Umbilical Cord Abnormalities Research Articles

Implementation and Outcomes of Universal Delayed Umbilical Cord Clamping at Term.

To evaluate the implementation of an institutional protocol for universal delayed umbilical cord clamping (DCC) at term on maternal, neonatal, and umbilical cord blood gas outcomes. This is a retrospective cohort study of singleton term gestations from April through July 2017. On June 1, 2017, a protocol was implemented for DCC in all deliveries. Outcomes were compared between patients delivered prior to and those delivered after implementation. The primary outcome was postpartum hemorrhage (PPH). Secondary outcomes were additional adverse maternal, neonatal, and umbilical cord blood gas outcomes. Multivariable logistic regression was used to adjust for potential confounders. Of 682 patients, 341 were delivered preprotocol and 341 were delivered postprotocol. After implementation, there was 91.8% adherence to the protocol. Overall, there was no significant difference in PPH between patients delivered preprotocol and those delivered postprotocol (8.2 vs. 13.2%; adjusted relative risk [aRR]: 1.26, 95% confidence interval [CI]: 0.98-1.51). There was a significant decrease in the ability to obtain paired arterial and venous umbilical cord blood gases from preprotocol to postprotocol (83 vs. 63.6%; aRR: 0.62 [95% CI: 0.50-0.76]). There were no significant differences in abnormal umbilical cord blood gases or neonatal outcomes. We did not find an increased risk of adverse outcomes associated with the widespread use of DCC.

Placental Histopathology Differences and Neonatal Outcome in Dichorionic-Diamniotic as Compared to Monochorionic-Diamniotic Twin Pregnancies.

We aimed to compare the differences in placental histopathology lesions and pregnancy outcome in dichorionic-diamniotic (DCDA) versus uncomplicated monochorionic-diamniotic (MCDA) twin gestations. Maternal characteristics, neonatal outcome, and placental histopathology reports of all twin deliveries between 24 and 41 weeks were reviewed. Excluded were pregnancies complicated by twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, selective intrauterine growth restriction, placenta previa, intrauterine fetal death, and malformation. Placental lesions were classified to maternal/fetal vascular malperfusion lesions. Umbilical cord abnormalities included hypo-/hypercoiling and abnormal insertion. Composite adverse neonatal outcome was defined as 1 or more early complications. Small for gestational age (SGA) was defined as birth weight ≤10th percentile. The DCDA group (n = 362) was characterized by higher rates of assisted reproductive techniques ( P < .001) and nulliparity ( P = .03) as compared to the MCDA group (n = 65). Gestational age at delivery was similar between groups. Placental maternal vascular malperfusion lesions were more common in placentas from DCDA group (38.2% vs 23.1%; P = .016), while fetal vascular malperfusion lesions and abnormal cord insertion were more common in placentas from MCDA group ( P = .027; P< .001). The SGA and composite adverse neonatal outcome were more common in the MCDA group ( P = .031 and P = .038, respectively). By multivariate regression analysis, composite adverse neonatal outcome was found to be independently associated with the MCDA group, adjusted odds ratio (aOR) = 1.2, 95% confidence interval (CI) = 1.04 to 1.89, P = .041, and with placental fetal malperfusion lesions aOR = 1.3, 95% CI = 1.1 to 2.09, P = .038. Placental pathology differs between MCDA and DCDA twin pregnancies. Adverse neonatal outcome in uncomplicated MCDA twins, as compared to DCDA twins, could be related to increased placental fetal malperfusion lesions and abnormal cord insertion.

Near to One's Heart: The Intimate Relationship Between the Placenta and Fetal Heart.

The development of the fetal heart is exquisitely controlled by a multitude of factors, ranging from humoral to mechanical forces. The gatekeeper regulating many of these factors is the placenta, an external fetal organ. As such, resistance within the placental vascular bed has a direct influence on the fetal circulation and therefore, the developing heart. In addition, the placenta serves as the interface between the mother and fetus, controlling substrate exchange and release of hormones into both circulations. The intricate relationship between the placenta and fetal heart is appreciated in instances of clinical placental pathology. Abnormal umbilical cord insertion is associated with congenital heart defects. Likewise, twin-to-twin transfusion syndrome, where monochorionic twins have unequal sharing of their placenta due to inter-twin vascular anastomoses, can result in cardiac remodeling and dysfunction in both fetuses. Moreover, epidemiological studies have suggested a link between placental phenotypic traits and increased risk of cardiovascular disease in adult life. To date, the mechanistic basis of the relationships between the placenta, fetal heart development and later risk of cardiac dysfunction have not been fully elucidated. However, studies using environmental exposures and gene manipulations in experimental animals are providing insights into the pathways involved. Likewise, surgical instrumentation of the maternal and fetal circulations in large animal species has enabled the manipulation of specific humoral and mechanical factors to investigate their roles in fetal cardiac development. This review will focus on such studies and what is known to date about the link between the placenta and heart development.

Study of Correlation of Neonatal Outcomes with Gross Abnormalities of Placenta and Umbilical Cord

Introduction: Perinatal outcome of new-borns is greatly influenced by abnormalities of placenta and umbilical cord. In most of the deliveries, whether home or institutional, the placenta and umbilical cords are discarded without examination. Due to paucity of information on abnormalities of placenta and cord, there is hardly any correlation with foetal outcomes. The aim was to study the correlation between the foetal outcome and the different types of abnormalities of placenta and umbilical cord.Materials and Methods: A prospective, cross-sectional, descriptive, randomised study was conducted from January 2016 to December 2016 in a tertiary care hospital in North India. The study was carried out on 1000 term singleton newborns. The placenta and umbilical cords were obtained from both normal and caesarean section deliveries. A proforma was used to gather data from the patients and new-borns. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc, Chicago, IL, IBM version) along with Microsoft Excel (2010 version).Results: One thousand placentae and umbilical cords were examined of which high placental weight/birth weight ratio, gross anomalies of placenta (infarctions, calcifications and retro placental haematoma), marginal (battledore and velamentous) umbilical cord insertions, long umbilical cords and single umbilical artery were associated with negative foetal outcomes.Conclusions: There was a high incidence of adverse foetal outcome with placental and umbilical cord abnormalities. Education of our health personnel dealing with deliveries on the importance of proper examination of the placenta and umbilical cords should be emphasised and instituted upon.

Association Between Umbilical Cord Coiling Index and Prenatal Outcomes

Objectives: This study aimed to measure the umbilical cord indices (UCIs) after birth and to determine its relationship with prenatal complications. Materials and Methods: The present analytical cross-sectional study was conducted on all the pregnant women admitted to AlZahra hospital of Rasht. After birth, the umbilical cord was measured in terms of the appearance, number of vascular coils, and umbilical cord length. In addition, the umbilical cord vascular coils index was calculated. Further, maternal and neonatal variables were evaluated. Results: The mean number of umbilical cord coils, umbilical cord length, and the umbilical cord coiling index for 397 umbilical cords were obtained as 16.02 ± 4.48, 51.6 ± 12.0 and 0.31 ± 0.05 cm, respectively. In evaluating the state of the coil, 9.8% were found as hypocoil while the remaining were either hypercoil (10.3%) or normocoil (79.85%). Furthermore, a significant difference was observed between the umbilical cord coiling index, as well as gestational hypertension and abnormal fetal heart rate (HR) (P &lt; 0.05). In the final logistic regression model, the umbilical cord length was recognized as a predictor variable for neonatal complications. Moreover, in multiple analyses regarding the effects of umbilical cord coiling index on neonatal complications by controlling the interferences, variables such as maternal age and parity in addition to the coil length were considered as predictors of neonatal complications. Conclusions: Generally, the abnormal umbilical cord coiling index was associated with pregnancy blood pressure (BP) and abnormal fetus HR. Therefore, diagnosing antenatal umbilical cord coiling index can be helpful in recognition of embryos at risk through a faster treatment process.

Altered expression of PGC-1α and PDX1 and their methylation status are associated with fetal glucose metabolism in gestational diabetes mellitus

PurposeTo investigate the effect of gestational diabetes mellitus (GDM) on the expression and methylation of PGC-1α and PDX1 in placenta and their effects on fetal glucose metabolism. Methods20 cases of full-term placenta without pregnancy complications and umbilical cord abnormalities and 20 cases of GDM group were collected. DNA and RNA were isolated from samples of tissue collected from the fetal side of the placenta immediately after delivery. DNA methylation was quantified at 7 CpG sites within the PGC-1α and PDX1 genes using PCR amplification of bisulfite treated DNA and subsequent DNA sequencing. PGC-1α and PDX1 mRNA levels were measured by reverse transcription-quantitative PCR (RT-qPCR). Meanwhile, the placental insulin, blood glucose and HbA1c levels were determined. ResultsThe fetus birth weight and placental weight in GDM group were significantly higher than those in control group (P < 0.05). Insulin, HbA1c and blood glucose levels in GDM group were significantly higher than those in control group (P < 0.01). Insulin content was positively correlated with newborn birth weight and placental weight while HbA1c and blood glucose were positively correlated with insulin concentration (r = 0.92, P < 0.01, r = 0.85, P < 0.01). The levels of PGC-1α and PDX1 mRNA were lower in the GDM group compared to the control group. The methylation level of PGC-1α gene was higher in the GDM group compared to the control group (P < 0.05). Blood glucose was negatively correlated with the expression of PGC-1α and PDX1 mRNA in the placenta (r = −0.42, P < 0.01, r = −0.49, P < 0.01). ConclusionThe changes of epigenetic modification of PGC-1α gene in pregnant women with gestational diabetes mellitus may be a mechanism of abnormal glucose metabolism in offspring.

Analysis of etiology and pregnancy outcome in 120 cases with fetal intrauterine growth restriction

Objective To explore the etiology and pregnancy outcome of fetal intrauterine growth restriction(FGR). Methods 120 cases of FGR pregnant women were selected as the research subjects(FGR group). And 120 healthy pregnant women who were successfully delivered during the same period were selected as the control group.The medical records and pregnancy outcomes in the two groups were analyzed and compared. Results There was no statistically significant difference in age between the FGR group and the control group (t=1.0978, P>0.05). In the FGR group, the proportions of pregnant women who came from the countryside, without prenatal examination and the choice of cesarean section were significantly higher than those in the control group, and the differences between the two groups were statistically significant(χ2=8.832, 4.842, 7.466, 4.843, all P<0.05). The proportions of pregnancy induced hypertension, heart lung disease, premature rupture of membranes, anemia, oligohydramnios, abnormal umbilical cord, placental abnormalities intrauterine distress and meconium infection and twin pregnant women in the FGR group were significantly higher than those in the control group(χ2=12.810, 4.655, 6.666, 12.860, 16.335, 6.587, 4.629, 6.696, 7.924, 8.038, all P<0.05), these factors were the causative factors of FGR.The neonatal quality and gestational age in the FGR group were (2 134.32±322.17)g and (35.74±2.12)weeks, respectively, which were significantly lower than those in the control group[(2 793.83±427.64)g, (38.23±2.75)weeks](t=13.493, 7.855, all P<0.05). The incidence rates of neonatal morbidity, neonatal asphyxia and neonatal death in the FGR group were 15.00%, 3.33% and 4.17%, respectively, which were significantly higher than 3.33%, 1.67%, 0.00% in the control group(χ2=9.808, 4.668, 5.106, all P<0.05). Conclusion The incidence of FGR is associated with pregnancy induced hypertension, heart lung disease, premature rupture of membranes, anemia, oligohydramnios, abnormal umbilical cord, placental abnormalities intrauterine distress, meconium infection and twins.FGR should be promptly diagnosed and treated in the clinical, can terminate pregnancy when necessary, as soon as possible to improve the adverse pregnancy outcome.Improving the adverse pregnancy outcomes as much as possible can achieve the purpose of eugenics. Key words: Fetal growth retardation; Risk factors; Pregnancy outcome

Umbilical Cord Coiling in High-risk Pregnancies: Associations With Determinants of Adverse Birth Outcomes and Iron Status.

Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes, but the etiology of these findings remains poorly characterized. This study was undertaken to examine associations between cord coiling and maternal iron (Fe) status and to identify potential determinants of hypo- and hypercoiling in 2 higher risk obstetric groups: pregnant adolescents (≤18 years, n = 92) and adult women carrying twins (n = 49), triplets (n = 11), or quadruplets (n = 1). Umbilical cords were classified as hypo-, normo-, or hypercoiled using digital photographs to assess gross appearance. Hypocoiling and hypercoiling were observed in 44% (n = 86/195) and 13% (n = 26/195) of the combined study population. The prevalence of hypocoiling among women carrying multiples was over 3-fold higher than the prevalence in singleton pregnancies based on the published data. Within the entire study population, hypocoiling was associated with a lower gestational age at birth when compared to normocoiling and hypercoiling (36.3 ± 3.6 weeks [n = 86] vs 37.8 ± 2.7 [n = 83], P < .01, and 38.2 ± 2.6 [n = 26], P < .01, respectively), whereas hypercoiling was associated with significantly lower serum ferritin when compared to normocoiling ( P < .01) and hypocoiling ( P < .001). In the multiples cohort only, hypercoiling was significantly associated with multiparity ( P < .01) and lower birth weight ( P < .05). Further studies are needed to identify the determinants and consequences of cord coiling.

Causes and risk factors for singleton stillbirth in Japan: Analysis of a nationwide perinatal database, 2013\u20132014

Over 80% of perinatal mortality in Japan is due to stillbirths after 22 weeks of gestation, with one in 300 families experiencing fetal loss every year. This study aimed to assess causes and risk factors for singleton stillbirth in Japan. A retrospective cross-sectional study was conducted using the Japan Society of Obstetrics and Gynecology Perinatal Database from January 2013 to December 2014. A total of 379,211 births including 2,133 stillbirths were analyzed. Causes of death were classified into eight categories. A multi-level Poisson regression model was used to assess the relationship between stillbirth and key covariates. Causes of death were unknown in 25–40% of stillbirths across gestational age. Placental abnormality accounted for the largest proportion of known causes, followed by umbilical cord abnormality. Stillbirth risk was increased among small-for-gestational-age infants (adjusted relative risk [ARR]: 3.78, 95% confidence interval [CI]: 3.31–4.32) and nulliparous women (ARR: 1.19, 95% CI: 1.05–1.35). Maternal underweight, pregnancy-induced hypertension and oligohydramnios showed a protective effect. Our finding suggests that stillbirths occurring among women with known complications are likely already being prevented. Further reduction in stillbirths must target small-sized fetuses and nulliparous women. Improved recording of the causal pathways of stillbirths is also needed.

A Systematic Approach to Stillbirth Examination in a tertiary Hospital

Background. Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause.&#x0D; Objectives. The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.&#x0D; Methods. A cross-sectional descriptive study was conducted among 29 stillbirths delivered in a tertiary hospital from March 2016 to September 2016. The probable causes of stillbirth were categorized as obstetrics complications, placental abnormalities, umbilical cord abnormalities, fetal malformations, infections, hypertensive disorders, medical complications, and undetermined causes.&#x0D; Results. 86% of stillbirths in this study had a probable cause of death. Umbilical and placental abnormalities were the most probable causes (62% and 41%, respectively). The two most common identified cord abnormalities were short cord length (34%) and marginal insertion (23%), while small placenta (27%) was the most common for placental abnormalities.&#x0D; Conclusion. To be able to come up with the probable cause of stillbirth, the delivering physician or health personnel should always account the gross findings of the fetus and placenta after delivery.

Anatomical Pathology of the Umbilical Cord and Its Maternal and Fetal Clinical Associations in 434 Newborns.

Introduction Umbilical cord (UC) abnormalities and their clinical relations in 434 newborns were analyzed. We had previously reported on clinical associations of long and short UCs with any kind of malformation. This study focuses on other UC features (insertion, vessels, entanglements, coiling, and knots) and their associations with clinical characteristics and neonatal prognosis. Methods An observational analytic study was performed on placentas from consecutive deliveries. Ordered logistic regression with bivariate and multivariate analysis was performed to evaluate the relationship between variables of interest concerning UC abnormalities. Results A total of 434 placentas made up the study. UC abnormalities were abnormal insertion, 82 (18.86%); coiling (hypo and hypercoiled), 177 (40.78%); single umbilical artery (SUA), 4 (0.92%); entanglements, 8 (1.84%); true knots, 3 (0.69%); webs in UC base, 9 (2.07%); and right twist, 68 (15.67%). After analyzing maternal and fetal complications during pregnancy, multivariate analysis confirmed the recognized association between malformations and SUA and male gender; further confirmation was also made between hypertensive disorders of pregnancy and true knots. Discussion UC abnormalities associated with undesirable outcomes are varied and should be recognized and described. Clinical factors associated with anatomical UC abnormalities are not completely understood and justify forthcoming studies.

Roles of venovenous anastomosis and umbilical cord insertion abnormalities in birthweight discordance in monochorionic-diamniotic twin pregnancies without twin-twin transfusion syndrome.

We evaluated risk factors for birthweight discordance in monochorionic diamniotic (MCDA) twin pregnancies without twin-twin transfusion syndrome (TTTS). We investigated all MCDA twin placentas injected with colored dye at our institution between 2007 and 2015. We excluded pairs of twins with TTTS, fetal demise, or severe fetal malformation. All pairs of twins were assigned to the discordant group (birthweight discordance ≥ 25%) or the concordant group (birthweight discordance < 25%). In each pair of twins, we described vascular anastomoses as either arterioarterial, venovenous (VV), or arterial-venous, and abnormal umbilical cord insertion as either marginal or velamentous. We also recorded placental sharing discordance. A total of 150 placentas were analyzed. The incidence of VV anastomosis in the discordant group (40%) was significantly higher than that in the concordant group (12%, P = 0.005). Unilateral abnormal umbilical cord insertion was significantly more common in the discordant group (85%) than in the concordant group (38%, P < 0.001). Placental sharing discordance was seen more frequently in the discordant group than in the concordant group. Multiple logistic analysis revealed that VV anastomosis (odds ratio: 4.7; 95% confidence interval: 1.2-18.6, P < 0.01) and unilateral abnormal umbilical cord insertion of the smaller twin (odds ratio: 5.7; 95% confidence interval: 1.4-22.9, P < 0.01) were independent risk factors for birthweight discordance. VV anastomoses and unilateral abnormal umbilical cord insertion of the smaller twin are independent risk factors for birthweight discordance in MCDA twin pregnancies without TTTS.

Umbilical cord thrombosis, a cause of intra-uterine fetal demise: A case study

Umbilical vein thrombosis accompanies umbilical cord abnormalities that cause blood vessel ectasia and lead to perinatal mortality. The precise diagnosis and management remains an unsolved puzzle to clinicians. This is to report a case of umbilical cord thrombosis in a patient with intrauterine fetal demise and propose an addendum to the current management. Early detection of umbilical cord abnormalities, intensive fetal monitoring, prompt intervention, and preemptive delivery may prevent perinatal mortality.

Risk factors for extrauterine growth retardation in moderate and late preterm infants

Objective To study the incidence and risk factors for extrauterine growth retardation (EUGR) at discharge in moderate and late preterm infants. Methods A retrospective analysis was performed on 607 premature infants who were admitted to the neonatal intensive care unit between January 1st, 2016 and December 31st, 2016.These subjects were classified into EUGR (n=159) and non-EUGR groups (n=448) based on the body weight at discharge.The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, the incidence of EUGR at discharge was 26.2%(159/607). The incidence of EUGR in intrauterine growth restriction (IUGR) infants was significantly higher than in non-IUGR infants (P<0.001). The very low birth weight (VLBW) infants had a higher incidence of EUGR than non-VLBW infants (P<0.05). Compared with the non-EUGR group, the fasting time, the age to achieve full enteral feeds, the length of mechanical ventilation, oxygen therapy and the length of hospital stays were significantly greater in the EUGR group (P<0.05). The percentages of caesarean section, multiple gestation, pregnancy-induced hypertension, intrahepatic cholestasis of pregnancy and umbilical cord abnormality in the EUGR group were higher than in the non-EUGR group(P<0.05). The incidences of septicemia, hypoalbuminemia, anemia, retinopathy of prematurity, brain injury in premature infants and mechanical ventilation in the EUGR group were higher than in the non-EUGR group(P<0.05). The logistic regression analysis showed that birth weight, IUGR, multiple gestation, abnormality of umbilical cord and the length of hospital stays were the independent risk factors for EUGR. Conclusion The causes of EUGR are multi-factorial.To strengthen pregnancy care, aggressive and reasonable nutritional strategy, prevention and treatment of complications may facilitate to reduce the occurrence of EUGR. Key words: Premature infant; Extrauterine growth retardation; Intrauterine growth retardation; Retinopathy of prematurity

Umbilical Coiling Index Assessment During Routine Fetal Anatomic Survey: A Screening Tool for Fetuses at Risk.

The umbilical cord is the lifeline of the foetus as it supplies water, nutrients, and oxygen. Protection of these blood vessels is needed and provided by Wharton's Jelly, amniotic fluid and the helical pattern, or coiling, of the umbilical cord vessels. To establish the relationship between antenatal umbilical cord coiling index (aUCI) measured at 18-20weeks along with level II USG and adverse perinatal outcomes. A cross-sectional study was conducted on 408 antenatal women, enrolled at the time of fetal anatomic survey, and their cord coiling index (aUCI) was measured, and its association with perinatal outcomes was observed. Umbilical coiling index was classified as Hypocoiled if UCI <10th percentile, hypercoiled >90th percentile, normocoiled between 10th and 90th percentile. 408 antenatal women were enrolled for the study. Mean aUCI was 0.43±0.30 (normocoiled group), 0.18±0.4 (hypocoiled), and 0.53±0.05 (hypercoiled group). The average gestational age at delivery in hypocoiled group was 36.8±2.34weeks, and it was shorter than 38.3±1.82weeks of the normocoiled group and 38.9±1.72weeks of the hypercoiled group. Mean birth weight observed was 2055±744 (hypocoiled group), 3049±564 (hypercoiled), and 3102±564 (normocoiled) p<0.001. Preterm births 52 (59%) and low birth weight 76 (69%) were significantly associated with hypocoiling. Abnormal umbilical cord coiling index, detected at the fetal ultrasound anatomic survey in the second trimester (18-20weeks), can be used potentially as a screening or as a predictive tool for adverse antenatal or perinatal events.

Fetal Intra-abdominal Umbilical Vein Aneurysm.

Fetal umbilical vein aneurysm is an uncommon anomaly that accounts for approximately 4% of umbilical cord abnormalities. The rate of intrauterine fetal death is reported to be approximately 4% to 5%, higher than the background rate of 0.7% that is generally reported during pregnancy. The aim of this study was to review the pathophysiology, diagnosis, and clinical management of fetal umbilical vein aneurysm. Advances in high-resolution ultrasound combined with color Doppler and 3-dimensional rendering have contributed to an increased understanding of the fetal venous circulation in recent years. When the diagnosis of umbilical vein aneurysm is made, the patient should undergo a detailed ultrasound evaluation of the fetal anatomy, including fetal echocardiography, to exclude associated anomalies. Amniocentesis should be offered when other anomalies are found. Patients should be informed about the potential for an unfavorable outcome of pregnancy and should undergo close ultrasound surveillance to assess the size of the aneurysm, as well as any evidence of thrombosis or signs of hydrops. The main prognostic feature associated with a poor outcome of umbilical vein aneurysm seems to be the presence of other anomalies. Early diagnosis is associated with a somewhat worse prognosis, and most fetal deaths have been observed between 27 and 30 weeks of gestation. In the third trimester, it is reasonable to perform serial ultrasound examinations to assess fetal growth, the size of the aneurysm, and the blood flow pattern within the aneurysm.

P29.05: Placental cord insertion site and adverse pregnancy outcome in twin pregnancy

Abnormal umbilical cord insertion has been associated with unequal sharing of the placental vasculature between twins. A higher prevalence has been reported in pregnancies complicated by selective growth restriction (sFGR), birth weight discordance (BWD). We aimed to investigate the association between cord insertion site and adverse pregnancy outcomes in twin pregnancies. A single-centre cohort study of twin pregnancies that had placental histology. Higher-order multiples, major fetal anomaly, aneuploidy and MCMA pregnancies were excluded. Cord insertion site was categorised into 3 groups: marginal (attachment <2cm to the placental margin), velamentous (attached to the membrane before reaching the placenta with vessels traversing the membranes), normal. Chorionicity, placental weight, number of cord vessels, examination of the membranes, ultrasound findings, maternal characteristics and pregnancy outcome were collected. 546 pregnancies were eligible; 497 (146 monochorionic; 351 dichorionic) were included in the analysis. Significant differences were found between the normal and abnormal cord insertion groups with regards to BWD (P=0.001), BWD>25% (P=0.001), and absolute Z-score differences (P=0.020). Velamentous, but not marginal, cord insertion was significantly associated with sFGR (OR 8.51,95%CI 2.09-34.58;P=0.03) and BWD>25% (OR 11.88,95%CI 3.54-39.79;P=0.04). In MCDA, but not DCDA pregnancies, the rate of composite adverse outcome was higher in those with abnormal cord insertion (70.0% vs 53.0%, p=0.04). Selective fetal growth restriction and birthweight discordance are more common in twin pregnancies with abnormal cord insertion. MCDA twins with velamentous cord insertion are at increased risk of sFGR, and composite adverse pregnancy outcome.

Andrea Fleisch Marcus, PhD, MPH winner of the American College of Epidemiology Annals of Epidemiology Junior Investigator Award, 2017

To determine the association between maternal exposure to childhood maltreatment (CM) and risk of stillbirth (fetal death at or after 20 weeks' gestation).Population-based case-control study from the Stillbirth Collaborative Research Network (SCRN) conducted in 2006–2008, and the follow-up study, SCRN-Outcomes after Study Index Stillbirth (SCRN-OASIS), conducted in 2009 in the United States. Cases (n = 133) included women who experienced a stillbirth, excluding stillbirths attributed to genetic/structural or umbilical cord abnormalities and intrapartum stillbirths. Controls (n = 500) included women delivering a healthy term live birth (excluding births less than 37 weeks gestation, neonatal intensive care unit admission, or death). CM exposure was measured using the Childhood Trauma Questionnaire, administered during the SCRN-OASIS study. Dichotomized scores for five subscales of CM (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and an overall measure of CM exposure were analyzed using logistic regression.Generally, there was no association between CM and stillbirth, except for the emotional neglect subscale (OR: 1.93; 95% CI: 1.17, 3.19).Childhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.

Associations between Shiftwork and 25-hydroxy Vitamin D3 Levels among Police Officers

To determine the association between maternal exposure to childhood maltreatment (CM) and risk of stillbirth (fetal death at or after 20 weeks' gestation).Population-based case-control study from the Stillbirth Collaborative Research Network (SCRN) conducted in 2006–2008, and the follow-up study, SCRN-Outcomes after Study Index Stillbirth (SCRN-OASIS), conducted in 2009 in the United States. Cases (n = 133) included women who experienced a stillbirth, excluding stillbirths attributed to genetic/structural or umbilical cord abnormalities and intrapartum stillbirths. Controls (n = 500) included women delivering a healthy term live birth (excluding births less than 37 weeks gestation, neonatal intensive care unit admission, or death). CM exposure was measured using the Childhood Trauma Questionnaire, administered during the SCRN-OASIS study. Dichotomized scores for five subscales of CM (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and an overall measure of CM exposure were analyzed using logistic regression.Generally, there was no association between CM and stillbirth, except for the emotional neglect subscale (OR: 1.93; 95% CI: 1.17, 3.19).Childhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.

Maternal exposure to childhood maltreatment and risk of stillbirth

PurposeTo determine the association between maternal exposure to childhood maltreatment (CM) and risk of stillbirth (fetal death at or after 20 weeks' gestation). MethodsPopulation-based case-control study from the Stillbirth Collaborative Research Network (SCRN) conducted in 2006–2008, and the follow-up study, SCRN-Outcomes after Study Index Stillbirth (SCRN-OASIS), conducted in 2009 in the United States. Cases (n = 133) included women who experienced a stillbirth, excluding stillbirths attributed to genetic/structural or umbilical cord abnormalities and intrapartum stillbirths. Controls (n = 500) included women delivering a healthy term live birth (excluding births less than 37 weeks gestation, neonatal intensive care unit admission, or death). CM exposure was measured using the Childhood Trauma Questionnaire, administered during the SCRN-OASIS study. Dichotomized scores for five subscales of CM (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and an overall measure of CM exposure were analyzed using logistic regression. ResultsGenerally, there was no association between CM and stillbirth, except for the emotional neglect subscale (OR: 1.93; 95% CI: 1.17, 3.19). ConclusionsChildhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.