DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174961

Abnormalities of the umbilical cord: correlation with placental histology and perinatal outcome

Umamaheswari Gurusamy, Ramya Thangavelu, Chaitra Venkataswamy

Abstract


Background: The purpose of this study was to evaluate gross umbilical cord abnormalities and to examine its relationship with placental pathological features and perinatal outcome.

Methods: We retrospectively collected 101 singleton placentas with gross umbilical cord abnormalities over 3-year period (delivered on or after 20 weeks of gestational age). Association between gross umbilical cord abnormalities such as hypercoiled cords, hypocoiled cords, thin cords, true knot, strictures, excessively long cord, and abnormal cord insertions were reviewed and evaluated for placental histology, clinical parameters and perinatal outcome.

Results: The most common umbilical cord abnormality (UCA) observed was coiling abnormality (hypercoiling, hypocoiling and strictures). Gross UCAs were associated with maternal factors (preeclampsia, oligohydramnios and gestational diabetes), foetal factors (intrauterine foetal death, SGA and intrapartum complications such as NRFHR tracing and low Apgar scores) and histologic placental features (maternal vascular malperfusion, foetal vascular malperfusion, villous capillary lesions and inflammation). Cords with multiple abnormalities were significantly correlated with histologic evidence of foetal vascular obstruction and intrauterine foetal death.

Conclusions: Gross UCAs, especially when multiple were associated with clinically significant placental findings and adverse perinatal outcome. Therefore, our study reinforces that all placentas with gross UCAs should be submitted for examination with complete (full length of the) umbilical cord.

 


Keywords


Coiling abnormality perinatal outcome, Foetal vascular malperfusion, Maternal vascular malperfusion, Placental histology, Umbilical cord abnormalities

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References


De Laat MW. The umbilical coiling index in complicated pregnancy. Eur J Obstet Gynecol. Reprod Biol. 2007;130(1):66-72.

Rebecca N. Baergen. Umbilical Cord Pathology. Surgical pathol. 2013;6:61-85.

Chan JS, Baergen RN. Gross umbilical cord complications are associated with placental lesions of circulatory stasis and fetal hypoxia. Pediatr Dev Pathol. 2012;15(6):487-94.

T. Yee Khong. Sampling and Definitions of Placental Lesions. Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140:698-713.

Benirschke K, Burton GJ, Baergen RN. Pathology of the Human Placenta. Sixth edition. New York, NY: Springer; 2012.

Amy Heerema-McKenney, MD, Monique E De Paepe, MD, MSc and Edwina J Popek, DO. Diagnostic Pathology: Placenta. Published by AMIRSYS; 2015.

Almog B. Placenta weight percentile curves for singleton and twins deliveries. Placenta. 2011;32:58e62.

Ernst LM, Minturn L, Huang MH, Curry E, Su EJ. Gross patterns of umbilical cord coiling: correlations with placental histology and stillbirth. Placenta. 2013;34(7):583-8.

Baergen RN. Cord abnormalities, structural lesions, and cord "accidents". Semin Diagn Pathol. 2007;24 (1):23-32.

Tantbirojn P, Saleemuddin A. Gross Abnormalities of the Umbilical Cord: Related Placental Histology and Clinical Significance. Placenta. 2009;30:1083-8.

Verkleij CPM. Evaluation of antenatal umbilical coiling index at 16–21 weeks of gestation as a predictor of trisomy 21and other chromosomal defects. Ultrasound Obstet Gynecol. 2013;42:545– 52.

Diwakar RK, Naik MM, Jindal MM. Umbilical cord coiling: case report and review of literature. BJR Case Rep. 2017;2:20150152.

Ryan WD, Trivedi N, Benirschke K. Placental Histologic Criteria for Diagnosis of Cord Accident: Sensitivity and Specificity. Pediatr Dev Pathol. 2012;15:275-80.

Tihana Rumboldt, Paul T Eberts. Disorders of Fetal Vascular Development Chorangioma, Localised Chorangiomatosis, Chorangiosis, and Diffuse Multifocal Chorangiomatosis, Pathology Case Reviews. 2008;13:236-40.

Shun-Jen Tan. Fetal demise by umbilical cord around abdomen and stricture. Archives Gynecol bstetr. 2010;281:137.

Waldo Sepulveda, MD et al. Improving Sonographic Evaluation of the Umbilical Cord at the Second-Trimester Anatomy Scan. J Ultrasound Med. 2009;28:831-5.

Kulkarni ML. Absence of Wharton's jelly around the umbilical arteries. Indian J Pediatr. 2007;74(8):787-9.

Hyeong Ju Kim. Association of isolated single umbilical artery with perinatal outcomes: Systemic review and meta-analysis. Obstet Gynecol Sci. 2017;60(3):266-73.

Pathak S, Sebire NJ, Hook L, Hackett G, Murdoch E, Jessop F, et al. Relationship between placental morphology and histological findings in an unselected population near term. Virchows Arch. 2011;459(1):11-20.