Characteristics of blood flow in intrauterine growth‐restricted fetuses with hypercoiled cord

Nishio, Junko; Nakai, Yuichiro; Mine, Makiko; Imanaka, Makoto; Ogita, Sachio

doi:10.1046/j.1469-0705.1999.13030171.x

Cited by 22 publications

(18 citation statements)

References 21 publications

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“…[4][5][6] In a small portion of SGA neonates (12.8%), an increased coiling index (hypercoiling) was observed postnatally compared with early ante- A Article natal hypocoiling detected on sonography. 7 This report indicated that possible reduction of umbilical cord supportive tissue, together in combination with fetal movements in the SGA fetuses, could cause increased cord coiling with advancing gestation. 7,8 In consideration of the possible reduced umbilical cord supportive tissue (thinner cords) involvement in the etiology of umbilical cord coiling, we hypothesized that aUCI should have a significant relationship with the umbilical cord thickness.…”

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confidence: 82%

“…7,8 In consideration of the possible reduced umbilical cord supportive tissue (thinner cords) involvement in the etiology of umbilical cord coiling, we hypothesized that aUCI should have a significant relationship with the umbilical cord thickness. Therefore, altered umbilical cord thickness may predispose the fetus to the umbilical coiling pattern 7 and possibly may hinder full fetal intrauterine growth potential.…”

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confidence: 99%

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Absence of a Relationship Between Umbilical Cord Thickness and Coiling Patterns

Predanić

Perni

2005

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate a relationship between the umbilical cord thickness and cord coiling patterns during the fetal sonographic anatomic survey in the second trimester of pregnancy. Methods. This was a prospective study of 470 patients with singleton pregnancies who had a fetal anatomic survey with recorded umbilical coiling patterns between 18 and 23 weeks' gestation. The umbilical cord thickness was assessed as an umbilical diameter at the level of the fetal abdominal cord insertion and compared with the antenatal umbilical coiling index (aUCI), calculated as a reciprocal value of the distance between a pair of umbilical cord coils. Results. Three hundred twenty-one patients had adequate sonographic umbilical cord images and maternal demographic, antenatal, and labor data to meet inclusion criteria. The mean aUCI was 0.41 with 10th and 90th percentiles of 0.21 and 0.60, respectively. A total of 10.6% (34/321) and 9.3% (30/321) of patients were categorized as having hypocoiled and hypercoiled umbilical cords, respectively. The mean cord diameter ± SD was 9.48 ± 0.97 mm (range 7.0-12.5 mm). There was no statistically significant correlation between aUCI and umbilical cord thickness (P = .1164). Conclusions. An aUCI, or umbilical coiling pattern, does not correlate with umbilical cord thickness. It appears that a lesser amount of the umbilical supportive tissue, mainly Wharton jelly, is not related to an increased umbilical cord coiling pattern.

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confidence: 82%

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confidence: 99%

Absence of a Relationship Between Umbilical Cord Thickness and Coiling Patterns

Predanić

Perni

2005

Journal of Ultrasound in Medicine

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“…This phenomenon was confirmed in cases of intra-uterine growth restriction with hypercoiled umbilical cords by Nakai et al in 1997 [50]. Moreover, Nishio et al reported umbilical venous pulsations without any changes to flow velocity waveforms in the fetal vena cava inferior in eight out of nine cases of intra-uterine growth restriction due to hypercoiled cord [51] and these patients delivered their neonates at term. From these findings, in the fetuses with hypercoiled umbilical cords, umbilical venous pulsation occurred without cardiac dysfunction and immediate delivery is not necessary for these fetuses in spite of umbilical venous pulsations.…”

Section: Umbilical Venous Blood Flowmentioning

confidence: 73%

“…Umbilical venous pulsations were observed only at several regions of the umbilical cord in normal fetuses [54], in spite of what was observed over the entire umbilical cord in intra-uterine growth restriction with a hypercoiled umbilical cord [50,51]. These regional umbilical pulsations occurred at points where the umbilical cord winded at large angles (especially more than 60 degrees) or where the umbilical cord was compressed [55].…”

Section: Umbilical Venous Blood Flowmentioning

confidence: 95%

Accurate diagnosis of umbilical circulation

Nakai

Tachibana

Yamamasu

2006

The Ultrasound Review of Obstetrics & Gynecology

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Umbilical arterial flow velocity has been widely used for the estimation of fetal status. This is clinically useful, but affected by physiological characteristics or other factors such as maternal drug administration. Otherwise, umbilical venous pulsation is also used for fetal estimation. But, this particular pattern appeared not only from fetal cardiac problems, but from umbilical cord characteristics. We summarized the various factors which affect the umbilical circulation.

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“…This interesting finding may support the nongenetic etiologic theory of cord coiling: the reduction in supportive tissue in the umbilical cord of SGA fetuses combined later with fetal movements may result in increased coiling. Nishio et al 19 reported cases in which a hypercoiled cord was associated with intrauterine growth restriction and suggested that in some cases the hypercoiled umbilical cord may have contributed to fetal growth restriction. Raio and colleagues 6 recently suggested a lean umbilical cord as a simple marker for the fetus at risk of being SGA at birth.…”

Section: Discussionmentioning

confidence: 99%

Early second‐trimester low umbilical coiling index predicts small‐for‐gestational‐age fetuses.

Degani

Leibovich

Shapiro

et al. 2001

J of Ultrasound Medicine

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Objective. To evaluate the role of the early second-trimester Doppler velocimetric studies of the umbilical coiling index and umbilical cord cross-sectional area as tests for the prediction of small-for-gestationalage infants. Methods. Doppler blood flow studies in 147 singleton pregnancies at risk for delivery of a small-for-gestational-age neonate were performed at 15 ± 1 (SD) weeks' gestation from the uterine artery, umbilical artery, middle cerebral artery, inferior vena cava, and ductus venosus. Pulsatility index values were calculated for the arteries, and preload index values and systolic-atrial contraction ratios were calculated for the veins. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. The umbilical coiling index was calculated by using sonographic longitudinal views of cord vessels from several segments antenatally and by dividing the total number of helices by cord length (centimeters) postnatally. Small-for-gestational-age neonates were identified when the birth weight was below the 10th percentile for gestational age. Results. Among 147 pregnancies studied, 124 fulfilled the study criteria. Thirty-nine of the neonates were small for gestational age at birth (31.5%). The mean ± SD gestational age at delivery of the appropriate-for-gestational-age neonates was 39.7 ± 1.28 weeks, and that of the small-forgestational-age neonates was 36.4 ± 2.9 weeks (range, 28-40 weeks). The best single predictor of a small-for-gestational-age infant was the coiling index, with sensitivity of 79%, specificity of 86%, a positive predictive value of 72%, and a negative predictive value of 90%. Conclusion. The umbilical coiling index measured in the second trimester is useful in predicting the birth of a small-forgestational-age infant and may serve as a marker for subsequent growth restriction.

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Characteristics of blood flow in intrauterine growth‐restricted fetuses with hypercoiled cord

Abstract: Fetal blood flow disturbance caused by a hypercoiled umbilical cord may be a cause of growth restriction.

Cited by 22 publications

References 21 publications

Absence of a Relationship Between Umbilical Cord Thickness and Coiling Patterns

Absence of a Relationship Between Umbilical Cord Thickness and Coiling Patterns

Accurate diagnosis of umbilical circulation

Early second‐trimester low umbilical coiling index predicts small‐for‐gestational‐age fetuses.

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