Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants

Abstract

Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants.Ullberg, Ulla; Lingman, Göran; Ekman-Ordeberg, Gunvor; Sandstedt, Bengt Link to publication Citation for published version (APA): Ullberg, U., Lingman, G., Ekman-Ordeberg, G., & Sandstedt, B. (2003). Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants. Acta Obstetricia et Gynecologica Scandinavica, 82(8), 716-721. DOI: 10.1034/j.1600-0412.2003 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background. The aim of this study was to investigate the occurrence and appearance of the anastomosis between the two umbilical arteries in placentas from infants small for gestational age (SGA). Methods. The arterial systems of 64 placentas from singleton pregnancies resulting in SGA infants were visualized by angiography. The method allowed study of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each artery. The results were compared with findings in a previous study of appropriate for gestational age (AGA) infants. One-way analysis of variance (ANOVA) and w 2 -analyses were used for statistics. Results. In 56 placentas the anastomosis was represented by a true vessel, in two by a fenestration, and in another two cases by fusion of the umbilical arteries. The anastomosis was absent in one case and another three cases had a single umbilical artery (SUA). When the diameter of the anastomosis was thinner than that of the umbilical arteries, their supply areas were significantly (p 0.001) more symmetrical than in cases with a wider anastomosis.The anatomy of the anastomosis and the relationship between its width and the symmetry between the supply areas of each umbilical artery did not differ in placentas from SGA and AGA infants, despite various types of cord insertion and placentation. Conclusion. Static measurements of Hyrtl's anastomosis do not indicate a contributing part for intrauterine growth retardation.

Morphological study of Hyrtl's anastomosis in gestational diabetes mellitus and its relation to umbilical cord insertion

“…Hyrtl's anastomosis was found normal in small for gestational age foetus and its static measurements were not contributing for the same [9]. Adoption of Hyrtl's anastomosis by GDM mothers if fails to overcome the resistance and pressure difference between the arteries to supply the placental territories equally may lead to abnormal insertions.…”

“…Perfectly symmetrical umbilical arteries may lack anastomosis [8]. The anatomy of Hyrtl's anastomosis is the main factor determining the area of supply by the umbilical arteries [9]. In case of partial compression of placenta it is considered as a safety valve that may occurs during uterine contraction or occlusion of an umbilical artery and its absence could be responsible for the incident of discordant umbilical arteries, which is often associated with placental anomalies like velamentous, marginal insertion and infarct [10].…”