Structural Analysis of the Umbilical Cord and Its Vessels in Intrauterine Growth Restriction and Pre-eclampsia

Abstract

AbstractBoth intrauterine growth restriction (IUGR) and pre-eclampsia (PE) are accompanied by alterations in the vascular structures of the umbilical cord (UC). However, it is unclear if the vasculature is significantly different when both conditions co-exist. Digitized sections of 77 UC from four groups of women were analyzed morphometrically. The groups included women with PE (group I), IUGR and PE (group II), IUGR (group III) and women with uncomplicated pregnancy as controls (group IV). The effect of PE, IUGR and their combination on UC parameters were examined using two-way ANOVA and the correlation of birth weight and placental weight in these parameters were measured. There were 12 cases in group I, 22 in group II, 26 in group III and 17 in group IV. The umbilical vein (UV) parameters like wall thickness (0.33 vs 0.42 mm, p = 0.04), cross sectional area, (2.9 vs 4.1 mm2, p = 0.01), diameter (2.2 vs 2.6 mm, p = 0.04) and muscle cross sectional area (1.53 vs 2.4 mm2, p = 0.01) were lower in the IUGR group as compared to other groups. In the group with PE, UV wall:lumen ratio (0.28 vs 0.2, p = 0.05), UA D (0.77 vs 0.63 mm, p = 0.04) and UA CSA (0.99 vs 0.8 mm2, p = 0.04) were significantly higher compared to other groups. The interaction effect of PE and IUGR was not significant for any of the umbilical vessel parameters. The UV dimensions are significantly smaller in IUGR and PE pregnancies. These differences were mainly seen in the IUGR group and the presence of PE did not amplify the differences.