Umbilical artery Thrombosis: A case report of prenatal diagnosis and systematic review of the literature

Umbilical Artery Thrombosis (UAT) is an extremely rare complication of pregnancy strongly associated with severe fetal distress and death. The pathogenesis is still unclear but it is often associated with anatomical cord abnormalities that leads to blood stasis and thrombosis formation. Other possible risk factors are maternal thrombophilia, autoimmune disease, gestational diabetes, hypertension disorders of pregnancy and Rh-alloimmunization. The most common clinical symptom is the reduction of fetal movements. The diagnosis is histopathological, but it can be suspected by clinical and prenatal ultrasound findings. Generally, the first choice therapy is the immediate delivery with cesarean section. This study reported a case of a spontaneous intrauterine UAT in a low-risk pregnancy and a systematic review of the literature on clinical, ultrasound and histopathological findings of UAT, in order to help clinicians in the diagnostic process and management of this rare complication.

424: Umbilical cord management in preterm and term infants

Objective

To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity.

Target Population

Women who are pregnant with preterm or term singletons or twins.

Benefits Harms and Costs

In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity. DCC in preterm twins is associated with some benefits. In term singletons, DCC for 60 seconds improves hematological parameters. In very preterm infants, umbilical cord milking increases risk for intraventricular hemorrhage.

Evidence

Searches of Medline, PubMed, Embase, and the Cochrane Library from inception to March 2020 were undertaken using Medical Subject Heading (MeSH) terms and key words related to deferred cord clamping and umbilical cord milking. This document represents an abstraction of the evidence rather than a methodological review.

Validation Methods

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

Xeno-Free Human Wharton's Jelly Mesenchymal Stromal Cells Maintain Their Characteristic Properties after Long-Term Cryopreservation

Objective

The past decade has witnessed a rapid growth in harnessing the potential of adult stem cells for regenerative medicine. An investigational new drug (IND) or a regenerative medicine advanced therapy (RMAT) product must fulfil many requirements, such as stability studies, after cryopreservation. Such studies are important to ascertain the utility of off-the-shelf allogeneic cells for clinical applications. The present work describes a complete characterisation of xeno- free human Wharton’s Jelly mesenchymal stromal cells (hWJ-MSCs) before and up to 28 months post-cryopreservation.

Materials and Methods

In this experimental study, culture methods that involved plasma derived human serum and recombinant trypsin were used to develop clinical grade cells. Complete cell characterisation involved flow cytometry studies for viability, positive and negative markers, colony forming unit (CFU) potential, population doubling time (PDT), soft agar assay to evaluate in vitro tumourigenicity, karyotype analysis and differentiation studies which were performed before and at 6, 12, 18 and 28 months post-cryopreservation.

Results

Our data showed consistency in the flow cytometry, CFU assay, PDT, soft agar assay, karyotyping and differentiation studies.

Conclusion

Using our protocols for extended xeno-free culture and cryopreservation of hWJ-MSCs, we could establish the shelf life of the cell-based product for up to 28 months.

Evaluating the effect of transplanting umbilical cord matrix stem cells on ischemic tolerance in an animal model of stroke

OBJECTIVE

Stroke, a cerebrovascular disease, has been introduced as the second cause of death and physical disability in the world. Recently, cell-based therapy has been considered by the scientific community as a promising strategy for reducing ischemic damages. The stem cells of the umbilical cord release growth and neurotrophic factors. The remarkable properties of these cells are the reason why they were selected as a potential candidate in the present research.

METHODS

In this study, the impact of transplanting umbilical cord stem cells on injuries resulting from ischemia was investigated. The male rats were categorized into three major. Using stereotaxic surgery, stem cells were injected to the right striatum of the brain. One week after transplantation, cerebral ischemic induction surgery was performed. The rats in the transplantation + ischemia group were separately divided into distinct sub-groups to explore the score of the neurological deficits, infarction volume, integrity of the blood-brain barrier, and brain edema.

RESULTS

In this study, a significant decrease was observed in the neurological deficits of the transplantation + ischemia group compared with those of the control group. Similarly, the volume of infarction, the permeability of the blood-brain barrier, and edema were significantly reduced in the transplantation + ischemia group in comparison with those of the control group.

CONCLUSION

The pretreatment of the transplanted umbilical cord stem cells in the striatum of ischemic rats possibly leads to restorative events, exerting a decreasing effect on cell death. Subsequently, these events may improve the motor ability and reduce ischemic injuries.

Injectable Amniotic Membrane/Umbilical Cord Particulate for Knee Osteoarthritis: A Prospective, Single-Center Pilot Study

OBJECTIVE

To evaluate the short-term safety and effectiveness of amniotic membrane/umbilical cord particulate (AMUC) in managing pain in patients with various severities of knee osteoarthritis (OA).

DESIGN

Single-center, prospective, investigator-initiated pilot study.

SETTING

Private practice.

SUBJECTS

A total of 20 knee OA patients aged ≥18 years were enrolled with pain >40 mm, as determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-A.

METHODS

Patients received an ultrasound-guided, intra-articular injection of 50 mg of AMUC particulate reconstituted in 2 mL of preservative-free saline. All patients were then monitored at six weeks, 12 weeks, and 24 weeks postinjection. Patients who did not show >30% reduction in pain received a second injection of AMUC at six weeks. WOMAC, Patient Global Assessment, medication usage, and magnetic resonance imaging (MRI) were assessed.

RESULTS

Knee OA pain significantly decreased from 74.3 ± 17.2 at baseline to 45.0 ± 25.4 at six weeks (P < 0.01), 35.4 ± 26.6 at 12 weeks (P < 0.001), and 37.4 ± 26.7 at 24 weeks (P < 0.001). This pain reduction was associated with a significant improvement in physical function (WOMAC-C) at all time points (P < 0.05) and stiffness (WOMAC-B) at 12 weeks (P = 0.01). Eleven patients received a second injection, which was significantly correlated with body mass index >30 kg/m2 (P = 0.025). MRI evaluation of the overall population revealed an improvement in the severity of bone marrow lesions in seven patients. No adverse events were observed.

CONCLUSIONS

AMUC particulate injection relieved pain and improved physical function in patients with symptomatic knee OA.

Phenotype Characteristics and Osteogenic Differentiation Potential of Human Mesenchymal Stem Cells Derived from Amnion Membrane (HAMSCs) and Umbilical Cord (HUC-MSCs)

Introduction:

Human amnion membrane mesenchymal stem cells (hAMSCs) and human umbilical cord mesenchymal stem cells (hUC-MSCs) are potential, non invasive sources of stem cells used for bone tissue engineering. Phenotyping characterization is an extremely important consideration in the choice of the appropriate passage in order to maximize its osteogenic differentiation potential.

Aim:

To explore phenotype characteristics and compare osteogenic differentiation potential of hAMSCs and hUC-MSCs.

Method:

Isolation and culture were performed on hAMSCs and hUC-MSCs from a healthy woman in her 38^th weeks of pregnancy. CD90, CD105 and CD73 phenotype characterization was done in passage 4-7. An osteogenic differentiation examination of hAMSCs and hUC-MSCs with Alizarin red staining and RUNX2 expression was performed in the passage that had appropriate expressions of phenotype characteristics.

Results:

The expression of CD90 hUC-MSCs was higher than that of hAMSCs in all passages. CD105 hUC-MSCs was higher in passage 4-6, while CD105 hAMSCs was equal to that of hUC-MSCs in passage 7. CD73 hUC-MSCs was higher than hAMSCs in passage 4 and 5, while in passage 6 and 7 hAMSCs was higher than hUC-MSCs. There was a decrease in the number of CD90, CD105 and CD73 on hAMSCs and hUC-MSCs in passage 5, then determined as appropriate passage. Alizarin red staining examination showed calcium deposition and revealed no significant difference, but RUNX2 expression of hUC-MSCs was significantly higher than that for hAMSCs.

Conclusion:

Both hAMSCs and hUC-MSCs had phenotype characteristics of mesenchymal stem cell and showed ostegenic differentiation potential.

Umbilical Cord Hemangioma with Pseudocyst: An Exceptional Finding

N/A.

Cord Blood Karyotyping: A Safe and Non-Invasive Method for Postnatal Testing of Assisted Reproductive Technology Children

Background:

To verify the hypothesis that the incidence of chromosomal abnormalities increases in babies conceived by different assisted reproduction procedures. The availability of the umbilical cord blood encouraged us to study this hypothesis via this method.

Materials and Methods:

This is a descriptive study, umbilical cord blood samples of assisted reproductive technology (ART) children were analyzed with standard cytogenetic techniques (G banding). Karyotyping was possible in 109 cases.

Results:

The number of abnormal cases was four (3.7%), among which, three cases (2.8%) were inherited and only 1 case (0.9%) was a de novo translocation. In total, the incidence of de novo chromosomal abnormalities was in the range observed in all live births in the general population (0.7-1%).

Conclusion:

No significant difference in the incidence of chromosomal abnormality was found between ART and naturally conceived babies. To date, several studies have examined the medical and developmental outcome of ART children and still have not reached a definite conclusion. Genetic counseling is recommended as an integral part of planning of treatment strategies for couples wishing to undergo ART.

Caring for Newborn's Umbilical Cord from Iranian Traditional Medicine Point of View

BACKGROUND

It is evident that infant's umbilical cord is essential for its survival and growth. In the past, it was not considered as a necessary tissue. However, nowadays, it has attracted lots of attention and its relation to different diseases has been demonstrated. In Iranian traditional medicine, caring for newborn's umbilical cord has been frequently recommended and it has been associated with different diseases.

METHODS

Herein, Iranian traditional medicine resources such as "Qanun-fil-Tibb", "Exir-e-Azam", and "Tib-e-Akbari" were studied. In addition, recent developments in classical medicine were reviewed using search engines including Google Scholar, PubMed, SID, and IranMedex.

RESULTS

It has been revealed that there is a direct relation between early cord clamping and oxidative stress, anemia, and low cardiac output. In Iranian traditional medicine, it is believed that the umbilical cord length, which should be cut off, is important. A short cord may lead to bladder contraction and frequent urination. Furthermore, if the umbilical cord is not squeezed efficiently, its content may enter the bladder, testis, and stomach leading to various diseases.

CONCLUSION

It seems that the remarks by the Iranian traditional medicine on caring for newborn's umbilical cord can be useful for the prevention of different diseases.

Comparing the Impact of Topical Application of Human Milk and Chlorhexidine on Cord Separation Time in Newborns

OBJECTIVES

The best umbilical cord care after birth is a controversial issue. Aim of this research was to compare the effect of topical application of human milk and chlorhexidin on cord separation time in newborns.

METHODS

One hundred seventy four neonates attending from hospitals affiliated to Kashan University of Medical Sciences were included. Newborns from birth were randomized to two groups. In group mother's milk, mother will rub her own milk to cord stump two times a day. chlorhexidin (group 2) were applied to the umbilical stump every 12 hours. The time to umbilical cord separation and any discomfort such as infection, hemorrhage, and discharge and odor were documented. Data was analyzed by SPSS software. Independent Samples t-Test, χ(2), Fisher were used in this study.

RESULTS

Results showed a significant statistical difference between cord separation time in two groups and the mean cord separation time in the human milk group (7.15±2.15days) was shorter than the chlorhexidin group (13.28±6.79 days). In addition, a significant correlation was found between Signs of infection (discharge, redness, swelling and odor) in both groups.

CONCLUSIONS

Topical application of breast milk on umbilical cord care leads to quick cord separation time and can be used as easy, cheep, non injury methods for umbilical cord care.

Sonographic Measurement of the Umbilical Cord and Its Vessels and Their Relation with Fetal Anthropometric Measurements

Background:

It has been established that presence of lean umbilical cord with reduced Wharton’s jelly in sonographic scans is a fetal marker for risk of small for gestational age at birth. With improvement of ultrasound techniques, more studies have been investigating the alterations of the umbilical cord on pregnancy outcomes.

Objectives:

To determine the reference ranges of the umbilical cord area during pregnancy and to find out the association between umbilical cord morphometry and fetal anthropometric measurements.

Patients and Methods:

A cross sectional study was carried out on a study population of 278 low-risk pregnant women between 15 and 41 weeks of gestational age. Fetal anthropometric measurements including biparietal diameter, abdominal circumference, and femur length were calculated. The measurements of the cross-sectional area (CSA) and circumference of the umbilical cord, vein and arteries were done on an adjacent plane to the insertion of umbilical cord into the fetus’s abdomen. The mean and standard deviation of the CSA of the umbilical cord and the 5th, 10th, 50th, 90th, 95th percentiles of it were calculated for each gestational age. Pearson correlation coefficient was used to assess the correlation between the measures of the cord and fetal anthropometric measurements. Polynomial regression analysis was performed for curves.

Results:

The values of the CSA of the umbilical cord, umbilical vein and Wharton’s jelly (WJ) increase consistently until 30 weeks of gestation, after which they reach a plateau. There was a significant correlation between anthropometric measurements and umbilical cord measurements especially with the CSA of the umbilical cord, umbilical vein and WJ. The regression equation for the umbilical cord CSA according to gestational age up to 30 weeks was y = -0.2159 x² + 23.828x-325.59 (R² = 0.6334) and for the WJ area according to gestational age up to 30 weeks, it was y = -0.2124 x ² +17.613x-221.66 (R² = 0.4979).

Conclusion:

Reference ranges for umbilical cord CSA have been generated. The CSA of the umbilical cord and other components of it increase as a function of gestational age. These measurements correlate with fetal size.

In Vitro Differentiation of Human Umbilical Cord Blood CD133(+)Cells into Insulin Producing Cells in Co-Culture with Rat Pancreatic Mesenchymal Stem Cells

Objective

Pancreatic stroma plays an important role in the induction of pancreatic cells by the use of close range signaling. In this respect, we presume that pancreatic mesenchymal cells (PMCs) as a fundamental factor of the stromal niche may have an effective role in differentiation of umbilical cord blood cluster of differentiation 133⁺ (UCB-CD133⁺) cells into newly-formed β-cells in vitro.

Materials and Methods

This study is an experimental research. The UCB-CD133⁺cells were purified by magnetic activated cell sorting (MACS) and differentiated into insulin producing cells (IPCs) in co-culture, both directly and indirectly with rat PMCs. Immunocytochemistry and enzyme linked immune sorbent assay (ELISA) were used to determine expression and production of insulin and C-peptide at the protein level.

Results

Our results demonstrated that UCB-CD133⁺differentiated into IPCs. Cells in islet-like clusters with (out) co-cultured with rat pancreatic stromal cells produced insulin and C-peptide and released them into the culture medium at the end of the induction protocol. However they did not respond well to glucose challenges.

Conclusion

Rat PMCs possibly affect differentiation of UCB-CD133⁺cells into IPCs by increasing the number of immature β-cells.

The effects of two bathing methods on the time of separation of umbilical cord in term babies in Turkey

Background:

Umbilical cord infection developing subsequent to bacterial colonization is one of the outstanding reasons of newborn mortality and morbidity in underdeveloped and developing countries

Objectives:

This study aimed to evaluate the influence of sponge and tub bathing methods on umbilical cord separation time in full term babies in Turkey.

Patients and Methods:

This quasi-experimental and randomized controlled study was performed on 100 healthy term newborn babies and their mothers. One-hundred full-term babies (51 sponge bathing, 49 tub bathing) born at a state hospital between 14.03.2013 and 18.05.2013 with gestational age of 38-42 weeks, weighing 2500 grams and above and met the selection criteria were included as the study sample. Two booklets were prepared about sponge bathing and tub bathing. Mothers were instructed about sponge bathing and tub bathing, umbilical cord care in prenatal and postnatal periods. The first postnatal visit was performed at the hospital. Home visits and telephone calls were continued until the day of cord separation. Number, percent, mean and standard deviation values, qui-square and Mann-Whitney U tests were used for data assessment.

Results:

The time of separation of umbilical cord in babies who were given sponge bathing (6.1 ± 1.4) was shorter compared to those given tub bathing (8.3 ± 2.5) (P < 0.005).

Conclusions:

Since wetting of umbilical cord during tub bathing delays the separation of umbilical cord, sponge bathing is recommended for newborns until the umbilical cord falls off.

Thin Cord Syndrome in a Thirty-year-old Pregnant Woman

Introduction:

The umbilical cord anomalies directly effect on the life quality of the fetus. It can lead to fetal death or many problems during pregnancy and delivery. Early detection of these abnormalities is of particular importance.

Case Presentation:

We report a case of thin cord syndrome (TCS) in a 30-year-old pregnant woman with suprapubic pain. After termination of pregnancy, histopathologic assessment confirmed the TCS.

Conclusions:

In all cases with suspected abortion, the umbilical cord disorder should be considered.

Wharton's jelly absence: a possible cause of stillbirth

The umbilical cord is a structure that provides vascular flow between the fetus and the placenta. It contains two arteries and one vein, which are surrounded and supported by gelatinous tissue known as Wharton’s jelly. There are many umbilical cord abnormalities that are related to the prognosis of fetus survival and birth weight. The authors report a case of umbilical cord constriction due to the localized absence of Wharton’s jelly, which was undiagnosed antenatally and had a fatal outcome. A review of the association between the absence of Wharton’s jelly and an unfavorable pregnancy outcome was undertaken.

Cardiac troponin T levels of umbilical cord in neonates with abnormal fetal heart rate

OBJECTIVE

Most neonatal encephalopathic disorders appear to be caused by perinatal events. Persistent myocardial ischemia leads to cellular necrosis and release of troponin from cardiac muscles. Fetal distress during labor may be detected by monitoring the fetal heart rate. However little is known about the relationship, if any, that exists between fetal heart rate abnormalities and the fetal cardiac musculature and its function. The aim of this study was to investigate the relationship, if any, of umbilical cord serum levels of cardiac troponin T with fetal bradycardia or late deceleration.

METHODS

In this cross sectional study, troponin T level in umbilical cord blood of 80 neonates are measured. There were 23 versus 57 fetuses with and without late deceleration or bradycardia.

FINDINGS

Level of cardiac troponin T in umbilical blood of neonates with fetal bradycardia or late deceleration was elevated in comparison to neonates without bradycardia or late deceleration. There was no relation between umbilical troponin T level and mode of delivery.

CONCLUSION

Infants with fetal bradycardia or late deceleration during labor had significantly higher cord cardiac troponin T levels. If troponin level is normal, the probability of hypoxia will be very low.

Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn infants

OBJECTIVE

Comparing the effect of topical human milk application and dry cord care on cord separation time.

METHODS

This research was a randomized clinical trial study on 130 singleton and mature newborns. Newborns were placed randomly in groups of topical application of human milk and dry cord care. The umbilical separation time was compared in the two groups. Data was analyzed by SPSS software. Independent Samples t-Test, χ(2), Fisher were used in this study.

FINDINGS

Median time of cord separation in human milk application group (150.95±28.68 hours) was significantly shorter than dry cord care group (180.93±37.42 hours) (P<0.001).

CONCLUSION

Topical application of human milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and non invasive way for cord care.

Chondrogenic differentiation of stem cells in human umbilical cord stroma with PGA and PLLA scaffolds

The stem cells in the umbilical cord stroma, or Wharton's jelly, are referred to as human umbilical cord mesenchymal stromal cells (hUCMSCs) and have been shown to differentiate along a chondrogenic lineage. The aim of this study was to evaluate the chondrogenic differentiation of hUCMSCs in either polyglycolic acid (PGA) or poly-L-lactic acid (PLLA) non-woven mesh scaffolds for cartilage tissue engineering. PGA is widely known to degrade faster than PLLA, and over longer time scales, and differences may be expected to emerge after extended culture periods. Therefore, the focus of this study was to evaluate differences over a shorter duration. After 21 days of culture in PLLA or PGA scaffolds, hUCMSC constructs were analyzed for biochemical content, histology, and gene expression. Overall, there were only minute differences between the two scaffold groups, with similar gene expression and biosynthesis. The most notable difference was a change in shape from cylindrical to spherical by the PGA, but not PLLA, scaffold group. The overall similar behavior of the groups may suggest that in vivo application of hUCMSC-seeded PLLA or PGA scaffolds, following a 21-day pre-culture period, may yield similar constructs at the time of implantation. However, differences may begin to become more apparent with in vivo performance following implantation, or with in vitro performance over longer time periods.