Umbilical sP-selectin levels are different in preeclamptic pregnancies with intrauterine normal growth and growth restricted fetus

Objective.?The aim of this study was the analysis of the umbilical cord serum sP-selectin levels in pregnancies complicated by severe preeclampsia with and without intrauterine growth restriction and in normotensive pregnancies.

Patients and methods. The study was carried out on 18 patients with singleton pregnancies complicated by severe preeclampsia with appropriate-for-gestational-age weight infants (group P) and 18 pregnant patients with severe preeclampsia complicated by intrauterine fetal growth restriction (IUGR) (group PI). The control group consisted of 34 patients with singleton uncomplicated pregnancies (group C). Umbilical serum sP-selectin concentrations were estimated using a sandwich ELISA assay according to the manufacturer's instruction (ELISA kit Bender MedSystems Vienna, Austria).

Results.?Our study revealed different concentrations of soluble P-selectin in the umbilical cord in our both studied groups of preeclamptic women with and without IUGR. The umbilical cord levels of sP-selectin were decreased in the group with preeclampsia complicated by IUGR and increased in the preeclamptic women with the normal intrauterine fetal growth. The mean values of umbilical sP-selectin were 839.008?±?625.703?ng/ml in group P, 275.873?±?174.339?ng/ml in group PI, and 288.719?±?199.039?ng/ml in the control group, respectively.

Conclusions.?Higher levels of the umbilical sP-selectin may confirm the presence of platelet and endothelial cell activation and confirm a hypercoagulant state in preeclamptic disorder, especially in preeclampsia without IUGR.     

Umbilical artery flow velocity waveforms and cord blood viscosity.

The role of cord blood viscosity in determining the umbilical artery Doppler flow velocity waveform (FVW) was investigated in 22 normal pregnancies and 29 complicated pregnancies. FVWs were quantified by calculating the pulsatility index (PI). There was a significant correlation between an abnormal PI (more than 2 SD from the mean) and fetal growth retardation (less than 5th birthweight centile), cesarean section for fetal distress, and raised cord blood hematocrit. However, there was no relationship between whole blood or plasma viscosity measurements and the umbilical artery PI.     

Umbilical vascular coiling and nuchal entanglement

We have frequently observed that fetuses born with nuchal cords have umbilical cords that contain less vascular coiling. To study the association between umbilical vascular coiling and nuchal entanglement, the density of umbilical coiling was objectively assessed in relationship to nuchal entanglement of the umbilical cord using the “umbilical coiling index” in 200 consecutive liveborn neonates. The umbilical coiling index of each cord was determined by dividing the number of complete vascular coils by the total length of the cord in centimeters. The mean umbilical coiling index among those with nuchal cords (0.18 ± 0.09 coils/cm) was significantly less than that among the group without nuchal entanglement (0.21 ± 0.07 coils/cm), P = 0.01. Among those with umbilical coiling indices ≤0.10 coils/cm, 42% had nuchal cords, while only 4.8% of cords with indices ≥0.30 coil/cm had nuchal cords (P = 0.007). It is concluded that a relationship exists between the density of umbilical vascular coiling and nuchal entanglement of the cord.     

The cross-sectional area of umbilical cord components in normal pregnancy.

OBJECTIVE: To determine the normal cross-sectional areas of the umbilical vein, umbilical artery, and Wharton jelly in healthy pregnancies, and correlate the obtained values with fetal anthropometric parameters. METHODS: A cross-sectional study was performed with 312 women between the 24th and 39th weeks of a normal pregnancy. The cross-sectional areas of umbilical cord vessels were measured at the junction of the cord and fetal abdomen, and the values were subtracted from the total cord cross-sectional area to assess the cross-sectional area of the Wharton jelly. The anthropometric parameters analyzed were biparietal diameter, head circumference, femur length, and estimated fetal weight, and the Spearman correlation was used to assess the correlation between the cross-sectional areas of umbilical cord components and fetal anthropometric parameters. A polynomial regression analysis was performed to identify the curves that best adjusted to mean and standard deviation according to gestational age. RESULTS: A statistically significant correlation was observed between the cross-sectional areas of cord components and fetal anthropometric parameters (P<0.001) as well as gestational age (P<0.001). CONCLUSIONS: Reference measurements of the cross-sectional areas of umbilical cord components are important tools in the assessment of fetal growth.     

Umbilical cord prolapse and perinatal outcomes.

OBJECTIVES: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. METHODS: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121,227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1-6.3), hydramnios (OR=3.0; 95% CI 2.3-3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8-5.1), preterm delivery (OR=2.1; 95% CI 1.6-2.8), induction of labor (OR=2.2; 95% CI 1.7-2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5-2.3), lack of prenatal care (OR=1.4; 95% CI 1.02-1.8), and male gender (OR=1.3; 95% CI 1.1-1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9-17.9), and had longer hospitalizations (mean 5.4+/-3.5 days vs. 2.9+/-2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5-9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. CONCLUSIONS: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality.     

Umbilical cord length in singleton gestations: A Finnish population-based retrospective register study

Introduction

Many complications of pregnancy and delivery are associated with umbilical cord length. It is important to examine the variation in length, in order to identify normal and abnormal conditions. Moreover, the factors influencing cord growth and development are not precisely known.

Objective

The main objectives were to provide updated reference charts for umbilical cord length in singleton pregnancies and to evaluate potential factors affecting cord length.

Methods

Birth register data of 47,284 singleton pregnant women delivering in Kuopio University Hospital, Finland was collected prospectively. Gender-specific centile charts for cord length from 22 to 44 gestational weeks were obtained using generalized additive models for location, scale, and shape (GAMLSS). Gestational, fetal, and maternal factors were studied for their potential influence on cord length with single variable analysis and stepwise multiple linear regression analysis.

Results

Cord length increased according to gestational age, while the growth decelerated post-term. Birth weight, placental weight, pregravid maternal body mass index, parity, and maternal age correlated to cord length. Gestational diabetes and previous miscarriages were associated with longer cords, while female gender and placental abruption were associated with shorter cords.

Discussion and conclusions

Girls had shorter cords throughout gestation although there was substantial variation in length in both genders. Cord length associated significantly with birth weight, placental weight, and gestational age. Significantly shorter cords were found in women with placental abruption. This important finding requires further investigation.     

单绒毛膜单羊膜囊双胎脐带打结二例

单绒毛膜单羊膜囊（monochorionic monoamnionic,MCMA）单卵双胎是双胎妊娠中极罕见的一种类型,为极高危的双胎妊娠。由于两胎儿共用一个羊膜腔,两胎儿之间无胎膜分隔,因脐带缠绕和打结而发生宫内意外的可能性较大。对于双胎妊娠的孕妇应尽早明确其绒毛膜性质,一旦诊断为MCMA双胎,应提高警惕,在指南推荐的妊娠周数及时终止妊娠,改善母儿结局。回顾性报道山西省妇幼保健院2例MCMA双胎妊娠脐带形成真结并成功分娩的病例,以提高产科医师对早期诊断并分辨双胎绒毛膜性的意识,当诊断为MCMA双胎时,要特别关注脐带形态学及结构学上的异常,并加强对MCMA双胎妊娠孕妇的产前管理。     

Umbilical cord ulceration and intestinal atresia

Umbilical ulceration is an extremely rare complication in the perinatal period. We encountered a case of intestinal atresia complicated by massive intrauterine hemorrhage due to the umbilical cord ulceration. This is the fifth reported case demonstrating an association between the umbilical cord ulceration and intestinal atresia.     

Umbilical cord prolapse

Prolapse of the umbilical cord is a rare obstetric emergency that in the viable fetus necessitates an expeditious delivery. A case of a periviable pregnancy complicated by preterm premature rupture of membranes and overt umbilical cord prolapse was prolonged 2 weeks with expectant management is described. An extensive review of the literature regarding the etiology, risk factors, and management options for umbilical cord prolapse in both viable and previable pregnancies accompanies this report.     

Umbilical cord complications in twin pregnancies

OBJECTIVES: The postpartum umbilical cord examination can provide a lot of significant information concerning discordant twin growth or reasons of intrauterine death of one or all the fetuses. The aim of this study was the postpartum assessment of umbilical cords in twin pregnancies. MATERIAL AND METHODS: The examination material consisted placentas coming from 110 twin pregnancies. The analysis concerned the assessment of placenta types, the umbilical cords attachment place and also the twins birth weight. RESULTS: Basing on the studies of placentas coming from 110 twin pregnancies 76 (69.0%) dichorionic and 34 (31.0%) monochorionic placentas were found. Among dichorionic, 40 (53%) separated and 36 (47%) fused placentas were observed. Among monochorionic 31 (91%) diamniotic and 3 (9.0%) monoamniotic placentas were present. Abnormal umbilical insertion to placenta was most frequently observed in monochorionic pregnancies: in diamniotic--marginal insertion in 21.2%, velamentous insertion in 15.9%, and in monoamniotic--equally 33.3%. In dichorionic pregnancies, for fused placentas--marginal in 8.7%, velamentous in 9.1%, and for separated--5.6% and 3.1%. CONCLUSIONS: The abnormal umbilical cord insertions to the placenta was most frequently found in monochorionic pregnancies. Among pairs of twin born with body weight discordance, the abnormal umbilical cord insertion was more frequently found in the case of the smaller newborn.     

Umbilical artery Doppler flow velocimetry in intrauterine growth restriction and its relation to perinatal outcome.

OBJECTIVE: The purpose of this retrospective analysis was to compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery Doppler flow and the outcomes of pregnancies with end-diastolic velocity either diminished or severely reduced/absent. METHODS: One hundred pregnant women with growth-restricted fetuses were followed with Doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal Doppler group (16%), the less-severely abnormal group (77%), and the group with severely reduced or absent end-diastolic velocity waveforms (7%). RESULTS: The diagnosis-to-delivery interval was significantly shorter, and the average birth weight and gestational age at delivery were significantly lower, for fetuses with abnormal Doppler velocimetry (showing diminished or severely reduced/absent end-diastolic velocity) than for those in the normal Doppler group. Fetuses with abnormal Doppler velocimetry also had a significantly higher incidence of oligohydramnios, low-birth weight (<10th percentile), and admission to the Neonatal Intensive Care Unit. There were no perinatal deaths among the normal Doppler patients. CONCLUSIONS: Growth-restricted fetuses with normal umbilical artery velocimetry are at significantly lower risk than those with abnormal velocity waveforms, and immediate delivery of the fetus with diminished end-diastolic flow may be unnecessary. Knowing this relationship may be useful in the clinical management of such pregnancies. Doppler surveillance of growth-restricted fetuses supplemented with cardiotocography, preferably combined with biophysical profile testing, results in a prolonged gestational age and acceptable fetal outcome.     

Umbilical cord blood concentration of soluble scavenger receptor for hemoglobin,but not pentraxin 3, is of value for the early postpartum identification of the presence of histological chorioamnionitis

Objective: To determine whether umbilical cord blood concentrations of soluble scavenger receptor for hemoglobin (sCD163) and pentraxin 3 (PTX3) are of value in the early postpartum diagnosis of histological chorioamnionitis in preterm prelabor rupture of membranes (PPROM). Methods: Eighty-three women with pregnancies complicated by PPROM between 24 and 36 weeks of gestation with (n?=?38) and without (n?=?45) the presence of histological chorioamnionitis were included in the study. We compared umbilical cord blood sCD163 and PTX3 levels in preterm neonates from PPROM pregnancies with versus without the presence of histological chorioamnionitis using nonparametric test (Mann–Whitney U test). Results: The presence of histological chorioamnionitis was associated with a higher median umbilical cord blood sCD163, but not PTX3 concentration, to compare with the absence of histological chorioamnionitis [sCD163: median 1466?ng/mL, interquartile range (IQR) 1187–1828 vs. 1168?ng/mL, IQR 887–1595; p?=?0.01; PTX3: median 3.96?ng/mL, IQR 2.24–6.77 vs. 2.95?ng/mL, IQR 1.74–6.93; p?=?0.49]. Conclusions: HCA is associated with an increase of umbilical cord blood sCD163, but not PTX3 concentration. Umbilical cord blood sCD163 seems to be a postpartum marker of the presence of histological chorioamnionitis.     

Lectin binding in the umbilical cord in altered glycemia

OBJECTIVE: Content and distribution of the oligosaccharides in the umbilical cord from pregnancies with altered glycemia were investigated. STUDY DESIGN: A prospective cohort study was conducted in the Florence Policlinic of Careggi, Italy. Samples of cord from physiological pregnancies (n=20), from pregnancies with minor degree of glucose intolerance (n=20) and from pregnancies with gestational diabetes mellitus (GDM) treated with insulin (n=20) were collected. Eleven lectins were used (ConA, WGA, PNA, SBA, DBA, LTA, UEA I, OOA, GSL II, MAL II and SNA) in combination with chemical and enzymatic treatments. RESULTS: Increase of N-acetyl-d-glucosamine and a loss of sialic acid in the umbilical cord of the cases with minor degree of glucose intolerance with respect to the other study groups was observed. d-Galactose(beta1-->3)-N-acetyl-d-galactosamine, N-acetyl-d-galactosamine and l-fucose were in less amount in both the pathological groups with respect to the control one. CONCLUSION: The increase of some glycoconjugates carbohydrates and the loss of others in the umbilical cord from pregnancies with minor degree of glucose intolerance might be related to its morphofunctional alterations in a not diabetic altered glycemia. Moreover, the treatment with insulin in the GDM might play a role in restoring partially the normal glycosilation in the cord components in the attempt to renew some their functions.     

The umbilical coiling index in complicated pregnancy

OBJECTIVE: To evaluate umbilical cord coiling in pregnancies with adverse outcome. STUDY DESIGN: Umbilical cords and hospital records of 565 consecutive cases with an indication for histological examination of the placenta were studied. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the cord in centimeters, by an observer blinded for pregnancy outcome. Data on obstetric history and pregnancy outcome of each case were obtained from the hospital records. We calculated odds ratios and their 95% confidence interval to evaluate the strength of associations between pregnancy outcome and abnormal cord coiling. RESULTS: Fetal death (OR 4.09, 95% CI 2.22-7.55), chorioamnionitis (OR 1.77, 95% CI 1.09-2.88), fetal structural or chromosomal abnormalities (OR 1.78, 95% CI 1.08-2.95), and lower Apgar score at 5 min (p=0.03) were associated with undercoiling (UCI below the 10th percentile, using reference values from uncomplicated pregnancies). Fetal death (OR 3.74, 95% CI 1.89-7.40), iatrogenic preterm delivery (OR 1.91, 95% CI 1.04-3.49), umbilical arterial pH<7.05 (OR 3.63, 95% CI 1.44-9.17), fetal structural or chromosomal abnormalities (OR 1.79, 95% CI 1.01-3.16), thrombosis in fetal placental vessels (OR 2.64, 95% CI 1.37-5.06), chronic fetal hypoxia/ischemia (OR 1.82, 95% CI 1.09-3.05), and lower weight for gestational age (p=0.01) were associated with overcoiling (UCI above the 90th percentile). CONCLUSIONS: Our findings confirm that adverse perinatal outcome is associated with both undercoiling and overcoiling of the umbilical cord.     

Umbilical cord serum vascular endothelial growth factor (VEGF) levels in normal pregnancies and in pregnancies complicated by preterm delivery or pre-eclampsia.

OBJECTIVES: The aim of this study was to determine whether increased levels of vascular endothelial growth factor (VEGF) are implicated in the pathogenesis of pre-eclampsia and in preterm delivery. METHODS: Umbilical cord serum VEGF levels from women with uncomplicated term pregnancies (control group, n=24), with pregnancies complicated by pre-eclampsia (n=21), or with preterm delivery (n=29) were compared. Statistical analysis was performed using the Mann-Whitney U-test, the t-test, and Smirnoff-Kolmogorov test. RESULTS: The mean VEGF concentration was significantly higher in the women with pre-eclampsia than in women from the control group (P<0.01). There were also increased but not significantly higher VEGF concentrations in the preterm delivery group compared with the control group (P=0.16). CONCLUSIONS: Our study results support previous findings that raised umbilical cord serum VEGF levels might be correlated with the clinical development of pre-eclampsia and, in some circumstances, of preterm delivery.     

超声引导下经皮脐静脉穿刺术的应用

目的 探讨超声引导下经皮脐静脉穿刺术应用的成功率和安全性。方法 对应用此穿刺术872例的成功率和并发症进行分析。结果 一次进针成功率62．7％，2～4次进针成功率36．0％。发生一过性并发症31．4％，发生严重并发症0．3％。结论 提高超声引导下经皮脐静脉穿刺术的成功率和安全性，使此项介人性诊断技术准确、有效、安全地应用于临床。     

Umbilical cord blood for newborn DNA identification

OBJECTIVE: To compare umbilical cord blood with newborn heel stick blood for newborn DNA identification. DESIGN: Prospective, correlational, comparative analysis utilizing a convenience sample of birth mothers and newborns. SETTING: Labor and delivery unit in a large, private, not-for-profit community hospital. PARTICIPANTS: One hundred thirty four mother/infant dyads participated. Birth mothers were at least 18 years of age and able to read and understand English. SAMPLES: Blood samples were collected from each newborn utilizing the umbilical cord and a heel stick. A blood sample was collected from each mother utilizing a finger stick. MAIN OUTCOME MEASURE: Computerized short tandem repeat analyses and visual matching to identify positive matches between the umbilical cord blood sample and heel stick sample. RESULTS: Umbilical cord blood contains a DNA profile identical to the newborn heel stick sample that can be used to identify a newborn. CONCLUSION: Umbilical cord blood samples are a valid source of newborn DNA identification.     

Umbilical cord androgens in infants of diabetic mothers

The aim was to measure umbilical cord testosterone and androstenedione and to explore possible relationships with fetal weight and insulin levels. Testosterone, androstenedione and insulin were measured at birth in venous umbilical blood in 12 infants of gestational diabetic mothers and in 12 control subjects. The mean concentrations of umbilical testosterone and androstenedione were not significantly different between the infants of the diabetic and control mothers. No significant correlation was found between maternal weight, fetal weight or insulin concentrations and androgen levels. Received: 15 October 1996 / Accepted: 31 October 1996     

Umbilical cord pH and base excess values in relation to neonatal morbidity for infants delivered preterm

OBJECTIVE: Our purpose was to determine the relationship/predictive value of umbilical cord pH and base excess (BE) values to adverse neonatal outcomes for preterm infants. STUDY DESIGN: A tertiary center perinatal/neonatal database was used to obtain umbilical cord pH and BE values, adverse neonatal outcomes, and patient demographics for preterm (PT, 32-36 weeks gestational age) and very preterm (VPT, 25-32 weeks gestational age) singleton live-born infants delivered between November 1995 and March 2002. RESULTS: PT (n=1807) and VPT (n=603) groups demonstrated a significant inverse curvilinear relationship of umbilical cord pH and BE values to Apgar score <7 at 5 minutes, respiratory distress syndrome, assisted ventilation, and intraventricular hemorrhage/periventricular leukomalacia. Receiver operating characteristic area under the curve values ranged from 0.69 to 0.86 (PT) and 0.70 to 0.87 (VPT). There was little difference between umbilical vein, umbilical artery, pH, or BE in predictive value. CONCLUSION: Umbilical cord pH and BE are related to subsequent adverse outcome events for infants delivered preterm. Worsening acidosis is associated with progressively greater increases in these outcomes with no discriminatory value within or between umbilical artery and umbilical vein pH and BE.     

脐带螺旋指数与脐动脉血流S/D比值及妊娠结局关系的研究

目的:探讨脐带螺旋指数(umbilical coiling index,UCI)与脐动脉血流收缩期最大血流速度(S)/舒张期末血流速度(D)比值(S/D比值)及妊娠结局之间的关系。方法:选择在我院住院分娩妊娠37~40周的孕产妇720例,计算UCI值,分析UCI与脐动脉血流S/D比值及胎儿窘迫、新生儿体重、新生儿窒息、围产儿死亡、羊水指数、产后出血及剖宫产率之间的关系。结果:UCI正常组与UCI不足组之间脐动脉血流S/D比值及羊水指数、产后出血、剖宫产率无显著差异,UCI不足组胎儿窘迫、新生儿窒息、围产儿死亡发生率显著高于UCI正常组。UCI过高组的脐动脉血流S/D比值、羊水过少发生率及剖宫产率明显高于UCI不足组,两组间胎儿窘迫、新生儿窒息、围产儿死亡发生率无显著差异。UCI过高组脐动脉血流S/D比值、胎儿窘迫、新生儿窒息、围产儿死亡、羊水过少发生率及剖宫产率明显高于UCI正常组,两组差异有统计学意义。结论:UCI异常可能与脐动脉血流S/D比值及妊娠结局相关。