Doppler Impedance Changes at the Fetal Brain Vessels in a Pregnancy Affected with a Multiple Combination of Uteroplacental Anomalies

Abstract

A fetus with a very rare five-fold combination of uteroplacental anomalies, bicornuate uterus, short cervix with cervical incompetence, multilobed placenta succenturiata, accessory cotyledon within the cervical funneling, and umbilical cord insertion into the anomalous cervical cotyledon, presented an early and marked decrease at the vertebral and middle cerebral arteries Doppler resistances. This cerebral low-impedance state, usually found before labor, and considered an adaptive mechanism developed to protect the fetus at term from labor asphyxia, was present for an unknown reason at 20 weeks. After the patient was treated with vaginal progesterone, the cervix shortening improved and markedly, at the same time, the cerebral vascular resistances increased and maintained an adequate for gestational age impedance until delivery at 34 weeks. As the described uteroplacental anomalies determined a high risk of preterm delivery, due to cervical dilation, cord compresion, and placental haemorrhage, these fluctuating brain vascular changes might be the result of the fetal adaptation to the changes preceding an imminent delivery.

Relationship between Abnormal Placenta and Obstetric Outcomes: A Meta-Analysis

“…A total of 963 studies were screened. Of these, 48 studies comprising 1625 pregnant women with abnormal placenta and 167,566 pregnant women without abnormal placentas met the inclusion criteria of the current systematic review for descriptive analysis [ 3 , 9 , 10 , 11 , 12 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ].…”

“…The metadata of the 48 eligible studies are shown in Supplementary Table S1 [ 3 , 9 , 10 , 11 , 12 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. The eligible studies were published between 1974 and 2022.…”

“…All studies were retrospective in nature, and none of them were randomized controlled studies. Of the included studies ( n = 48), 26 were case reports [ 3 , 25 , 27 , 29 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 , 53 , 56 , 57 , 58 , 63 , 64 , 65 ], 4 were case series [ 33 , 59 , 60 , 61 ], and the remaining 18 were original research articles [ 9 , 10 , 11 , 12 , 13 , 24 , 26 , 28 , 30 , 31 , 34 , 44 , 45 , 46 , 52 , 54 , 55 , 62 ]. The majority of the studies (approximately one-third) were from the United States of America ( n ...…”

“…Of the included studies ( n = 48), 26 were case reports [ 3 , 25 , 27 , 29 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 , 53 , 56 , 57 , 58 , 63 , 64 , 65 ], 4 were case series [ 33 , 59 , 60 , 61 ], and the remaining 18 were original research articles [ 9 , 10 , 11 , 12 , 13 , 24 , 26 , 28 , 30 , 31 , 34 , 44 , 45 , 46 , 52 , 54 , 55 , 62 ]. The majority of the studies (approximately one-third) were from the United States of America ( n = 15, 31.3%) [ 10 ...…”

“…Evidently, a similar rate of circumvallate placentas was observed between the experimental and control groups. The outcomes of succenturiate lobe placenta were mentioned in 20 studies (Supplementary Table S4) [9,13,24,27,28,30,31,35,37,40,41,43,44,46,47,49,51,60,61,63]. Of these (n = 20), 8 studies were original research articles [9,13,24,28,30,31,44,46], 2 were case series [60,61], and the remaining 10 were case reports [27,35,37,40,41,43,47,49,51,63].…”