger J. Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition. Pediatr Dev Pathol 2020; 23:107-114. [PMID: 31345137 DOI: 10.1177/1093526619865426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.
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Affiliation(s)
- Henning Feist
- Department of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - Kais Hussein
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Thordis Blöcker
- Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
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Excessive umbilical cord coiling confers risk of elevated nocturnal blood pressure and severe/early-onset preeclampsia. J Hypertens 2020; 37:187-196. [PMID: 30015757 DOI: 10.1097/hjh.0000000000001849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The associations between umbilical cord coiling, feto-placental vascular resistance and maternal blood pressure (BP) are not well understood. METHOD We retrospectively analyzed 502 pregnant women suspected of hypertensive disorders in the third trimester from a hospital-based cohort, who underwent ambulatory BP monitoring and umbilical artery Doppler velocimetry examinations within 14 days before delivery. By applying quantile regression, a significant quantile-dependent positive association between umbilical cord coiling index and umbilical artery pulsatility index (UAPIMOM; converted to multiples of median) was observed from above 0.75th quantiles for each parameter. RESULTS Using the cutoffs both at the 0.75th quantile to define high umbilical cord coiling (≥0.28 coils/cm) and high UAPIMOM (≥1.30), respectively, a graded increase in BP level was observed from patients with both low, either high and both high categories. Multivariate linear and quantile regression revealed that the high umbilical cord coiling/high UAPIMOM interaction was significantly correlated with night-time mean DBP level. Moreover, umbilical cord hypercoiling (≥0.3 coils/cm) was significantly correlated with night-time DBP with an average increase of ∼5 mmHg from the 0.05th to 0.70th quantiles and independently predicted the occurrence of severe (odds ratio 2.32, 95% confidence interval: 1.22-4.41) and early-onset (odds ratio 2.43, 95% confidence interval: 1.18-4.97) preeclampsia after adjusting for covariates. Further mediation analysis showed that elevated high UAPIMOM (≥1.30) could explain 11.4% of the umbilical cord hypercoiling → high night-time DBP association. CONCLUSION Therefore, this retrospective study identifies excessive umbilical cord coiling, and its interaction with increased feto-placental vascular resistance, as novel risk factors for nocturnal BP elevation and preeclampsia.
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Ayala NK, Ernst LM, Miller ES. Is umbilical coiling genetically determined? J Perinatol 2018; 38:653-657. [PMID: 29467518 DOI: 10.1038/s41372-018-0078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Abnormal umbilical cord coiling is associated with adverse perinatal outcomes; however, the etiology of the umbilical coiling pattern is poorly understood. STUDY DESIGN Retrospective cohort of all twin deliveries >20 weeks in 2014. Pregnancies were dichotomized by chorionicity and the umbilical coiling index (UCI) and placental cord insertion location were compared. In cases with one or both cords hypercoiled, the direction and pattern of coiling were compared by chorionicity. A similar analysis was performed stratified by zygosity. RESULTS Three hundred sisty two twin pairs were included; 26 (7.2%) monochorionic and 174 (87.0%) definitively dizygotic. Concordance in the UCI and coiling category were similar between dichorionic and monochorionic as well as dizygous and monozygous gestations, (73.2% vs 80.8%, p = 0.399 and 71.4% vs 80.8%, p = 0.399, respectively). Analyses of the coiling direction and pattern also demonstrated no difference by chorionicity or zygosity. CONCLUSION These data do not support a genetic basis for umbilical cord coiling.
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Affiliation(s)
- Nina K Ayala
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA.
| | - Linda M Ernst
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Emily S Miller
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chicago, IL, USA
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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.
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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.
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