Cord Vessels Research Articles

Signaling Through FSH Receptors on Human Umbilical Vein Endothelial Cells Promotes Angiogenesis

The FSH receptor (FSHR) is traditionally thought to play a role in female reproductive physiology solely within the context of ovarian FSHR. However, FSHR is also expressed in endothelial cells of the placental vasculature and human umbilical cord vessels, suggesting additional facets of female reproduction regulated by extragonadal FSHR. We sought to determine the functional role of FSHR on human umbilical cord endothelial cells (HUVECs), hypothesizing that activation of the FSHR would stimulate angiogenesis. The ability of FSH to stimulate several angiogenic processes in HUVECs was determined. This was a laboratory-based study using commercially prepared HUVECs. Tube formation, wound healing, cell migration, cell proliferation, nitric oxide production, and cell survival were stimulated in response to FSH. Quantitative comparisons between HUVECs incubated with maximally stimulatory concentrations of FSH vs vascular endothelial growth factor (VEGF), a well-characterized angiogenic factor, revealed that FSH is as efficacious as VEGF in promoting angiogenic processes. FSH did not provoke increased secretion of VEGF by HUVECs, suggesting the direct stimulation of angiogenic processes by FSH in endothelial cells. In contrast to gonadal cells, the FSHR on HUVECs did not mediate an FSH-stimulated increase in cAMP. However, increased phosphorylation of AKT in response to FSH was observed, suggesting that FSH stimulation of HUVEC FSHR stimulates the PI3K/AKT signaling pathway. Our studies reveal a novel role for FSHR in female reproductive physiology. Its ability to promote angiogenesis in placental endothelial cells suggests that the FSHR may have an influential role in pregnancy.

Ultrasound measurements of umbilical cord transverse area in normal pregnancies and pregnancies complicated by diabetes mellitus

A voluminous umbilical cord has been described in diabetic pregnancies. The aim of this studywas to see if measurements of cord diameters might be of value in the evaluation of diabetic pregnancies and especially those suspected of a large for gestational age (LGA) fetus. In an observational, prospective study umbilical cord areas and vessel diameters were measured between gestational age of 22 and 40 weeks in transverse ultrasound images of the central part of the cord in 141 normal and 135 diabetic pregnancies of which 30 were suspected of being LGA. Wharton's jelly area was calculated by subtracting the vessel area from the total transverse cord area. Normal reference curves were constructed for gestational age. Umbilical cord and Wharton's jelly areas increased with gestation. The vessel area leveled out at 32-33 weeks of gestation and the umbilical vein area decreased after 36 weeks of gestation. The umbilical cord parameters in diabetic pregnancies did not differ from controls. Cord areas were enlarged in 1/3 of the LGA fetuses. Umbilical cord area measurements are of limited value for the evaluation of diabetic pregnancies suspected having a LGA-fetus.

Pediatric pedicle screw (In)accuracy based on postoperative computed tomography

Though pedicle screws are widely used in spinal stabilization, studies evaluating the variables affecting placement accuracy and effects of accuracy on outcome are limited. Using computed tomography (CT), we evaluated the accuracy of pedicle screw placement in pediatric and transitional patient populations. We evaluated screw placement in a series of 276 thoracic, lumbar, and sacral pedicle screws implanted in 41 patients with the assistance of fluoroscopy by a single surgeon at a single institution from September 1, 2007 to December 31, 2012. Postoperative CT was performed and each screw was graded based on relation to neurologic, osseous, and intra thoracic and intra-abdominal landmarks by an independent neuro radiologist: Grade I, entirely intra pedicular; Grade II, violates lateral pedicle but screw tip entirely within the vertebral body; Grade III, tip penetrates the anterior or lateral vertebral body; Grade IV, breaches medial or inferior pedicle; and Grade V, violates pedicle or vertebral body and threatens spinal cord, nerve root, or great vessels, requires immediate revision or removal. The accuracy rate (Grades I and II) was lower than expected (76.8%). Screw misplacements (Grades III, IV, and V) were numerous (23.2%), although the overall complication rate remained low. There was no statistically significant difference in pedicle screw accuracy as a function of surgeon experience, patient age, or patient diagnosis. This suggests the need for advanced intraoperative imaging, such as neuronavigation or CT, to aid placement of spinal instrumentation in the pediatric and transitional patient population. While postoperative CT should be considered gold standard for evaluating pedicle screw placement, further study is warranted to evaluate overall accuracy and assess the need for more extensive intraoperative imaging to improve accuracy.

155: Assessment of the number of umbilical cord vessels at the time of nuchal translucency screening

Objective: To investigate feasibility of identifying the number of vessels in umbilical cord during nuchal translucency screening. Methods: We performed a prospective study in patients undergoing nuchal translucency screening at 11.0-13.9 weeks’ from 2011-2012. An oblique transverse view of fetal abdomen utilizing Doppler flow and a cross section view of free loop of umbilical cord were obtained. Maternal characteristics, technical aspects of first trimester ultrasound, and number of umbilical cord vessels identified in the second trimester were collected. McNemar’s test and kappa analysis were used to compare quantification of umbilical cord vessels in the first vs. second trimesters. Results: Total of 123 women were included. The number of umbilical cord vessels was successfully visualized in 95.9% of patients utilizing the bladder view, and 65.0% of patients on cross sectional cord views. Three-vessel cord was correctly identified in 99.2% of patients; one case was incorrectly diagnosed with a two two-vessel cord. McNemar’s test indicated that overall, first and second trimester ultrasounds have the same propensity to detect umbilical cord vessels (p=0.414), with moderate agreement (kappa=0.226). Conclusions: Identification of umbilical cord vasculature is possible in the first trimester and can be used as an adjunct to early fetal anatomy evaluation.

Description of a utrophin associated protein complex in lipid raft domains of human artery smooth muscle cells

The dystrophin-associated protein complex (DAPC) is a multimeric complex that links the extracellular matrix to the actin cytoskeleton, and in some cases dystrophin can be substituted by its autosomal homologue utrophin to form the utrophin-associated protein complex (UAPC). Both complexes maintain the stability of plasma membrane during contraction process and play an important role in transmembrane signaling. Mutations in members of the DAPC are associated with muscular dystrophy and dilated cardiomyopathy. In a previous study with human umbilical cord vessels, we observed that utrophin colocalize with caveolin-1 (Cav-1) which proposed the presence of UAPC in the plasma membrane of vascular smooth muscle (VSM). In the current study, we demonstrated by immunofluorescence analysis, co-immunoprecipitation assays, and subcellular fractionation by sucrose gradients, the existence of an UAPC in lipid raft domains of human umbilical artery smooth muscle cells (HUASMC). This complex is constituted by utrophin, β-DG, ε-SG, α-smooth muscle actin, Cav-1, endothelial nitric oxide synthase (eNOS) and cavin-1. It was also observed the presence of dystrophin, utrophin Dp71, β-SG, δ-SG, δ-SG3 and sarcospan in non-lipid raft fractions. Furthermore, the knockdown of α/β-DG was associated with the decrease in both the synthesis of nitric oxide (NO) and the presence of the phosphorylated (active) form of eNOS; and with a reduction in the downstream activation of some cGMP signaling transduction pathway components. Together these results show the presence of an UAPC complex in HUASMC that may participate in the activity regulation of eNOS and in the vascular function.

The pathophysiology of venous hypertensive myelopathy—study of an animal model

The authors undertook this study to establish an animal model to investigate the pathophysiological changes of venous hypertensive myelopathy (VHM). This study was a randomized control animal study with blinded evaluation. The VHM model was developed in 24 adult New Zealand white rabbits by means of renal artery and vein anastomosis and trapping of the posterior vena cava; 12 rabbits were subjected to sham surgery. The rabbits were investigated by spinal function evaluation, abdominal aortic angiography, spinal MRI, and pathological examination of the spinal cord at different follow-up stages. Twenty-two (91.67%) of 24 model rabbits survived the surgery and postoperative period. The patency rate of the arteriovenous fistula was 95.45% in these 22 animals. The model rabbits had significantly decreased motor and sensory hindlimb function as well as abnormalities at the corresponding segments of the spinal cord. Pathological examination showed dilation and hyalinization of the small blood vessels, perivascular and intraparenchymal lymphocyte infiltration, proliferation of glial cells, and neuronal degeneration. Electron microscopic examination showed loose lamellar structure of the myelin sheath, increased numbers of mitochondria in the thin myelinated fibers, and pyknotic neurons. This model of VHM is stable and repeatable. Exploration of the sequential changes in spinal cord and blood vessels has provided improved understanding of this pathology, and the model may have potential for improving therapeutic results.

Myonecrosis in umbilical cord and chorionic plate blood vessels

Objectives: The term myonecrosis is used to refer to necrotic/degenerative changes of the myocytes in the vessel walls of the umbilical cord and/ or in the chorionic plate. Myonecrosis is usually considered to be a consequence of meconium toxicity in cases of prolonged meconium exposure. However, degenerative changes of the myocytes may also occur in the absence of meconium due to autolysis of the umbilical cord and fetal surface vessels after intrauterine fetal death. We hypothesized that the patterns of myonecrosis in these two instances would differ with changes of meconium myonecrosis involving the portions of vessel walls adjacent to the amniotic cavity, the outer layers of the vessel walls more than the inner layers and the arteries (carrying less well oxygenated blood) more than the veins. This preferential patterning was not expected to be seen in autolysis. Methods:We examined the umbilical cord vessels of the placentas from 10 stillborn term fetuses with myonecrosis to determine its distribution. As a control group we used 4 term fetuses terminated by KCl injection because of severe brain anomalies. The location and extent of myonecrosis was assessed by dividing each umbilical cord vessel into 4 quadrants, two facing the amniotic cavity and two towards the centre, and then applying a semi-quantitative score to evaluate the extent. Results:Myonecrosis involved the arteries affecting first the portion of the vessel wall facing the amniotic cavity and extending from the outer to the inner layers. The vein wall showed the same pattern, but tended to be spared in the quadrants towards the centre of the cord. Meconium laden macrophages were only abundant in Wharton's jelly in two cases. In the other cases, myonecrosis presented with a variable degree of involvement of inner and outer vessel wall involving the whole vessel circumference. Myonecrosis in the chorionic plate was seen in 3/10 cases and was only seen in association with meconium. The history in some of the stillbirth cases without meconium pointed to hypoxic ischemic conditions in utero as causing or contributing to myonecrosis. In 2/4 KCl control cases the cord vessels showed degenerative changes involving the whole circumference, but in the other two, myonecrosis was present in the quadrants facing the amniotic cavity with a variable degree of extension through the wall. Conclusion: We conclude that myonecrosis may or may not be associated with meconium and, whether associated with meconium or autolysis alone, its location and extension also reflect oxygen levels in the fetal blood and in the amniotic fluid.

Abstract 290: Microrna-199a and Glut1 are Differentially Expressed in Primary Human Arterial and Venous Endothelium and are Deregulated in Culture

Introduction Studies over the last decade have established that the identity of arterial and venous endothelial cells (ECs) is governed by both genetic and environmental factors. Although the ephrin/Eph system is known to be a key determinant of that identity, it is unlikely that system is solely responsible for all the differences between arterial and venous ECs. Furthermore, microRNAs are becoming increasingly recognized for their important role in regulating gene expression and cell fate. We investigate here novel potential markers and regulators of arterial EC identity and the effects of environmental cues on these molecules. Methods ECs were freed from the basement membrane of human umbilical arteries and veins (HUAECs, HUVECs) (n=6) by enzymatic digestion and purified by flow cytometry (CD31+, CD45-) prior to lysis and quantitative PCR or analysis using HPLC-MS/MS. Protein quantification was performed using a proprietary software package (IdentiQuantXL TM ). HUVECs and HUAECs were harvested directly from umbilical cords and placed directly into collagen coated 6-well plates and cultured in standard conditions in EGM2. Results We found that microRNA-199a levels were 23 fold higher in HUVECs than HUAECs (p=0.0001). One of microRNA-199a’s theoretical downstream targets is GLUT1, a facilitative glucose transporter thought to be responsible for basal glucose uptake. GLUT1 mRNA and protein levels were significantly higher (5.5 and 4.3 fold, respectively) in HUAEC than HUVECs (p=0.00002). Using tissue immunohistochemistry (IHC) of we confirmed that GLUT1 expression is restricted to arterial ECs in human umbilical cord and adult peripheral artery and vein sections. Finally, GLUT1 mRNA levels are 2 fold higher in HUAECs than HUVECs in culture at P2 and levels decrease until P5 when they become equal indicating that culture has a homogenizing effect on endothelial heterogeneity. Conclusions MicroRNA-199a levels are higher in HUVECs than HUAECs and GLUT1, its downstream target, is higher in HUAECs both at the mRNA and protein level. Protein expression is restricted to arteries in both the new born umbilical cord and adult peripheral vessels. Importantly, expression in both cell types is downregulated and equilibrated by cell culture.

Cytological changes in the placenta after early hgh dose intravaginal progesterone

Intravaginal progesterone in the first trimester after IVF and in twins, has mixed results (BJOG 120:50, 2013), as has veterinary progesterone for apparent low levels (J.Zoo.Wildlife Med. 43:296, 2012). Early placental progesterone and receptors have been studied without reports on placental cytostructure. A 40 year old g 2 p 0 passed a 9 week blighted ovum four months prior to the current conception. No background health issues for either. At 6 weeks menstrual age low normal progesterone (9.21 ng/ml) prompted 200 mg vaginal insert progesterone daily for 18 days, then 400 mg daily for 10 days, a total of 7.6 g. Pregnancy was normal to loss of fetal movement at 27 weeks confirmed by sonography. Induction: 831 g fetus and 178 g placenta. Ponderal index and placental:fetal ratio below 27 week means. Placenta grossly ordinary, 14.3 × 11.7 × 1.8 cm; eccentric 3 vessel cord. Microscopic: significant villus dysplasia with many trophoblastic intrusions; scant formation of tertiary villi; reduced paracapillary migration; many persistent cytotrophoblastic columns‐islands, some arising from ramuli chorii; and extensive persistent and marked subsyncytial cytotrophoblast. The latter cells were enlarged with clear cytoplasm. Placental remodeling, and of decidual vessels by extravillous trophoblast, begins about 8 weeks. Herewith a case of first impression on changes from intensive progesterone in the first trimester.

Angiogenesis in villous chorangiosis observed by ultrastructural studies

Chorangiosis is microscopically designated as more than ten terminal capillaries within the villous stroma of the placenta and is mostly related to chronic fetal hypoxia. However, the histogenetic relationship between increased number of terminal villous capillaries and chronic hypoxia has not yet been clarified. Of 665 placentas histologically examined at Saitama Medical University from 2003 to 2010, chorangiosis was found in 58 cases (8.7 %), which were mostly more than 35 gestational weeks. In addition, low birth weight (less than 2,500 g) infants (74.1 %) and those who suffered from cardiac anomalies, chromosome anomalies, and single umbilical artery comprised 32.7 % of cases. Placental lesions were associated with chorangiosis involved in infarct (46.6 %), intervillous thrombosis (20.7 %), and marginal hemorrhages (22.4 %). Scanning electron microscopic studies showed narrowing of vessel ostium and disorders of endothelium in the umbilical cord vessel complicated by chorangiosis. Furthermore, in transmission electron microscopic observation, not only the chorionic villi had multiple enlarged vessels within the villous stroma, but we also found that new capillaries were formed by angiogenesis with endothelial cells derived from fibroblasts under the chronic hypoxic state.

Anterior decompression and fusion for cervical spinal canal stenosis

After age 50, half of the population experiences occasional neck pain and restricted cervical motion. As disks degenerate, the cervical spine becomes less stable, and the neck is more vulnerable to injuries, including muscle and ligament strains. With increasing age, the vertebrae gradually form bony spurs and disks loose their height. This often alters alignment and stability of the cervical spine and may lead to instability and spinal canal stenosis resulting in pressure on the spinal cord, nerves and blood vessels. In cases of intractable neck and arm pain or a significant neurological deficit due to spinal canal stenosis a surgical decompression is indicated. Most favourable approach is the anterior [1]. To stabilize and fuse the motion segment is reasonable, because instability is considered to be an essential part of the problem. Case description

Chorioamnionitis without foetal inflammatory response is associated with stillbirth in early preterm pregnancies

Objective: The aim of this study was to compare placental findings from early preterm stillbirths with gestational week-matched liveborn infants. The main focus was to investigate the differences in the presence and distribution of inflammatory signs in the placentas of these two groups, especially referring to histological acute chorioamnionitis (CAM).Methods: A case-control study of preterm stillbirths, between 22 and 32 weeks gestation, here referred to as early preterm, (cases, n = 112) and gestational week-matched liveborn infants (references, n = 166) in Stockholm. Relevant clinical data were collected from a web-based database (for cases) and delivery records (for references). Macroscopic and histological examinations of placentas were performed according to a structured protocol (placental weight relative to gestational age, accelerated villous maturation, infarction, intervillous thrombosis, foetal thrombosis, chronic villitis and CAM (polymorphonuclear leucocytes in the chorion/amnion), with and without foetal inflammatory responses (FIRs) (vasculitis in placental and/or cord vessels and funisitis). Statistical analyses were performed using a multivariable logistic regression.Results: Small for gestational age (AOR: 2.13, CI: 1.26–3.62) and CAM without a FIR (AOR: 2.44, CI: 1.10–5.41) were associated with an elevated risk of preterm stillbirth.Conclusions: Histological acute CAM without a FIR is associated with a higher risk for stillbirth in early preterm pregnancies.

Severe hemorrhage from the umbilical cord at birth: a preventable cause of neonatal shock.

Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. We believe that umbilical cord bleeding from errors in cord clamping could be an important cause of acute blood loss in the delivery room and that it may result in significant clinical morbidity, especially in extremely premature infants.

Perinatal outcomes associated with placental fetal thrombotic vasculopathy

Objectives Fetal thrombotic vasculopathy (FTV) is known to be associated with poor fetal outcomes. We aimed to assess the impact of this placental lesion on a local population. Methods 50 consecutive placental cases with FTV were identified. The perinatal outcomes associated with these gestations were investigated. The accepted cases were restricted to those diagnosed by specialist perinatal pathologists at the Royal Brisbane and Women’s Hospital and of at least moderate severity. Diagnosis of FTV was made according to current criteria including: • Macroscopically visible lesions including vascular thrombosis and foci of uniform avascular villi. • Presence of more than one endothelial cushion lesion/thrombosis of umbilical cord vessels, chorionic plate or large stem villous vessels. • More than two foci of uniform avascular villi affecting 15 or more villi per focus. • Medical records and pathology reports were used to extract information regarding previous obstetric history, antenatal history and perinatal outcomes. Results Placentas with moderate to severe FTV were consistently associated with poor perinatal outcomes such as intrauterine fetal death and intrauterine growth retardation and neonatal complications requiring intensive care postnatally. Placentas with FTV and other co-existent placental pathology such as chorioamnionitis or severe villitis of unknown aetiology were associated with more severe outcomes.

High and low protein∶ carbohydrate dietary ratios during gestation alter maternal-fetal cortisol regulation in pigs.

Imbalanced maternal nutrition during gestation can cause alterations of the hypothalamic-pituitary-adrenal (HPA) system in offspring. The present study investigated the effects of maternal low- and high-protein diets during gestation in pigs on the maternal-fetal HPA regulation and expression of the glucocorticoid receptor (GR), mineralocorticoid receptor (MR), 11β-hydroxysteroid dehydrogenase 1 and 2 (11β-HSD1 and 11β-HSD2) and c-fos mRNAs in the placenta and fetal brain. Twenty-seven German Landrace sows were fed diets with high (HP, 30%), low (LP, 6.5%) or adequate (AP, 12.1%) protein levels made isoenergetic by varying the carbohydrate levels. On gestational day 94, fetuses were recovered under general anesthesia for the collection of blood, brain and placenta samples. The LP diet in sows increased salivary cortisol levels during gestation compared to the HP and AP sows and caused an increase of placental GR and c-fos mRNA expression. However, the diurnal rhythm of plasma cortisol was disturbed in both LP and HP sows. Total plasma cortisol concentrations in the umbilical cord vessels were elevated in fetuses from HP sows, whereas corticosteroid-binding globulin levels were decreased in LP fetuses. In the hypothalamus, LP fetuses displayed an enhanced mRNA expression of 11β-HSD1 and a reduced expression of c-fos. Additionally, the 11β-HSD2 mRNA expression was decreased in both LP and HP fetuses. The present results suggest that both low and high protein∶carbohydrate dietary ratios during gestation may alter the expression of genes encoding key determinants of glucocorticoid hormone action in the fetus with potential long-lasting consequences for stress adaptation and health.

Case Report: Curetting Osteoid Osteoma of the Spine Using Combined Video-assisted Thoracoscopic Surgery and Navigation

A spinal osteoid osteoma is a rare benign tumor. The usual treatment involves complete curettage including the nidus. In the thoracic spine, conventional open surgical treatment usually carries relatively high surgical risks because of the close anatomic relationship to the spinal cord, nerve roots, and thoracic vessels, and pulmonary complications and postoperative pain. We report the case of a 16-year-old girl with a symptomatic osteoid osteoma at the T9 level whose lesion was currettaged using video-assisted thoracoscopic surgery (VATS) guided by a navigation system (VATS-NAV). There were no complications and the patient had immediate relief of the characteristic pain after surgery and was asymptomatic at 5 months' followup. Progressive advances in the technology of spinal surgery have evolved to offer greater safety and less morbidity for patients. The advent of minimally invasive surgery has expanded the indications for VATS for anterior spinal disorders. Spinal navigation systems have become useful tools allowing localization and excision of the nidus of osteoid osteomas with minimal bone resection and without radiation exposure. The VATS-NAV combination in our patient allowed accurate localization and guidance for complete excision of a spinal osteoid osteoma through a minimally invasive approach without compromising spinal stability.

A case of a four-vessel umbilical cord: don’t stop counting at three!

Abstract There are various numerical abnormalities of umbilical cord vessels known in the literature, the single umbilical artery being the most prevalent. A four-vessel umbilical cord is found less frequently, and moreover, is less well-known in daily practice. A persistent right umbilical vein, however, can be associated with potentially serious congenital defects. A case of a four-vessel umbilical cord containing two arteries and two veins is presented. The literature on this subject reports both a differentiation between the two variants, intrahepatic and extrahepatic, which can be distinguished during antenatal ultrasound screening, and a possible association with congenital abnormalities, some of which can carry substantial morbidity and mortality. Although the incidence of a four-vessel umbilical cord is low, its presence should be considered both during routine antenatal ultrasound screening and on physical examination of any neonate.

Differential distribution of cathepsin B in human umbilical cord tissues.

The extracellular matrix components are differentially distributed among various structures of the umbilical cord. Wharton's jelly is especially rich in collagens and growth factors. Cathepsin B is a major cysteine protease involved in collagen degradation, as well as in the activation of precursor forms of other collagenolytic enzymes and growth factors. We assessed the activity and expression of cathepsin B in the umbilical cord arteries, veins and Wharton's jelly. Extracts of separated umbilical cord components were subjected to an activity assay with the use of specific fluorogenic substrate. The expression of cathepsin B protein was qualitatively evaluated by Western immunoblotting and quantitatively determined with an immunoenzymatic method. The total cathepsin B activity and content calculated per gram of DNA were higher in Wharton's jelly than in the umbilical cord vessels, and the latter parameter was the lowest in the umbilical cord arteries. Moreover, the expression and the activity of latent cathepsin B (following activation by pepsin digestion) calculated per gram of DNA were the highest in Wharton's jelly and the lowest in the umbilical cord arteries. High expression and activity of latent, pepsin-activatable cathepsin B related to DNA content in Wharton's jelly seem to reflect the stimulation of its cells by high amounts of collagen I and growth factors.

Feto-placental nitric oxide, asymmetric dimethylarginine and vascular endothelial growth factor (VEGF) levels and VEGF gene polymorphisms in severe preeclampsia

Objective: To measure plasma nitric oxide (NO), asymmetric dimethylarginine (ADMA) and vascular endothelial growth factor (VEGF) levels and VEGF gene polymorphisms in fetal circulation in severe preeclampsia. Methods: Cord vessels of singleton gestations complicated with severe preeclampsia 36 weeks or more (n = 31) and controls were sampled upon delivery for analyte measuring. Additionally, DNA was extracted from umbilical vein whole blood to determine the frequency of VEGF gene single nucleotide polymorphisms (SNPs): −2578 A/C, −1498 C/T, −1154 A/G, −634 C/G and +936 C/T. Coefficient correlations between analyte levels and placental and neonatal weight were calculated. Results: NO plasma levels in umbilical vessels (artery and vein) were significantly higher in preeclampsia cases as compared to controls (4.67 ± 3.0 vs. 0.82 ± 0.90; 4.46 ± 3.0 vs. 0.82 ± 0.99 mmol/L, respectively, p = 0.0001 both). ADMA levels displayed a similar increased trend in both fetal vessels, but this did not reach statistical significance (2.57 ± 1.03 vs. 2.34 ± 0.57; 2.74 ± 0.94 vs. 2.42 ± 0.59 mmol/L, respectively, p > 0.05). VEGF was significantly lower in artery but not in vein in preeclampsia cases (200.48 ± 225.62 vs. 338.61 ± 287.03 pg/mL, p = 0.04). A significant positive correlation was found between NO and ADMA levels (artery and vein) among preeclampsia cases. Overall, the frequency of the studied VEGF gene SNPs did not differ among pre-eclamptic cases and controls; nevertheless, a significant trend toward lower umbilical vein VEGF levels was observed in pre-eclampsia cases in the presence of -2578 CC and −1154 AG genotypes. Conclusion: Near term gestations complicated with severe preeclampsia presented higher NO levels in fetal circulation, which correlated to ADMA and lower artery VEGF values. More research is warranted to confirm that selected VEGF SNPs may be associated with lower umbilical vein VEGF.

TWISTING OF THE UMBILICAL CORD CAUSING INTRAUTERINE FETAL DEATH

Umbilical cord accident(UCA) is an emergency situation , as it threatens fetal wellbeing and or results into fetal jeopardy. Cord prolapse , cord compression, cord entanglement ,true knot formation , thrombosis and rupture of cord blood vessels are some of the known cord related causes of stillbirths .Twisting of the umbilical cord occurs less often than above mentioned cord accidents. Twisting of the umbilical cord leads to obstruction in the flow of blood in umbilical cord vessels leading to acute placental insufficiency and sudden fetal death. A rare case of full term pregnancy with multiple twists of the umbilical cord, leading to intrauterine fetal death is presented in this case report .The antenatal diagnosis, predisposing factors and preventive measures are discussed in the end