Umbilical Cord Pathology Research Articles

Dynamics of the prevalence of diseases that complicated the course of childbirth and the postpartum period (based on the materials of the Samara region)

The prevalence of diseases that complicated childbirth and the postpartum period in the Samara region for the period 2009–2021 was investigated. The study was performed based on the official statistical reporting of the Samara region according to a standard scheme. The structure of pathological conditions was assessed. Then, the dynamics were analyzed, and modeling and medium-term forecasting were conducted. Structure analysis was carried out based on the 2016 data. Forecast was performed for the medium term (5 years). Notably, premature rupture of membranes (55.8%) is the most common complication of childbirth and in the postpartum period, followed by obstructed labor (11.4%), childbirth complicated by umbilical cord pathology (10%), childbirth complicated by hypertensive disorders such as preeclampsia and eclampsia (9.3%), and various labor disorders (9.1%). However, the considered conditions indicated in the official statistical reporting explain only 61.1% of all complications of childbirth and in the postpartum period, and 38.9% of all conditions remain unknown, which makes prevention, timely diagnosis, and effective treatment of these conditions challenging. The underreporting of cases of hypertensive disorders during pregnancy is evidenced by their higher frequency during childbirth. Only 25%–30% are complications during pregnancy of the number of complications of this pathology during childbirth and the postpartum period, and the downward trend in the prevalence of this complication during pregnancy is combined with an upward trend during childbirth and the postpartum period. The prevalence of all major extragenital complications during labor and the postpartum period showed a downward trend, except diabetes mellitus. The complexity of the analysis lies in the fact that the level of registration of the same pathological conditions during pregnancy and childbirth and in the postpartum period is extremely different. The data obtained indicate the need for improving the early diagnosis of gestosis and statistical recording of complications of pregnancy and childbirth and provide basis for improving the system of monitoring pregnant women and correct diagnosis of pathology in early pregnancy.

EP17.05: Clinically useful classification of umbilical cord pathology

EP17.05: Clinically useful classification of umbilical cord pathology

Gross and histological features associated with umbilical cord torsion in equine abortions

Equine pregnancy failure can occur throughout gestation, with causes varying by region. In the UK, umbilical cord torsion (UCT) accounted for 44.0% of pregnancy loss (PL) cases occurring after day 70 of gestation and submitted to a diagnostic laboratory. Limited reports on the features of UCT are available. This study aimed to compare the gross and histological features in PLs resulting from UCT to those with no UC pathology. Cases submitted to a UK diagnostic laboratory diagnosed with definitive or suspected UCT (n=81) were compared to PLs diagnosed as not associated with umbilical cord (UC) pathology (nUCT) (n=33). Logistic regression analysis was used for categorical data and Mann-Whitney U tests for non-parametric continuous data. Median gestation age at loss was significantly lower in the UCT (215 days, inter-quartile range (IQR) 32) group compared to nUCT (325 days, IQR 56), p<0.005, with 83.5% of the UCT abortions occurring prior to day 240 of gestation compared to 10.3% of the nUCT cases. The median fetal weight in the UCT group was significantly lighter than the nUCT group, 11.0kg (IQR 6.4) and 45.4kg (IQR 22.5) respectively, remaining after adjustment for gestational age (p<0.005). The UCT group had a significantly longer median total UC length (UCL) (79cm, IQR 19, p<0.001) and amniotic UCL (45cm, IQR 14, p<0.001) but not allantoic UCL (p=0.32) compared tothe nUCT group (total UCL 61cm, IQR 22 and amniotic UCL 27.5cm, IQR 13). A 7.3-fold (95% confidence interval (CI) 2.9-18.2) increase in the risk of UCT diagnosis was identified when the amniotic:allantoic UCL ratio was >1. There was no significant difference in the fetal sex ratio between the two groups (p=0.79). Seven gross features were associated with UCT diagnosis (p<0.05), with reddening of the chorioallantois leading to the greatest increase in the odds of UCT diagnosis (OR 17.4, 95% CI 5.7, 53.4). Histological assessment of the chorioallantois in a subset of cases (46 UCT and 31 nUCT) identified three features associated with UCT diagnosis: autolysis, villous mineralisation and villous karyorrhexis (p<0.001). No UCT cases (0/46) exhibited a significant inflammatory infiltrate in the chorioallantois, compared to 9/31 cases of nUCT. The presence of karyorrhexis and mineralisation likely reflects ischaemic injury resulting from malperfusion of the chorion, in the case of UCT, as a response to episodes of venous stasis following increased vascular resistance associated with the significant increase in UCL and/or vascular obstruction. Collectively, this suggests a more chronic pathophysiology involving lengthening of the amniotic, not allantoic, UC. Identification of these features enables evidence-based refinement of diagnostic criteria for UCT, which can now undergo consultation to reach a universally accepted consensus.

Analysis of the causes of antenatal death of premature fetuses in the Chelyabinsk region

Introduction. The stillbirth rate is steadily increasing accounting for about 80 per cent of perinatal mortality in Russia. There is currently no uniform international classification for coding the causes of perinatal death.The aim of the study was a comparative analysis of the causes of antenatal death of full-term fetuses in the Chelyabinsk region on the basis of various classifications of perinatal mortality to determine possible reserves for reducing the stillbirth rate.Materials and methods A retrospective case-control study based on the analysis of medical documentation of all cases of antenatal death of full-term fetuses during the period of pregnancy 37 weeks 0 days - 41 weeks 6 days held in the Chelyabinsk region from 2019 to 2021. We use the MedCalc software package (Version 20.110, Belgium, 2022) for statistical analysis.Results Based on the ICD-10 classification applied to perinatal deaths (ICD-PM), the leading cause of antenatal death of full-term fetuses is acute antenatal complication. In this case, disorders related to duration of pregnancy and growth of the fetus are the main concomitant pathology. There has also been an increase in the proportion of maternal conditions that have a direct impact on antenatal fetal death (placental and umbilical cord pathology) and other diseases or pathological conditions of the mother (hypertensive disorders and infectious and parasitic diseases). According to the Scandinavian-Baltic Classification, most cases fall into category III and are considered preventable. The distribution of full-term fetal death by CODAC showed that antenatal hypoxia of the fetus is rarely the primary and only cause. First comes the pathology of the placenta and umbilical cord.Discussion The ICD-PM classification allows to lead the most detailed analysis of the causes of antenatal death, considering the pathological conditions of the fetus and the mother, which have a direct influence on the occurrence of the adverse outcome. However, a comparison of the distribution of the cases studied by other classifications showed that the pathology of the placenta and umbilical cord could be considered as the main cause of antenatal death of full-term fetuses, rather than a concomitant cause.Conclusion The main cause of antenatal death of full-term fetuses in Chelyabinsk region is antenatal hypoxia of the fetus. At the same time, all cases of antenatal fetal death relate to preventable losses, which determines the urgent need to identify predictors of this unfavorable outcome in order to reduce the stillbirth rate.

Perinatal Loss as an Urgent Issue of Obstetrics and Perinatology

Perinatal losses are an urgent medical and socioeconomic problem of obstetrics and perinatology. Perinatal mortality in the world is about 30‰, varying widely across continents and countries. Perinatal losses are one of the main indicators of the level of medical care, characterize, on the one hand, the state of health of a woman and the fetoplacental system, and therefore the degree of viability of the fetus, and on the other, the quality of medical care for the mother during pregnancy, childbirth and the child before and during childbirth, as well as after birth. In numerous studies, the study of the structure of perinatal loss factors and adverse perinatal outcomes is of paramount importance. The most significant factors, according to some researchers, are intrauterine hypoxia and fetal asphyxia in childbirth, intrauterine anomaly of fetal development, respiratory disorders, intrauterine infections, placental and umbilical cord pathology, birth injuries, intraventricular hemorrhages, neonatal infections. Perinatal losses suggest a high risk of pregnancy. This dictates the need for a correct approach to assessing perinatal risk during pregnancy during the follow-up period with an obstetrician-gynecologist, in most cases there is an underestimation of the degree of risk, incorrect management of pregnancy. Women who have undergone COVID-19 in the first trimester of pregnancy may be at increased risk of adverse perinatal and maternal complications. The increase in the number of surgical interventions in obstetric practice over the past decades, noted in all countries of the world, is directly related to the expansion of the indications for the performance of caesarean section operations to prevent perinatal pathology. At the same time, being a unique measure of preserving the health and life of a mother or fetus, a global increase in its frequency is alarming. Currently, one of the main tasks remains the development of a clear multifactorial, highly differentiated system for predicting perinatal losses in order to prevent them.

Angiogenic imbalance as a starting point for the development of placental dysfunction and pregnancy complications in patients with pathology of the fetal environment

In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy.The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an anti-angiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package.Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1).The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units compared to control data - 0.16±0.01 units).Conclusions. In the period of 12–16 weeks of pregnancy a vascular imbalance was established at the stage of placentation in patients who were diagnosed pathology of the perinatal environment at 30–32 weeks. In particular, by oligohydramnios there is a 2.5-fold decrease in the concentration of PlGF compared to the control data, a 1.8-fold decrease in the level of VEGF-1, and an increased antiangiogenic growth factor (sFlt-1), which became a prerequisite for the development of placental dysfunction.The results of the postnatal examination of the placenta and umbilical cord became an indirect reflection of placentation conditions. They demonstrated the predominance of abnormal forms, the predominance of the eccentric and marginal type of attachment of the umbilical cord, the main and intermediate type of vascular branching, an increased rate of umbilical cord pathology (Warton’s jelly deficiency, anomalies of the umbilical cord vessels) and a decreased placental-fetal ratio in women with amniotic fluid pathology, which was it is especially pronounced with oligohydramnios.

RISK FACTORS OF UMBILICAL CORD PATHOLOGY AND FACTORS OF NEGATIVE PERINATAL CONSEQUENCES AND NEWBORN INCIDENCE

According to literature sources, the real frequency of many umbilical cord pathologies differs significantly from the statistical data indicated by researchers in their works (from 15% to 38%). The implementation of a system of diagnostic and treatment and preventive measures, based on mandatory antenatal and postnatal assessment of the features and characteristics of the umbilical cord, allows to improve perinatal outcomes and reduce perinatal morbidity. The aim of the work was to identify the main risk factors of umbilical cord pathology and negative perinatal consequences; to develop elements of standardization of antenatal and postnatal diagnosis of umbilical cord pathology. Research materials and methods. A retrospective assessment of medical documentation data (3,280 individual medical records of pregnant women) made it possible to establish the frequency of umbilical cord pathology in the population. In the future, a more detailed extended antenatal and postnatal examination of the umbilical cord and placenta after delivery was carried out in 637 patients of reproductive age with pregnancy complicated by pathology of the umbilical cord (main group). The control group was formed by 40 patients with an uncomplicated course of pregnancy and live birth of full-term healthy children. The study was conducted taking into account the main principles of the Helsinki Declaration on Biometric Research and the powers of the GCH ICH, in accordance with biometric norms with compliance with the principles of confidentiality and ethics (excerpt from protocol No. 128/22 of the meeting of the Bioethics Commission dated September 29, 2022, Ivano-Frankivsk National Medical University, Ministry of Health of Ukraine).Data analysis was performed using the Statistica 7.0 package of statistical programs (StatSoftInc., USA). The association of independent variables with the condition being studied is presented as odds ratio (OR) and 95% confidence interval (CI).The materials of the article are the result of the research of the complex research work fragment of the Department of Obstetrics and Gynecology named after I.D. Lanovyi of the Ivano-Frankivsk National Medical University: “Development of diagnostic tactics and pathogenetic substantiation of effective methods of preserving and restoring reproductive potential and improving parameters of a woman’s quality of life in obstetric and gynecological pathology” (state registration number 0121U109269, implementation dates 2021-2026 ), the author is a co-executor of the topic.Research results and their discussion. The following data were noted: an excess of the population norm of the length of the umbilical cord, a high proportion of eccentric and marginal insertion of the umbilical cord (22.14%) and umbilical cord coiling (33.28%), a decrease in the proportion of the reference limits of the umbilical cord tortuosity index (15.86%), in 56.7% of observations, the specific gravity of the umbilical cord was lower. Probable risk factors for umbilical cord pathology with a predominance of age over 35 years, nicotine addiction in pregnant women, multiple fertility, use of IVF programs, change in the amniotic fluid index, overweight and obesity, other clinical conditions associated with metabolic disorders (gestational diabetes, insulin resistance) were identified. Conclusion. The share of the umbilical cord pathology both in the isolated type and in the combination of characteristic features of the umbilical cord is 40.98%. The increase in the risk of negative perinatal consequences has a close relationship with the umbilical cord pathology and the combination of different types of pathology, as well as the addition of gestational complications, which allows for the formation of screening programs and optimization of the diagnostic algorithm.

Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound.

The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue.

EVALUATION OF CERTAIN BIOCHEMICAL AND ANGIOGENIC MARKERS IN THE FIRST TRIMESTER OF PREGNANCY IN WOMEN WITH UMBILICAL CORD PATHOLOGY

At the stage of formation of fetoplacental complex, various factors of the external and internal environment create prerequisites for subsequent unfavorable course of pregnancy and childbirth. Their influence falls on the period of formation and differentiation of extraembryonic structures in the first trimester of pregnancy. That is why umbilical cord pathologies are considered to be one of the main causes of the development of fetal distress, low birth weight and post-hypoxic states of newborns.&#x0D; The purpose of the research: to analyze changes in the parameters of certain biochemical and angiogenic markers in patients with umbilical cord pathology.&#x0D; Research materials and methods. Medical documentation of 56 patients (the main group) with umbilical cord pathology and abnormalities of its insertion (27 pregnant women with a single umbilical artery and 29 women with velamentous insertion) was processed. The comparison group included 30 patients with normal structural components of the umbilical cord. The level of free ȕ-hCG, PAPP-A, free estriol, AFP, placental lactogen, certain growth factors PIGF and sFlt-1 was evaluated using the method of immunoenzymatic analysis. “Astraia Obstetrics” software (“Astraia software gmbH”, Germany) was used to determine the risk of preeclampsia, chromosomal abnormalities, fetal growth retardation, and premature birth.&#x0D; Research results and their discussion. An imbalance in the concentration of PAPP-A and β-hCG, when its low levels corresponded to high levels of β-hCG, was revealed in the main group. An increase in the average values of the level of PAPP-A MoM was established in almost half of the observations (42.9%), a significantly higher level of free ȕ-hCG was noted in 28.6 % of samples. The combined indicators of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times) compared to the data of the comparison group; placental lactogen has a tendency to decrease. The combined values of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times) compared to the data of the comparison group, and the indicators of the level of sFlt-1 – by 1.5 times (p&lt;0.05). This made it necessary to evaluate the calculated parameters of the angiogenic coefficient, which reflects the depth of vascular disorders and the severity of vascular imbalance.. At the same time, this ratio was found to be 2.0 times lower in the patients of the comparison group compared to the combined total indicator in the main group - in pregnant women with umbilical cord pathology - 155.7 units. (p&lt;0.05)&#x0D; Conclusions. Among pregnant women with umbilical cord pathology, a high proportion of the increased PAPP-A indicator, probably a lower level of free β-chorionic gonadotropin subunit, and low parameters of placental lactogen in the third trimester of pregnancy were observed. The combined indicators of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times), and the indicators of sFlt-1 level – by 1.5 times higher compared to the data of the comparison group, which can be a marker of the abnormal formation of fetoplacental complex with the deterioration of the intrauterine fetal condition, as well as an increase in the angiogenic factor. The use of “Astraia Obstetrics” module in combination with prenatal biochemical screening made it possible to assign 23.2 % of examined patients with umbilical cord pathology to the risk group for the development of chromosomal abnormalities, preeclampsia, fetal growth retardation and premature birth.

Different aspects of umbilical cord insertion in twin pregnancies

Cord insertion during pregnancy may take and arise different series of characteristics. Intrapartum fetal assessment depends in a significant matter on the umbilical cord, amniotic fluid and placenta. It is also obvious that the umbilical cord may cause problems that can influence labor and pregnancy altogether. There are many concerns about umbilical cord pathology in the past few years, now more than ever because of high morbidity and mortality in both mother and fetus. This high rate of such concern is because of the fetal hypoxia, neonatal asphyxia and hypoxic-ischemic injury at birth. Modern approach and justified interventions are skills required by any young obstetrician and physician who works in Ob-gyn field. The faster the diagnostic and the proper care are embedded, the quicker and better the outcome of the newborn will be, under the circumstances. Multiple gestation involve some risks and they need to be recognized; preterm birth, growth restriction, fetal demise and perinatal mortality nowadays are associated with unfavorable results and traumatized or touching events. The labor and delivery anomalies which might occur is the only clear objective about studying the umbilical cord pathologies and make sure of improving the perinatal outcomes.

Diagnostic algorithm and monitoring of pregnant women with umbilical cord pathology = Діагностичний алгоритм та моніторингу вагітних з патологією пупочного канатику

Diagnostic algorithm and monitoring of pregnant women with umbilical cord pathology = Діагностичний алгоритм та моніторингу вагітних з патологією пупочного канатику

Placental pathology and neonatal encephalopathy.

Neonatal encephalopathy (NE) is an important cause of neonatal morbidity and mortality worldwide; however, there remain gaps in our knowledge about its pathogenesis. The placenta has been implicated in the pathogenesis of this disease but conclusive evidence related to the placental factors that influence it is sparse. This review aims to outline the current knowledge on the role of the placenta with particular attention to its role in NE as a consequence of hypoxia-ischemia. A total of 26 original articles/review papers were used to compile this review. Three themes were identified from these publications: fetal vascular malperfusion including umbilical cord pathology, inflammatory changes in the placenta, and maternal vascular malperfusion including placental weight. These features were identified as being significant in the development of NE. Advancing our understanding of this relationship between placental pathology and NE may facilitate the development of additional antenatal screening to better identify at-risk fetuses. We highlight areas for further research through antenatal screening and placental histology.

Impact of Immunization Prophylaxis on the Course of Pregnancy in Rh-Negative Women

The purpose of the work was to study the characteristics of the course of pregnancy in women who received Rh immunoprophylaxis. Materials and methods. 64 pregnant women were examined, the average age of whom was 30.55 ± 7.0 (18–43) years. Out of 64 pregnant women, 24 (37.5%) were pre-pregnant, 40 (62.5%) were re-pregnant. The somatic and obstetric anamnesis of all pregnant women included in this study was studied. The average number of pregnancies in 40 repeat-bearing women with Rh (-) blood was 2.34 ± 0.6 (1–5). The obtained results of the study were subjected to statistical processing. At the same time, a computer program "Statgraph" was used, designed for statistical data processing in a parametric and nonparametric way. The work was carried out on the basis of the Educational and Surgical Clinic of the Azerbaijan Medical University. Results and discussion. The study of the course of pregnancy in women with no Rh isosensitization made it possible to establish the presence in the first trimester of a high incidence of anemia (27.3%), vomiting and nausea (21.2%), asymptomatic bacteriuria (17.4%), threatened abortions (14.4%). In the second trimester, there was also a high incidence of anemia (28.6%), asymptomatic bacteriuria (21.4%), threatened abortions (15.7%), exacerbation of chronic pyelonephritis (12.9%), mild preeclampsia (10%). In the third trimester, a high frequency of the menace of uterine rupture along the scar was 22.6%, the threat of preterm birth was 18.5%, and acute respiratory viral infection was 16.9%. It was found that the frequency of abdominal delivery was 73.4%, the frequency of the vaginal birth was 26.6%. A study of the condition of newborns made it possible to establish a satisfactory condition in 70%, a moderate condition in 18.8%, and a serious condition in 6.3% of infants. The severity of the condition was determined by the presence of prematurity in 15.6%, weakness of labor and labor stimulation in 6.3%, and the presence of umbilical cord pathology in 6.3%. None of the newborns had clinical and laboratory manifestations of hemolytic disease of the newborn, which reflects the effectiveness of the prevention of Rh isosensitization, the introduction of anti-D immunoglobulin during pregnancy and after childbirth. Conclusion. The use of anti-D immunoglobulin after previous births and at a gestational age of 27.7 ± 0.09 weeks in present pregnancy eliminates isosensitization in pregnant women with Rh-negative blood. Timely prophylaxis of anti-D immunoglobulin prevents the development of hemolytic disease of the newborn in this group of women. The use of anti-D immunoglobulin is of great importance to reduce perinatal morbidity and mortality in pregnant women with Rh-negative blood

Umbilical cord vascular thrombosis: literature review and two clinical cases

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Anomalies of vascular attachment (velamentous attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, maternal diabetes mellitus and preeclampsia as well as meconium found in the amniotic fluid are among the risk factors of developing thrombosis in the umbilical cord vessels. Here we present two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, no signs of umbilical cord pathology were found according to cardiotocography and Doppler ultrasound; despite this, the children were born in hypoxic state. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Velamentous attachment, intrauterine infections as well as meconium found in the amniotic fluid were the risk factors of developing umbilical vein thrombosis described in case 1 and case 2, respectively. During pregnancy, both female patients suffered from clinically confirmed novel coronavirus infection (COVID-19) and contacted patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the novel coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires to be further explored.

Congenital heart defects and umbilical cord abnormalities, an unknown association?

Few studies exist that research the association between umbilical cord characteristics with cardiac malformations. In this study, we describe a population of newborns with congenital heart defects (CHD) and the frequency of presentation of umbilical cord (UC) alterations, based upon the hypothesis that the continuity of the cardio-placental circuit can be affected by similar noxas during early development. We carried out a descriptive study at a hospital in Bogota based on clinical records from newborns with congenital heart disease with placental and UC pathology results. Group analyses were done according to the major categories of the ICD-10. We analyzed 122 cases and found that the most frequent alterations where hypercoiling (27.9%) and abnormal UC insertion (16.4%). Additionally, in almost every group of CHD, more than 65%of patients had some type of cord alteration. We discovered a high frequency of UC alterations in patients with CHD. This outcome suggests that a possible association exists between the two phenomena, further research is needed.

Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology.

Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies.

Сочетанная патология пуповины, как причина перинатальных потерь

The article presents a clinical case of the antenatal death of a fetus due to a combined umbilical cord pathology prenatally diagnosed with ultrasound: the absence of Wharton’s jelly, thin umbilical cord and the only artery of the umbilical cord. Stages of prenatal care using the methods of visual examination of the fetus are described.

The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks

Umbilical cord pathology accounts for 20–25% of stillbirths worldwide. Recent publications suggest that stillbirths could be prevented by routine 18 – 20-week ultrasound evaluations that include the full anatomy of the umbilical cord from the placenta to the fetal umbilicus. This manuscript reviews our current understanding of this field and includes suggestions for the future.

Fetal, neonatal, and infant death in central China (Hubei): A 16-year retrospective study of forensic autopsy cases.

Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them.A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed.In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1–12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis.This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.

Perinatal injuries of the fetal nervous system and contributory factors

The issue of perinatal injury of the central nervous system and birth trauma draws close attention of various specialists. The objective: to identify the effect of extragenital pathology of the pregnant woman and obstetric factors on the formation of perinatal CNS injuries and traumatic injuries of the newborn. Materials and methods. The authors studied ante- and intranatal risk factors for perinatal CNS damage and birth trauma in 183 babies in severe or moderately severe condition (main group) born in the City Clinical Perinatal Center in 2011–2017. There were assessed the clinical manifestations and results of instrumental studies. The control group was formed by the case – control type of 183 women in labor and their children without birth injuries. The results. There were revealed the most significant risk factors for the formation of perinatal CNS injury and birth trauma of the newborn: a high frequency of pregnancy complications (100%), extragenital diseases (90.2%), urogenital infections (33.3%), umbilical cord pathology (33.3%) and other complications of labor (42.1%). The conclusion. The complications of pregnancy and childbirth, extragenital diseases, urogenital infections contribute to the frequency of perinatal CNS damage and development of birth trauma.