The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

Miremberg, Hadas; Gindes, L.; Schreiber, Letizia; Sternfeld, Alona Raucher; Bar, Jacob; Kovo, Michal

doi:10.1002/pd.5515

Cited by 37 publications

(25 citation statements)

References 31 publications

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“…In the present study, lower neonatal weight was significantly correlated with torsion of the umbilical cord. Miremberg et al 11 found that because adequate coiling prevents the umbilical cord from compressing, torsion of the umbilical cord results in reduced fetoplacental circulation in the long term, thus restricting growth.…”

Section: Discussionmentioning

confidence: 99%

“…We found that a UCI of >0.36 can predict fetal distress. Miremberg et al 11 proposed that the number of coils remains constant throughout pregnancy. They stated that 30% of non-coiled umbilical cords that are detected before 20 weeks' gestation with an ultrasound scan will become coiled during the latter half of gestation, but that previously coiled umbilical cords do not become uncoiled.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED: Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion

et al. 2020

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This study analyzed factors influencing umbilical cord torsion, measured the umbilical coiling index (UCI) postnatally, and analyzed the association of umbilical cord torsion with maternal and perinatal outcomes. Methods: In total, 845 antenatal women who went into labor at the Fujian Provincial Maternity and Children's Hospital from January 2016 to January 2017 were retrospectively studied. The patients were divided into those with and without umbilical cord torsion. Possible influencing factors and the UCI were noted, and maternal and perinatal outcomes were compared. Results: Higher morbidity in the presence of umbilical cord torsion was affected by multiparous pregnancy and a long cord. The area under the curve was 0.666 for the UCI to predict fetal distress and 0.505 for the umbilical artery peak systolic to end diastolic flow velocity ratio (S/D ratio) to predict fetal distress. Umbilical cord torsion was associated with higher rates of fetal distress, forceps-assisted delivery, cesarean sections, fetal heart rate abnormalities, amniotic fluid meconium staining, neonatal intensive care unit admission, and small for gestational age. Conclusions: Multiparous status and longer umbilical cord length were highly associated with umbilical cord torsion. The UCI is a better predictor of fetal distress than is the umbilical artery S/D ratio.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

RETRACTED: Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion

et al. 2020

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“…In the study by Rychik et al, the most common lesion seen was thrombosis in 41% of CHD placentas as well as infarction (17%) (14). On histopathology, higher rates of both maternal and fetal vascular malperfusion (MVM and FVM) were seen in a case control study of placentas from pregnancy terminations due to severe CHD compared to controls (26). FVM represents a group of placental lesions that can result from abnormal fetal perfusion to the villous parenchyma of the placenta.…”

Section: Histopathologymentioning

confidence: 98%

Placental abnormalities in congenital heart disease

Andescavage¹,

Limperopoulos²

2021

Transl Pediatr

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Congenital heart disease (CHD) remains the most common birth defect in infants, and critical CHD is associated with significant rates of morbidity and mortality. With the advent of powerful yet noninvasive advanced fetal imaging, it is becoming increasingly evident that the presence of CHD in utero disrupts typical development and contributes to the lifelong morbidity in this population. Across healthy and high-risk populations, intrauterine influences can permanently alter fetal development that may manifest in complex morbidities later in life, the so-called fetal-onset-of-adult-disease (FOAD) phenomenon. The placenta plays a critical role in not only supporting fetal development, but also by adapting to specific intrauterine conditions. The role of placental health, adaptation and dysfunction, however, in CHD is not well understood. In this article, we will review current evidence relating placental health in CHD, appraise existing knowledge-gaps in the field and highlight promising new avenues to better understand the impact of placental function on fetal well-being. We will review evidence of ex vivo human placental studies that describe abnormal placental findings in pregnancies complicated by CHD, as well evidence for in vivo assessments of the human placenta. While overall clinical in vivo assessments of placental development are rather limited, we will also review emerging evidence from advanced quantitative and functional magnetic resonance imaging that are bringing new insights into placental structure and function throughout gestation.By providing novel information about placental development, we can now explore the maternal-fetalplacental connection in greater detail, and better understand the multi-factorial mechanisms that may contribute to adverse outcomes seen in survivors of CHD.

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“…The previous studies did not either have a control group or selected a control group with other anomalies for comparison and/or reported on selected histopathology rather than a full classification of perfusion defects. 10,12,16 Rychik et al. investigated placental weight and a combination of FVM and MVM markers including villous maturity, villous chorangiosis, villous infarction, and thrombosis in 120 severe CHD cases without a control group and reported a high risk of thrombosis in 41%.…”

Section: Discussionmentioning

confidence: 99%

“…9 Although a small placenta and abnormal cord insertion have been reported, PPD have not been well defined in pregnancies with CHD of the fetus. 10–12 In this study, we sought to assess the rates of PPD in severe isolated fetal CHD cases.…”

Section: Introductionmentioning

confidence: 99%

The Association of Fetal Congenital Cardiac Defects and Placental Vascular Malperfusion

et al. 2021

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Objectives Abnormal early angiogenesis appears to impact both placental disorders and fetal congenital heart defects (CHD). We sought to assess the association of placental perfusion defects (PPD) and fetal (CHD). Methods Singleton pregnancies with isolated severe fetal CHD were compared to controls without congenital anomalies or maternal malperfusion (MVM) risk factors. CHD was categorized into group 1: single left ventricle morphology and transposition of the great vessels (TGA) and group 2: single right ventricle and two ventricle morphology. Malperfusion was defined as fetal vascular malperfusion (FVM), MVM, and both FVM and MVM. Results PPD was increased for all CHD (n = 47), CHD with or without risk factors, and CHD groups compared to controls (n = 92). Overall CHD cases and CHD with risk factors had an increased risk of FVM (30% and 80% vs 14%), and MVM (43% and 50% vs 21%), respectively. MVM rates were similar in CHD with and without maternal risk factors. FVM (38% vs 14%) and MVM (44% vs 21%) were increased in Group 1. MVM (42% vs 21%) and both FVM and MVM (16% vs 3%) were increased in Group 2. Conclusions PPD risk is increased in severe isolated fetal CHD. The highest risk is seen in fetal CHD with maternal risk factors.

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The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

Cited by 37 publications

References 31 publications

RETRACTED: Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion

RETRACTED: Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion

Placental abnormalities in congenital heart disease

The Association of Fetal Congenital Cardiac Defects and Placental Vascular Malperfusion

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