Hypercoiled Cord Research Articles

Knots of the Umbilical Cord: Incidence, Diagnosis, and Management

(Int J Gynecol Obstet. 2024;00:1–8. doi: 10.1002/ijgo.15373) The umbilical cord is surrounded by Wharton jelly and is frequently referred to as the “lifeline” because of its essential function in transporting nutrients and expelling fetal waste. Factors such as the length and coiling of the cord impact its health and functionality. An essential aspect of umbilical cord function is an arterial anastomosis, known as “Hyrtl anastomosis,” which helps regulate and distribute blood flow to the placenta. This structure, typically located 3 cm before the cord enters the placenta, is vital for fetal well-being, and abnormalities can increase fetal stress or, in severe cases, lead to fetal demise. Umbilical cord knots (UCK) are among the observed abnormalities, often detected accidentally during routine sonography. True knots range from 0.3% to 2.1%, and while usually solitary, multiple knots can occur. Such knots have also been observed in monkey fetuses. The clinical significance of a knot depends on whether it is tight or loose; a tight knot, especially in a hyper-coiled cord, is less flexible and more prone to complications during birth.

Evaluation of the relationship between reduced fetal movement and obstetric-neonatal outcomes and placental pathologies.

Fetal movements are one of the simple methods that show the baby's well-being. Conditions associated with decreased fetal movements have not been determined, so it is important to analyze their different aspects. This study aimed to evaluate the relationship between reduced fetal movement and obstetric-neonatal outcomes, and placental pathologies. In this prospective controlled study, laboratory results (blood glucose, hemoglobin, thyroid-stimulating hormone [TSH]), a non-stress test (NST), biophysical profile results, obstetric and neonatal outcomes, and placental pathological results of 74 pregnant women at 35 or more gestational weeks (to exclude the effect of prematurity on obstetric and neonatal outcomes) attending the obstetrics clinic between December 26, 2017 and January 30, 2019 with complaints of reduced fetal movement, were compared with 74 healthy pregnant women. Since prematurity and post-maturity may adversely affect obstetric-neonatal and placental pathology results, term pregnancies between 370/7-406/7 weeks were evaluated separately. In the group with reduced fetal movement, the biophysical profile was lower than the controls (P=0.013). Among placental pathologies, chorangiosis and hypercoiled cord were significantly higher in the group with reduced fetal movement than controls (P<0.05). Small for gestational age (SGA) and fetal growth restriction (FGR) in this group had these pathologies. Results of women at 370/7-406/7 weeks were similar except for the additional finding of chorioamnionitis. Reduced fetal movement may be associated with the low biophysical profile. In cases where fetal movement decreases, placental chorangiosis and hypercoiled cord seem to be associated with fetal growth restriction.

The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature.

Stillbirth has an important economic and social impact, though it remains “inexplicable” in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of the study is to quantify the contribution of the autopsy and placental examination in identifying the cause of stillbirths. For each case, the medical record was analyzed with the relative maternal and partner data, the results of the external fetal and autopsy examination as well as the macroscopic and histological placental examination. The peak of stillbirth was found in a maternal age group between 30 and 39 years, below the 32nd week and above the 37th week of gestation. The results obtained from the clinical history and external fetal examination make it possible to trace the cause of death in only 18.2% of cases. By adding to these data, the results of the fetal autopsy and the placental examination, it is possible to establish the cause of death in 90.9% of cases. The most frequent abnormalities found in the placenta and cord were short or hypercoiled cord, umbilical cord vascular thrombosis, turns around the neck or stretching of the funiculus, placental infarction and placental insufficiency; also, amniotic fluid abnormalities, such as suspected oligohydramnios and chorioamniositi, were found. The accurate analysis of post-mortem placental and fetal examination is essential to reduce the number of unresponsive intrauterine fetal deaths. Determining the cause of fetal death must help clinicians and parents in better management and care in future pregnancies.

Successful amnioinfusion for severe fetal growth restriction with umbilical cord complications: two case reports

BackgroundThere is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications.Case presentationWe encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions.ConclusionsAmnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.

Maternal obesity and stillbirth at term; placental pathology-A case control study.

ObjectiveThe aim was to explore the potential role of the placenta for the risk of stillbirth at term in pregnancies of obese women.MethodsThis was a case-control study comparing placental findings from term stillbirths with placental findings from live born infants. Cases were singleton term stillbirths to normal weight or obese women, identified in the Stockholm stillbirth database, n = 264 and n = 87, respectively. Controls were term singletons born alive to normal weight or obese women, delivered between 2002–2005 and between 2018–2019. Placentas were compared between women with stillborn and live-born infants, using logistic regression analyses.ResultsA long and hyper coiled cord, cord thrombosis and velamentous cord insertion were stronger risk factors for stillbirth in obese women compared to normal weight women. When these variables were adjusted for in the logistic regression analysis, also adjusted for potential confounders, the odds ratio for stillbirth in obese women decreased from 1.89 (CI 1.24–2.89) to 1.63 (CI 1.04–2.56).ConclusionApproximately one fourth of the effect of obesity on the risk of stillbirth in term pregnancies is explained by umbilical cord associated pathology.

Umbilical Coiling Index, A Predictor of Perinatal Outcome

Umbilical cord (UC) represents the “life source”, or the “entry and exit” point of humans which is the only source of energy. It is essential for the development, well-being, and survival of the nourishing baby. The characteristic of the coiling of the umbilical cord makes the cord a structure that is both flexible and strong and provides resistance to external forces which could compromise the blood flow to the foetus. UC is vulnerable to kinking, compressions, traction, and torsion, which may affect the intrauterine life and perinatal outcome due to coiling. One complete spiral of 360º of the umbilical vessels around each other is defined as Umbilical Coil. Abnormal coiling is defined as UCI less than the 10th percentile (i.e., Hypocoiled cord), UCI more than the 90th percentile (i.e., Hypercoiled cord), and the UCI between 10th and 90th percentile is Normocoiled cord. According to the literature studies, hypercoiled cords are usually associated with intrapartum foetal acidosis and asphyxia, foetal growth restriction, vascular thrombosis, and cord stenosis while the increased incidence of foetal demise, intrapartum FHR deceleration, low APGAR scores, preterm delivery, chorioamnionitis, structural and chromosomal abnormalities, and operative delivery have been associated more with hypocoiled cords. Hence, if the umbilical coiling index can be measured reliably in utero by ultrasound antenatally, then in future, it might become a promising prognostic marker for a better pregnancy and adverse foetal outcome.

Amnioinfusion and Bed Rest May Effectively Improve the Insufficient Circulation of the Umbilical Cord in Pregnant Women With Hyper-Coiled Cord and Oligohydramnios

We experienced two cases with hyper-coiled cord in which fetal-umbilical-placental circulation was improved after amnioinfusion or bed rest. Therefore, amnioinfusion and bed rest to reduce the compression of the vulnerable umbilical cord in cases of hyper-coiled cord might improve the pathologic fetal-umbilical-placental circulation. J Med Cases. 2021;12(1):1-4 doi: https://doi.org/10.14740/jmc3581

Perinatal outcomes of cases with umbilical hypocoiled cord: a study at a single perinatal center

Objectives To evaluate the perinatal outcomes of hypocoiled cord. Methods This retrospective study was carried out in the Department of Obstetrics and Gynecology at Showa University Hospital between 2011 and 2017. Umbilical cord index (UCI) was calculated by dividing the total number of coils by the total length of umbilical cord. All umbilical cords were measured and calculated coiling index by obstetrician after delivery. Perinatal outcomes like non-reassuring fetal status (NRFS), emergency cesarean sections, and other perinatal complications were compared. Results From January 2011 to December 2017, a total of 4047 fetuses were born at our hospital after 28 weeks’ gestation. After excluding 100 fetuses of hypercoiled cord, a total of 3947 fetuses were included in this study, of which 71 fetuses were hypocoiled cord and 3876 fetuses were normal coiled cord. There were no association between maternal background and both UCI group. NRFS during labor was significantly associated with hypocoiled cord compared with normal cord (p = .02). Additionally, the rates of emergency cesarean section were raised in cases of hypocoiled cord (p = .02). Conclusion In this study, it was found that hypocoiled cord is related to NRFS and emergency cesarean section. In addition, hypocoiled cord was not associated with any maternal factors. However, in previous studies, no opinion has been reported on the timing of diagnosis of hypocoiled cord during pregnancy. It is difficult to evaluate hypocoiled cord correctly in third trimester. It is a task to find the hypocoiled cord correctly before birth.

AI-PLAX: AI-based placental assessment and examination using photos

Post-delivery analysis of the placenta is useful for evaluating health risks of both the mother and baby. In the U.S., however, only about 20% of placentas are assessed by pathology exams, and placental data is often missed in pregnancy research because of the additional time, cost, and expertise needed. A computer-based tool that can be used in any delivery setting at the time of birth to provide an immediate and comprehensive placental assessment would have the potential to not only to improve health care, but also to radically improve medical knowledge. In this paper, we tackle the problem of automatic placental assessment and examination using photos. More concretely, we first address morphological characterization, which includes the tasks of placental image segmentation, umbilical cord insertion point localization, and maternal/fetal side classification. We also tackle clinically meaningful feature analysis of placentas, which comprises detection of retained placenta (i.e., incomplete placenta), umbilical cord knot, meconium, abruption, chorioamnionitis, and hypercoiled cord, and categorization of umbilical cord insertion type. We curated a dataset consisting of approximately 1300 placenta images taken at Northwestern Memorial Hospital, with hand-labeled pixel-level segmentation map, cord insertion point and other information extracted from the associated pathology reports. We developed the AI-based Placental Assessment and Examination system (AI-PLAX), which is a novel two-stage photograph-based pipeline for fully automated analysis. In the first stage, we use three encoder-decoder convolutional neural networks with a shared encoder to address morphological characterization tasks by employing a transfer-learning training strategy. In the second stage, we employ distinct sub-models to solve different feature analysis tasks by using both the photograph and the output of the first stage. We evaluated the effectiveness of our pipeline by using the curated dataset as well as the pathology reports in the medical record. Through extensive experiments, we demonstrate our system is able to produce accurate morphological characterization and very promising performance on aforementioned feature analysis tasks, all of which may possess clinical impact and contribute to future pregnancy research. This work is the first for comprehensive, automated, computer-based placental analysis and will serve as a launchpad for potentially multiple future innovations.

Differences in perinatal outcomes according to forming period of single umbilical cord in singleton pregnancy.

The aim of this study was to establish the frequency and associations of single umbilical artery (SUA) diagnosed until the first vs second or third trimester. A retrospective cohort study was conducted on singleton pregnancies at a tertiary perinatal center. All women underwent both the first and second trimester scans in which the number of arteries in the umbilical cord was routinely documented. SUA was classified as aplastic type when the diagnosis was made in the first trimester and as occlusion type when diagnosed in the second or third trimester. Adverse perinatal outcome was calculated as occurrence of fetal death, birthweight centile < 10th , or Apgar score at 5 minutes < 7. A total of 8675 women underwent ultrasound examinations during the study period. Of the 32 SUA cases, 17 (0.2%) were of the aplastic type and 15 (0.2%) of the occlusion type. Congenital anomalies were more in aplastic than in occlusive SUA (58.8% vs 20%, .043). The occlusive SUA had higher postnatal coiling index (0.3 vs 0.2, .034) and diagnosis of hypercoiled cord (46.7% vs 5.9%, .013) than the aplastic type. The different gestational age at diagnosis and coiling characteristics suggest two types of SUA, namely, aplastic and occlusion types, which are associated with differences in perinatal outcomes.

Hypercoiled cord can cause a reversible abnormal Doppler in ductus venosus in cases of fetal growth restriction.

Although an absent or reversed a-wave in ductus venosus (DV-RAV) is reported to be the terminal finding of fetal growth restriction (FGR), we have seen DV-RAV that disappears within a short span of time in some FGR cases with a hypercoiled cord. The purpose of this study was to investigate the relationship between hypercoiled cord and reversible DV-RAV in FGR. This was a retrospective study of 499 FGR cases, including 14 with DV-RAV. Transabdominal amnioinfusion (AI) was performed when oligohydramnios was severe (maximum vertical pocket <2 cm) and/or variable deceleration was detected. DV-RAV that disappeared quickly was defined as 'temporary DV-RAV'. DV-RAV that continued until delivery or fetal death (FD) was defined as 'persistent DV-RAV'. A hypercoiled cord was defined as one with an umbilical coiling index >0.6 antenatally or >0.3 postnatally. Clinical characteristics and clinical courses of the two types of DV-RAV were compared. DV-RAV disappeared after AI in all five cases in which temporary DV-RAV was identified. The incidence of a hypercoiled cord was significantly higher among temporary DV-RAV cases (100%) than among persistent DV-RAV cases (14.3%; P = 0.015). The time from detection of DV-RAV to delivery or FD was significantly longer among temporary DV-RAV cases (4.5 weeks) than among persistent DV-RAV cases (0.7 weeks; P = 0.027). Temporary DV-RAV is suspected to be related to the combination of a hypercoiled cord and oligohydramnios. DV-RAV may not be always be a terminal finding in FGR with a hypercoiled cord.

Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies

ObjectiveTwin fetuses grow slower during the third trimester compared with singletons. However, the extent to which the relative smallness of twins is the result of placenta-mediated factors similar to those associated with fetal growth restriction in singletons remains unclear. Our aim was to address this question by comparing placental findings between small for gestational age (SGA) twins and SGA singletons. MethodsRetrospective cohort study of all SGA non-anomalous newborns from singleton and dichorionic twin pregnancies in a single tertiary referral center between 2002 and 2015. SGA was defined as birth weight <10th percentile for gestational age according to sex-specific national reference charts. Placental findings were compared between SGA twins and SGA singletons and were classified into lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, placental hemorrhage and chronic villitis. ResultsA total of 532 SGA twins and 954 SGA singletons met the inclusion criteria. SGA twins had a higher mean placental weight (371 ± 103 g vs. 319 ± 107, p < 0.001) and a lower fetal-placental ratio (6.0 ± 2.5 vs. 6.7 ± 3.2, p < 0.001) compared with SGA singletons. Compared with SGA singletons, SGA twins were less likely to have any placental pathology (aOR 0.37, 95%-CI 0.29–0.46), hypercoiled cord (aOR 0.45, 95%-CI 0.33–0.61), placental weight<10th% (aOR 0.13, 95%-CI 0.08–0.20), maternal vascular malperfusion pathology (aOR 0.24, 95%-CI 0.18–0.30) and fetal vascular malperfusion pathology (aOR 0.62, 95%-CI 0.48–0.82). By contrast, SGA twins had higher odds of a marginal or velamentous cord insertion compared with SGA singletons (aOR 13.82, 95%-CI 10.44–18.30). Similar significant associations were observed in subgroups of SGA fetuses with a birth weight below the 5th and 3rd percentile for gestational age. ConclusionsOur findings illustrate that the mechanisms underlying reduced fetal growth in dichorionic twins differ from those involved in singletons, and may provide support to the hypothesis that smallness in dichorionic twins may be more benign than in singletons.

EP14.09: A hypercoiled cord can cause an atypical ductus venosus Doppler in cases of fetal growth restriction

Although an absent or reversed a-wave in ductus venosus (DV-RAV) is reported to be the terminal finding of fetal growth restriction (FGR), we have seen a DV-RAV that disappears in a short span of time, causing us to reconsider the mechanism of DV-RAV in FGR. This was a retrospective study of 499 FGR cases, including 14 with DV-RAV. Transabdominal amnioinfusion (AI) was performed when oligohydramnios was severe and/or a sign of cord compression was detected. DV-RAV that disappeared in a short span of time was defined as “temporary DV-RAV”. DV-RAV that continued until delivery or fetal death (FD) was defined as “persistent DV-RAV”. The clinical characteristics and clinical courses were compared between the two types of DV-RAV. Temporary DV-RAV was detected in five cases. DV-RAV disappeared after AI in all of the temporary DV-RAV cases. The incidence of a hypercoiled cord was significantly higher in temporary DV-RAV cases than in persistent DV-RAV cases. The time from detection of DV-RAV to delivery or FD was significantly longer in temporary DV-RAV cases than in persistent DV-RAV cases. Temporary DV-RAV may be related to disturbed umbilical cord blood flow. DV-RAV may not be always be a terminal finding in FGR with a hypercoiled cord.

Causes of intrauterine fetal death are changing in recent years.

To investigate, how causes of intrauterine fetal death (IUFD) have changed in recent years with the advancement of prenatal diagnosis at a single perinatal center in Japan. Medical records were retrospectively reviewed for all cases of IUFDs that occurred between 2001 and 2014. The most commonly associated causes of fetal deaths were compared between 2001-2007 and 2008-2014. The number of IUFD after 20 weeks' gestation/all deliveries in our center was 38/6878 cases (0.53%) in 2001-2007 and 35/7326 (0.48%) in 2008-2014. The leading cause of IUFD in 2001-2007 was fetal abnormalities (43.2%), the prevalence of which was only 8.6% in 2008-2014 (P<0.01). Meanwhile, the prevalence of umbilical cord abnormalities was relatively increased from 30.0% in 2001-2007 to 54.5% in 2008-2014 (P=0.06). In 2001-2007, chromosomal abnormalities were frequently observed (56% of IUFDs due to fetal abnormalities). Hyper-coiled cord (HCC) and umbilical ring constrictions were the most frequent cause of IUFD in both periods. The relatively decreased prevalence of IUFD due to velamentous cord insertion and umbilical cord entanglement, HCC and umbilical cord constriction was increased. The prevalence of IUFD due to fetal abnormalities was reduced, but IUFD associated with umbilical cord abnormalities tended to increase relatively.

Intrauterine fetal death caused by large placental chorioangioma and hypercoiled umbilical cord: A case report

Intrauterine fetal death caused by large placental chorioangioma and hypercoiled umbilical cord: A case report

Ultrasound Assessment of the Umbilical Cord

ABSTRACTAs a nonreassuring fetal status and intrauterine fetal death are often caused by umbilical cord abnormalities, obtaining an ultrasound diagnosis of umbilical cord abnormalities is required for a safe delivery. We believe that the prenatal detection of umbilical cord abnormalities and appropriate management of the delivery improves perinatal morbidity and mortality rates. In the present review, the protocol for ultrasound diagnosis and management of umbilical cord abnormalities, including abnormalities of cord insertion, hypercoiled cord, nuchal cord and fore-lying umbilical cord, is discussed considering current knowledge regarding the physiological and pathological aspects of these umbilical cord abnormalities.How to cite this articleHasegawa J. Ultrasound Assessment of the Umbilical Cord. Donald School J Ultrasound Obstet Gynecol 2014;8(4):382-390.

P15.01: Umbilical cord anomalies: detection and expectations

Fetal ultrasonographic screening has to include assessment of the umbilical cord for possible abnormalitiesthat can be: hypercoiled cord and nuchal cord, abnormal length and thickness of the cord, anomalies of the placental insertion site, vascular abnormalities and primary tumors of the cord. These conditions may be associated with fetal anomalies, chromosomal anomalies and intrauterine growth restriction. In our study we describe and analyze the ultrasound diagnosis and management of major umbilical cord abnormalities, considering the current knowledge on physiologic and pathologic aspects of each of them. A retrospective study was conducted in Universitary Emargency Hospital Bucharest over a 3-year period. We found 18 cases of single umbilical arteries, 6 cases of velamentous cord insertion, 3 of them associated with placental adherence abnormalities, partial placenta previa and one with vasa previa, 16 cases of more than 2 loops nuchal cord, 7 cases of true knot cord with 2 ultrasound undiagnosed cases, 5 true cord cysts and 3 cases of fetal intra-abdominal umbilical vein dilatation. A pregnancy with umbilical cord anomalies is more likely to be complicated with polyhydramnios, preterm delivery under 34 weeks, low birthweight, Caesarean delivery for fetal distress, perinatal death, admission to NICU and placental abnormalities compared with a pregnancy with a normal umbilical cord. We sustain that prenatal detection of umbilical cord abnormalities will decrease the number of emergent Caesarean sections and intrauterine fetal death. Safe fetal delivery, fetal echocardiography and karyotype analysis should be offered depending on risk associated to each umbilical cord abnormality. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities, whereas 3D/4D Doppler US of the fetal umbilical cord and abdominal vasculature allows a high accurate diagnosis of vascular abnormalities.

Fetal thrombotic vasculopathy is associated with thromboembolic events and adverse perinatal outcome but not with neurologic complications: A retrospective cohort study of 54 cases with a 3-year follow-up of children

Objectiveto test the hypothesis that placental fetal thrombotic vasculopathy (FTV) is associated with obstetric complications and predisposes the child to unfavorable outcomes. Methods54 placentas with FTV lesions and 100 placentas without FTV lesions were collected over a 5-year period at the Croix-Rousse Pathology Department. Clinical findings including maternal, fetal, neonatal condition and pediatric outcome up to three years were collected for each case and control observation. The statistical analyses were assessed with Wald's chi-square derived from conditional logistic regression modeling. ResultsFTV was associated with a significantly higher frequency of obstetric complications: (pregnancy-induced hypertension (OR 3.620, CI 1.563–8.385), preeclampsia (OR 3.674, CI 1.500-8.998), emergency delivery procedures (OR 3.727, CI 1.477–9.403), cesarean sections (OR 2.684, CI 1.016–7.088)), poor fetal condition (intrauterine growth restriction (IUGR) (OR 5.440, CI 2.007–14.748), nonreassuring fetal heart tracing (OR 6.062, CI 2.280–16.115), difficulties in immediate ex utero adaptation (OR 3.416, CI 1.087–10.732)) and perinatal or early childhood demise (OR 3.043, CI 1.327–6.978). On pathological examination, FTV was associated with marginal cord insertion (OR 3.492, CI 1.350–9.035), cord stricture and hypercoiled cord (OR 3.936, CI 1.209–12.813). Thromboembolic events were significantly more frequent in cases with FTV (OR 2.154, CI 1.032–5.622). Neurological complications within the first 3 years of life were also more frequent in the FTV group compared to the control group, but this association was not statistically significant. ConclusionsFTV is associated with maternal complications, pathological findings in the placenta, especially gross cord abnormalities, IUGR, and poor perinatal or early childhood outcome. It may also predispose children to somatic thromboembolic events.

A case report of umbilical ring constriction with application of amnioinfusion.

This is a case report of a pregnant 38-year-old primigravida woman. Due to severe fetal growth restriction and oligohydramnios, she was referred to our tertiary perinatal center at 24weeks' gestation. To rule out chromosomal abnormalities and facilitate ultrasound evaluation of fetal morphology, we performed amniocentesis and subsequent amnioinfusion. Thereafter, a precise ultrasound examination revealed no obvious fetal morphological abnormalities except for a hyper-coiled cord and marginal placenta previa. During expectant management, the amount of amniotic fluid was maintained at 20-26mm for a few days; however, the pregnancy resulted in intrauterine fetal death after 26 weeks+5days of gestation. The stillborn infant weighed 530g (-3.3 SD) and had no obvious external abnormalities apart from umbilical ring constriction. Although a postmortem autopsy was not performed, it is suspected that the fetal growth restriction and the intrauterine fetal death were associated with the hyper-coiled cord and the umbilical ring constriction. It is thought that umbilical ring constriction might therefore be an irreversible fatal condition in cases with a hyper-coiled cord.

Periarterial stem villous edema is associated with hypercoiled umbilical cord and stem obliterative endarteritis

To assess clinicopathologic correlations of a novel placental lesion featuring a distinct ring-like periarterial edema of stem villi (PASE). A retrospective case-control statistical comparison (Yates χ2 or analysis of variance) of 30 clinical and 41 placental features of 100 consecutive placentas with PASE and 100 gestational age-matched cases without PASE, extracted from 2403 placentas from high-risk pregnancies signed out by the author since year 2006. The PASE was seen in 4.2% of placentas, average gestational age 35.9 weeks (range, 24 - 42 weeks). Frequencies of stem obliterative endarteritis and hypercoiled umbilical cord (coiling index > 0.3) were 23% vs 5% (p = 0.005), and 20% vs 9% (p = 0.04) in the study group and comparative group, respectively. There were no statistically significant differences (p > 0.05) between the groups in clinical or other placental variables. The PASE may be linked to chronically abnormal blood flow in umbilical cord arteries and their stem branches and may be a histological placental sign of non-obliterative umbilical cord compromise.