Umbilical cord and preeclampsia

Contreras, Mercedes Olaya; Salcedo-Betancourt, J.; Galvis, S.H.; Ortiz, A. Moro; Gutierrez, Susan; Bernal, Jaime

doi:10.3233/npm-16814108

Cited by 19 publications

(16 citation statements)

References 35 publications

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“…In the multivariate analysis, true knots were associated with HDP risk, association not previously reported, but understandable in the context of the relation between HDP and UC abnormalities: both the placenta and the UC are primary vascular structures that may reflect problems originated from inadequate blood flow in the intervillous space secondary to abnormal vascular flow or abnormalities remodeling of maternal vasculature in HDP. 33 We also observed other alterations although at much lower frequency for complications; among them were amniotic webs, which can be exceptionally tight up to the surface of the placenta and may stretch along the cord for considerable lengths. Such webs may limit cord mobility, possibly compromising blood flow.…”

Section: Discussionmentioning

confidence: 64%

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Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns

et al. 2018

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Introduction Umbilical cord (UC) abnormalities and their clinical relations in 434 newborns were analyzed. We had previously reported on clinical associations of long and short UCs with any kind of malformation. This study focuses on other UC features (insertion, vessels, entanglements, coiling, and knots) and their associations with clinical characteristics and neonatal prognosis. Methods An observational analytic study was performed on placentas from consecutive deliveries. Ordered logistic regression with bivariate and multivariate analysis was performed to evaluate the relationship between variables of interest concerning UC abnormalities. Results A total of 434 placentas made up the study. UC abnormalities were abnormal insertion, 82 (18.86%); coiling (hypo and hypercoiled), 177 (40.78%); single umbilical artery (SUA), 4 (0.92%); entanglements, 8 (1.84%); true knots, 3 (0.69%); webs in UC base, 9 (2.07%); and right twist, 68 (15.67%). After analyzing maternal and fetal complications during pregnancy, multivariate analysis confirmed the recognized association between malformations and SUA and male gender; further confirmation was also made between hypertensive disorders of pregnancy and true knots. Discussion UC abnormalities associated with undesirable outcomes are varied and should be recognized and described. Clinical factors associated with anatomical UC abnormalities are not completely understood and justify forthcoming studies.

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Section: Discussionmentioning

confidence: 64%

“…We attribute this to our hospital's complex obstetric needs, where preeclampsia is a predominant factor often associated with UC alterations. 33 Two other factors could be involved. First, fixation in formalin, given that it causes UC shrinkage.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns

et al. 2018

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“…Advances in some molecular alterations related to the VEGF family in PE30 currently have clinical applications,25 including as predictors of maternal outcomes in the short term. On the other hand, UC abnormalities are well recognized as risks for the fetus and newborns;31,32 the association between UC alterations and PE has also been established 15–17. This relation should guide neonatologists to be prepared for complications derived from both PE and UC abnormalities.…”

Section: Discussionmentioning

confidence: 92%

“…All of these alterations have been described as risk factors for fetus and newborns and are linked to neurological delay; neurological abnormalities (degenerative cerebral changes, white matter damage, altered imaging studies, and cerebral palsy) have been explained through germinal matrix or intraventricular hemorrhage, gliosis, or necrosis of the white matter and neuronal necrosis 19,37–39. The UCAA have been described as being more frequently associated with HDP 15. We found more abnormal length that expected: for short cords 5% (2%–4%), and for long cords 10% (4%–6%), similar to what has been observed in another series in the same population and in the population with malformations 40…”

Section: Discussionmentioning

confidence: 99%

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The umbilical cord, preeclampsia and the VEGF family

Contreras

Garrido

Hernández-Losa

et al. 2018

IJWH

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IntroductionThe VEGF family has been identified as abnormal in preeclampsia (PE). Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal morbidity and mortality worldwide; likewise, umbilical cord anatomical abnormalities (UCAA) are linked to poor neonatal outcomes. Based on the relationship described between PE and UCAA and the role of the VEGF family in PE, this study explored VEGF expression in placental and UC tissued from patients with PE and with UCAA.MethodsWe performed an observational, analytical study on placentas, comparing protein and mRNA expression in four groups: patients with PE, patients with UC abnormalities, patients with both, and patients with none of them. Using immunohistochemistry, we studied VEGF A, VEGF R1 (FLT1), MMP1, and PLGF. With quantitative reverse transcription polymerase chain reaction we described mRNA expression of PLGF, VEGF and sFLT1, and sFLT1/PLGF ratio.ResultsForty newborns were included. Sixty-seven percent of mothers and 45% of newborns developed no complications. Immunohistochemistry was performed on UC and placental disc paraffin-embedded tissue; in the latter, the mRNA of the VEGF family was also measured. Statistically significant differences were observed among different expressions in both HDP and UCAA groups. Interestingly, the UCAA group exhibited lower levels of sFLT1 and VEGF-A in comparison with other groups, with significant P-value for sFLT1 (P=0000.1).ConclusionThe origin of UCAA abnormalities and their relation with HDP are still unknown. VEGF family alterations could be involved in both. This study provides the first approach related to molecules linked to UCAA.

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Knots of the umbilical cord: Incidence, diagnosis, and management

Al Qasem,

Meyyazhagan,

Tsibizova

et al. 2024

Intl J Gynecology & Obste

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Knot(s) of the umbilical cord have received emphasis because the clinical assessments and sonographic literature show a crucial role in fetal outcomes. The true umbilical cord knot could be a knot in a singleton pregnancy or an entanglement of two umbilical cords in monoamniotic twins. Clinical manifestations are almost silent, which can raise clinical challenges. They worsen outcomes, and the pathology can be easily missed during prenatal visits because ultrasonographers do not pay attention to the cord during an obstetric ultrasound scan. However, most medical centers now have ultrasound machines that improve fetal assessment. The umbilical cord should be routinely evaluated during a fetal assessment, and suspicion of an umbilical cord knot can be more frequently diagnosed and is detected only incidentally. Clinical outcome is usually good but depends on the knot's characteristics and if it is tight or loose. In this review, we discuss pathophysiology, the theories on formation, the main risk factors, ultrasound signs and findings, different opinions in the management, and features of pregnancy outcomes feature.

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Umbilical cord and preeclampsia

Abstract: In women with gestational hypertension, umbilical cord abnormalities are associated with fetal and neonatal consequences.

Cited by 19 publications

References 35 publications

Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns

Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns

The umbilical cord, preeclampsia and the VEGF family

Knots of the umbilical cord: Incidence, diagnosis, and management

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