Abstract
Objective: Previous studies have shown that umbilical cord morphology and its components affect the pregnancy process, mode of delivery, and outcome. Within the scope of this research, we aimed to elucidate and compare placental histological features and perinatal outcomes in all deliveries with or without umbilical cord anomaly.
Materials & Methods: A total of 1105 females who had a delivery in our institution have been enrolled in this prospective study. Regarding patient groups, 270 cases were in the study group, and 835 cases in the control group. All patients' demographic data, prenatal information, intrapartum information, postpartum information, postpartum period, and newborn follow-up were recorded. After delivery, umbilical cord abnormalities and placenta macroscopic and microscopy results were monitored prospectively.
Results: No placental pathology was detected in the control group, but statistical significance was achieved in the study group, including fetal vascular thrombosis and ectasia pathology and fetal vasculopathy or avascular villi pathology. There was no difference between the study and control groups regarding preeclampsia, ablatio placenta, and intrauterine maternal loss. Intrauterine growth retardation was detected at a higher rate in the study group, and the difference was significant. It was found that the follow-up of the babies of the cases in the neonatal intensive care unit study group was more complicated and required longer treatment.
Conclusion: Gros cord anomalies, fetal vascular ectasia and thrombosis, and fetal thrombotic vasculopathy lead to pathologies associated with placental insufficiency, suggesting that it is an independent risk factor for intrauterine growth retardation.
Keywords
cord anomaly intrauterine maternal loss intrauterine growth retardation Apgar Score newborn
Project Number
-
References
- 1. Heil JR, Bordoni B. Embryology, Umbilical Cord. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491422.
- 2. Larcher L, Jauniaux E, Lenzi J, Ragnedda R, Morano D, Valeriani M, Michelli G, Farina A, Contro E. Ultrasound diagnosis of placental and umbilical cord anomalies in singleton pregnancies resulting from in vitro fertilization. Placenta. 2023 Jan;131:58-64. doi: 10.1016/j.placenta.2022.11.010. Epub 2022 Nov 29. PMID: 36493624.
- 3. Damiani GR, Arezzo F, Vimercati A, Del Boca G, Biffi A, Gaetani M, Cicinelli E. Thrombosed Arteriovenous Malformation of Umbilical Cord. J Obstet Gynaecol India. 2023 Jun;73(3):287-289. doi: 10.1007/s13224-022 01635-w. Epub 2022 May 25. PMID: 37324371; PMCID: PMC10267090.
- 4. Hemmati F, Barzegar H, Oboodi R. Giant umbilical cord in a normal preterm infant: a case report and review of the literature. J Med Case Rep. 2023 Jan 15;17(1):14. doi: 10.1186/s13256-022-03747-3. PMID: 36641443; PMCID: PMC9840833.
- 5. Uribe K, Chiruvolu A, Jelin AC. Maternal implications of placental transfusion. Semin Perinatol. 2023 Jun;47(4):151733. doi: 10.1016/j.semperi.2023.151733. Epub 2023 Mar 17. PMID: 37068968.
- 6. Waldron JE, Muir SM, Hubbard J. Double and Single True Knot of an Umbilical Cord: A Case Report. Cureus. 2023 Mar 20;15(3):e36393. doi: 10.7759/cureus.36393. PMID: 37090371; PMCID: PMC10115747.
- 7. Visentin S, Londero AP, Santoro L, Pizzi S, Andolfatto M, Venturini M, Saraggi D, Coati I, Sacchi D, Rugge M, Cosmi E. Abnormal umbilical cord insertions in singleton deliveries: placental histology and neonatal outcomes. J Clin Pathol. 2022 Nov;75(11):751-758. doi: 10.1136/jclinpath-2020-207342. Epub 2021 Jun 3. PMID: 34083414.
- 8. 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 Nov 12;17(1):414. doi: 10.1186/s13023-022-02563-8. PMID: 36371215; PMCID: PMC9652808.
- 9. Parast MM, Crum CP, Boyd TK. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum Pathol. 2008 Jun;39(6):948-53. doi: 10.1016/j.humpath.2007.10.032. Epub 2008 Apr 21. PMID: 18430456.
- 10. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000 Sep-Oct;3(5):462-71. doi: 10.1007/s100240010103. PMID: 10890931.
- 11. Tantbirojn P, Saleemuddin A, Sirois K, Crum CP, Boyd TK, Tworoger S, Parast MM. Gross abnormalities of the umbilical cord: related placental histology and clinical significance. Placenta. 2009 Dec;30(12):1083-8. doi: 10.1016/j.placenta.2009.09.005. Epub 2009 Oct 22. PMID: 19853300.
- 12. Santana EFM, Castello RG, Rizzo G, Grisolia G, Araujo Júnior E, Werner H, Lituania M, Tonni G. Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound. Diagnostics (Basel). 2022 Nov 16;12(11):2810. doi: 10.3390/diagnostics12112810. PMID: 36428871; PMCID: PMC9689386.
- 13. Stanek J. Shallow Placentation: A Distinct Category of Placental Lesions. Am J Perinatol. 2021 Sep 29. doi: 10.1055/s-0041-1735554. Epub ahead of print. PMID: 34587634.
- 14. Benirschke K. Obstetrically important lesions of the umbilical cord. J Reprod Med. 1994 Apr;39(4):262-72. PMID: 8040842.
- 15. Collins JH. Umbilical cord accidents: human studies. Semin Perinatol. 2002 Feb;26(1):79-82. doi: 10.1053/sper.2002.29860. PMID: 11876571.
- 16. Naeye RL. Umbilical cord length: clinical significance. J Pediatr. 1985 Aug;107(2):278-81. doi: 10.1016/s0022-3476(85)80149-9. PMID: 4020556.
- 17. Peng HQ, Levitin-Smith M, Rochelson B, Kahn E. Umbilical cord stricture and overcoiling are common causes of fetal demise. Pediatr Dev Pathol. 2006 Jan-Feb;9(1):14-9. doi: 10.2350/05-05-0051.1. Epub 2006 Apr 4. PMID: 16808633.
- 18. Hayes DJL, Warland J, Parast MM, Bendon RW, Hasegawa J, Banks J, Clapham L, Heazell AEP. Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta analysis. PLoS One. 2020 Sep 24;15(9):e0239630. doi: 10.1371/journal.pone.0239630. PMID: 32970750; PMCID: PMC7514048.
- 19. Morrison I, Olsen J. Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol. 1985 Aug 15;152(8):975-80. doi: 10.1016/0002-9378(85)90542-3. PMID: 4025459.
- 20. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000 Sep-Oct;3(5):462-71. doi: 10.1007/s100240010103. PMID: 10890931.
- 21. Baergen RN, Malicki D, Behling C, Benirschke K. Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study. Pediatr Dev Pathol. 2001 Mar-Apr;4(2):144-53. doi: 10.1007/s100240010135. PMID: 11178630.
- 22. Airas U, Heinonen S. Clinical significance of true umbilical knots: a population-based analysis. Am J Perinatol. 2002 Apr;19(3):127-32. doi: 10.1055/s-2002-25311. PMID: 12012287.
- 23. Rhoades DA, Latza U, Mueller BA. Risk factors and outcomes associated with nuchal cord. A population based study. J Reprod Med. 1999 Jan;44(1):39-45. PMID: 9987738.
- 24. Elameer M, Harris MV, Cox J. Diagnosis of venous thromboembolism in pregnancy: a review of current guidelines. Clin Radiol. 2022 Dec;77(12):904-912. doi: 10.1016/j.crad.2022.08.122. Epub 2022 Sep 16. PMID: 36123200.
- 25. Larson JD, Rayburn WF, Harlan VL. Nuchal cord entanglements and gestational age. Am J Perinatol. 1997 Oct;14(9):555-7. doi: 10.1055/s-2007-994333. PMID: 9394166.
- 26. Simon LV, Hashmi MF, Bragg BN. APGAR Score. 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262097.
Abstract
Amaç: Önceki çalışmalar, göbek kordonu morfolojisinin ve bileşenlerinin gebelik sürecini, doğum şeklini ve sonucunu etkilediğini göstermiştir. Bu araştırma kapsamında göbek kordonu anomalisi olan ve olmayan tüm doğumlarda plasentanın histolojik özelliklerin ve perinatal sonuçların aydınlatılması ve karşılaştırılması amaçlandı.
Gereç ve Yöntem: Bu prospektif çalışmaya kurumumuzda doğum yapan toplam 1105 kadın dahil edildi. Hasta gruplarına bakıldığında çalışma grubunda 270, kontrol grubunda 835 olgu yer aldı. Tüm hastaların demografik verileri, prenatal bilgileri, intrapartum bilgileri, postpartum bilgileri, postpartum dönemleri ve yenidoğan izlemleri kaydedildi. Doğumdan sonra göbek kordonu anormallikleri ve plasenta makroskobik ve mikroskopi sonuçları prospektif olarak izlendi.
Bulgular: Kontrol grubunda plasenta patolojisi saptanmadı, ancak çalışma grubunda fetal vasküler tromboz ve ektazi patolojisi ve fetal vaskülopati veya avasküler villus patolojisi gibi istatistiksel anlamlılık sağlandı. Çalışma ve kontrol grupları arasında preeklampsi, plasenta dekolmanı ve intrauterin anne kaybı açısından fark yoktu. Çalışma grubunda intrauterin gelişme geriliği daha yüksek saptandı ve aradaki fark anlamlıydı. Yenidoğanların 1. ve 5. dakika Apgar skorları ve yenidoğan yoğun bakım ünitesinde yatış gerekliliği açısından iki grup arasında fark izlenmedi. Yenidoğan yoğun bakım çalışma grubundaki olguların bebeklerinin takibinin daha komplike olduğu ve daha uzun tedavi gerektirdiği saptandı.
Sonuç: Gros kord anomalileri, fetal vasküler ektazi ve tromboz ve fetal trombotik vaskülopati plasenta yetmezliği ile ilişkili patolojilere yol açarak intrauterin gelişme geriliği için bağımsız bir risk faktörü olduğunu düşündürmektedir.
Supporting Institution
destekleyen kurum bulunmamaktadır
Project Number
-
References
- 1. Heil JR, Bordoni B. Embryology, Umbilical Cord. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491422.
- 2. Larcher L, Jauniaux E, Lenzi J, Ragnedda R, Morano D, Valeriani M, Michelli G, Farina A, Contro E. Ultrasound diagnosis of placental and umbilical cord anomalies in singleton pregnancies resulting from in vitro fertilization. Placenta. 2023 Jan;131:58-64. doi: 10.1016/j.placenta.2022.11.010. Epub 2022 Nov 29. PMID: 36493624.
- 3. Damiani GR, Arezzo F, Vimercati A, Del Boca G, Biffi A, Gaetani M, Cicinelli E. Thrombosed Arteriovenous Malformation of Umbilical Cord. J Obstet Gynaecol India. 2023 Jun;73(3):287-289. doi: 10.1007/s13224-022 01635-w. Epub 2022 May 25. PMID: 37324371; PMCID: PMC10267090.
- 4. Hemmati F, Barzegar H, Oboodi R. Giant umbilical cord in a normal preterm infant: a case report and review of the literature. J Med Case Rep. 2023 Jan 15;17(1):14. doi: 10.1186/s13256-022-03747-3. PMID: 36641443; PMCID: PMC9840833.
- 5. Uribe K, Chiruvolu A, Jelin AC. Maternal implications of placental transfusion. Semin Perinatol. 2023 Jun;47(4):151733. doi: 10.1016/j.semperi.2023.151733. Epub 2023 Mar 17. PMID: 37068968.
- 6. Waldron JE, Muir SM, Hubbard J. Double and Single True Knot of an Umbilical Cord: A Case Report. Cureus. 2023 Mar 20;15(3):e36393. doi: 10.7759/cureus.36393. PMID: 37090371; PMCID: PMC10115747.
- 7. Visentin S, Londero AP, Santoro L, Pizzi S, Andolfatto M, Venturini M, Saraggi D, Coati I, Sacchi D, Rugge M, Cosmi E. Abnormal umbilical cord insertions in singleton deliveries: placental histology and neonatal outcomes. J Clin Pathol. 2022 Nov;75(11):751-758. doi: 10.1136/jclinpath-2020-207342. Epub 2021 Jun 3. PMID: 34083414.
- 8. 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 Nov 12;17(1):414. doi: 10.1186/s13023-022-02563-8. PMID: 36371215; PMCID: PMC9652808.
- 9. Parast MM, Crum CP, Boyd TK. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum Pathol. 2008 Jun;39(6):948-53. doi: 10.1016/j.humpath.2007.10.032. Epub 2008 Apr 21. PMID: 18430456.
- 10. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000 Sep-Oct;3(5):462-71. doi: 10.1007/s100240010103. PMID: 10890931.
- 11. Tantbirojn P, Saleemuddin A, Sirois K, Crum CP, Boyd TK, Tworoger S, Parast MM. Gross abnormalities of the umbilical cord: related placental histology and clinical significance. Placenta. 2009 Dec;30(12):1083-8. doi: 10.1016/j.placenta.2009.09.005. Epub 2009 Oct 22. PMID: 19853300.
- 12. Santana EFM, Castello RG, Rizzo G, Grisolia G, Araujo Júnior E, Werner H, Lituania M, Tonni G. Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound. Diagnostics (Basel). 2022 Nov 16;12(11):2810. doi: 10.3390/diagnostics12112810. PMID: 36428871; PMCID: PMC9689386.
- 13. Stanek J. Shallow Placentation: A Distinct Category of Placental Lesions. Am J Perinatol. 2021 Sep 29. doi: 10.1055/s-0041-1735554. Epub ahead of print. PMID: 34587634.
- 14. Benirschke K. Obstetrically important lesions of the umbilical cord. J Reprod Med. 1994 Apr;39(4):262-72. PMID: 8040842.
- 15. Collins JH. Umbilical cord accidents: human studies. Semin Perinatol. 2002 Feb;26(1):79-82. doi: 10.1053/sper.2002.29860. PMID: 11876571.
- 16. Naeye RL. Umbilical cord length: clinical significance. J Pediatr. 1985 Aug;107(2):278-81. doi: 10.1016/s0022-3476(85)80149-9. PMID: 4020556.
- 17. Peng HQ, Levitin-Smith M, Rochelson B, Kahn E. Umbilical cord stricture and overcoiling are common causes of fetal demise. Pediatr Dev Pathol. 2006 Jan-Feb;9(1):14-9. doi: 10.2350/05-05-0051.1. Epub 2006 Apr 4. PMID: 16808633.
- 18. Hayes DJL, Warland J, Parast MM, Bendon RW, Hasegawa J, Banks J, Clapham L, Heazell AEP. Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta analysis. PLoS One. 2020 Sep 24;15(9):e0239630. doi: 10.1371/journal.pone.0239630. PMID: 32970750; PMCID: PMC7514048.
- 19. Morrison I, Olsen J. Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol. 1985 Aug 15;152(8):975-80. doi: 10.1016/0002-9378(85)90542-3. PMID: 4025459.
- 20. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000 Sep-Oct;3(5):462-71. doi: 10.1007/s100240010103. PMID: 10890931.
- 21. Baergen RN, Malicki D, Behling C, Benirschke K. Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study. Pediatr Dev Pathol. 2001 Mar-Apr;4(2):144-53. doi: 10.1007/s100240010135. PMID: 11178630.
- 22. Airas U, Heinonen S. Clinical significance of true umbilical knots: a population-based analysis. Am J Perinatol. 2002 Apr;19(3):127-32. doi: 10.1055/s-2002-25311. PMID: 12012287.
- 23. Rhoades DA, Latza U, Mueller BA. Risk factors and outcomes associated with nuchal cord. A population based study. J Reprod Med. 1999 Jan;44(1):39-45. PMID: 9987738.
- 24. Elameer M, Harris MV, Cox J. Diagnosis of venous thromboembolism in pregnancy: a review of current guidelines. Clin Radiol. 2022 Dec;77(12):904-912. doi: 10.1016/j.crad.2022.08.122. Epub 2022 Sep 16. PMID: 36123200.
- 25. Larson JD, Rayburn WF, Harlan VL. Nuchal cord entanglements and gestational age. Am J Perinatol. 1997 Oct;14(9):555-7. doi: 10.1055/s-2007-994333. PMID: 9394166.
- 26. Simon LV, Hashmi MF, Bragg BN. APGAR Score. 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262097.
Details
| Primary Language | English |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Research Articles |
| Authors | |
| Project Number | - |
| Publication Date | September 9, 2024 |
| Submission Date | July 9, 2023 |
| Published in Issue | Year 2024Volume: 63 Issue: 3 |
