Impact of umbilical cord length on fetal circulatory system by Doppler assessment

Contreras, Mercedes Olaya; Vargas, William Fernando Bautista; Martínez, Rodolfo; Peñaloza, Ivan Felipe; Sanchez, M.E Lopez; Madariaga, Ithzayana; Aldana, Sergio; Bernal, Jaime

doi:10.1007/s40477-020-00495-2

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…According to our findings, BMI ≥30 kg/m 2 , umbilical cord around the neck, spinal anesthesia, and perfusion index≥4 are risk factors for poor neonatal prognosis. The existence of high-risk factors may lead to abnormal fetal umbilical arterial blood flow, make the fetus in a state of chronic hypoxia, and ultimately lead to poor perinatal prognosis [ 29 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates

Liu

Qian

2022

Applied Bionics and Biomechanics

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Objective. To analyze the risk factors of intraoperative hypotension in cesarean section women and poor prognosis of neonates. Methods. The clinical data of 1071 cesarean section women admitted to The Affiliated Jiangning Hospital of Nanjing Medical University from January 2021 to December 2021 were retrospectively analyzed. They were divided into hypotension group ( n = 472 ) and normal control group ( n = 599 ) according to whether there was hypotension during operation. The correlations between the clinical data of cesarean section and the occurrence of intraoperative hypotension and poor prognosis of neonates were analyzed by logistic regression analysis. Receiver operating curve (ROC) was drawn and the area under the curve (AUC) was calculated. Results. Logistic regression analysis results showed that BMI ≥30 kg/m2, infant weight ≥3500 g, spinal anesthesia, puncture site L2-3, bupivacaine dose>10 mg, ropivacaine dose>50 mg, and perfusion index≥4 were the risk factor for intraoperative hypotension in cesarean section ( p < 0.01 ) and BMI ≥30 kg/m2, umbilical cord around neck, spinal anesthesia, and perfusion index≥4 were risk factors for poor prognosis of neonates ( p < 0.01 ). The AUC of ROC for BMI to diagnose intraoperative hypotension in cesarean section women was 0.6240 (95% CI: 0.59-0.66, p < 0.01 ), the sensitivity was only 30.20% (95% CI: 26.73%-35.02%), and the specificity was 87.65% (84.77%-90.04%), and the AUC of BMI for the diagnosis of poor prognosis of neonates was 0.5647 (95% CI: 0.5013-0.6280, p = 0.049 ), and the sensitivity was 51.19% (95% CI: 40.69%-61.59%), and the specificity was 64.34% (61.30%-67.26%). The AUC of perfusion index for the diagnosis of intraoperative hypotension in cesarean section women was 0.8333 (95% CI: 0.8081-0.8584, p < 0.01 ), the sensitivity was 94.49% (95% CI: 92.05%-96.21%), and the specificity was 73.12% (69.43%-76.52%); the AUC of perfusion index for the diagnosis of ROC with poor prognosis of neonates was 0.6164 (95% CI: 0.5538-0.6791, p < 0.01 ), the sensitivity was 70.24% (95% CI: 59.75%-78.96%), and the specificity was 50.86% (47.75%-53.97%). Conclusion. The prediction model established by BMI, infant weight, anesthesia method, puncture site, anesthetic drug dose, and perfusion index has guiding value for clinical prediction of cesarean section maternal hypotension. The prediction model established by BMI, umbilical cord around neck, anesthesia method, and perfusion index has guiding value for clinical prediction of poor prognosis of neonates.

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Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates

Liu

Qian

2022

Applied Bionics and Biomechanics

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“…Detailed sonographic evaluation of the fetus with karyotyping has been recommended in cases with giant umbilical cord as there exists no standard evaluation for monitoring and treatment of the same. However, serial evaluation and closer surveillance of fetal umbilical cord length and Doppler findings performed on a weekly basis in fetuses with giant umbilical cord may result in favorable outcomes 7 …”

Section: Discussionmentioning

confidence: 99%

“…However, serial evaluation and closer surveillance of fetal umbilical cord length and Doppler findings performed on a weekly basis in fetuses with giant umbilical cord may result in favorable outcomes. 7 Omphalo-mesenteric duct cysts and pseudocysts due to degeneration of the Whartons' jelly have been implicated as causes for majority cases with giant umbilical cord. The giant umbilical cord noted in the current study did not demonstrate the typical circular cross-section, but was rather ellipsoid with no typical mickey mouse configuration of the vessels on cross-section.…”

Section: Discussionmentioning

confidence: 99%

Giant umbilical cord with impending heart failure—Prognostic significance of prenatal ultrasound

Ravikanth

2022

Sonography

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Detection of giant umbilical cord prenatally should lead to vigilant monitoring particularly at term as fetal demise is a possibility, as noted in the present case because of altered hemodynamics and related vascular complications such as compromised fetal circulation. A case of prenatally diagnosed, giant umbilical cord with fetoplacental insufficiency and impending heart failure is reported. An 18‐year‐old primigravida, presented at 34 weeks of gestational age with complaints of acute onset abdominal pain. Fetal umbilical artery obstetric Doppler examination demonstrated reversal of diastolic flow. 2D echocardiography demonstrated dilated all 4 chambers of the heart with reduced contractility suggesting impending heart failure. Subsequently, fetal demise was noted after 2 days, and labour was induced followed by vaginal delivery of the dead fetus. A giant umbilical cord was seen at delivery with absent knots or strictures. This case report deserves a special mention as there were no earlier reported cases of giant umbilical cord in literature presenting with impending heart failure and fetal demise. We have presented the detailed clinical course of the fetus with giant umbilical cord along with a review of the related literature.

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“… 2 Elongated UCs may affect cardiac dynamics and increase peripheral vascular resistance; excessive long umbilical cords (ELUCs) predispose to stasis which is a risk factor for thrombosis (Virchow’s triad). 3 Generally, UC abnormalities such as short cord, long cord, knots, hyper-coiling, hypo-coiling, stricture and single umbilical artery can lead to increased morbidity and mortality of the fetus. 4 To consider the cord abnormally long, it must be longer than 100 cm.…”

Section: Introductionmentioning

confidence: 99%

A misdiagnosed case of a 150-cm umbilical cord coiled twice around the fetal neck with a true cord knot: A rare Syrian case report

Hanna

Martini

Deeb

et al. 2023

SAGE Open Medical Case Reports

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The normal umbilical cord is a crucial component during pregnancy, but sometimes it could become compromised due to some abnormalities such as excessive long umbilical cord, and though they usually end up with a healthy baby, they may lead to severe consequences. Excessive long umbilical cords are found in 4% of pregnancies and represent a risk factor for nuchal cords and true knots. We report a case of a 37-year-old Syrian pregnant woman who presented to the hospital at 37 weeks of gestation asking for a C-section for a fear of ambiguous ultrasound findings that have been interpreted as fetal malformation. At delivery, a healthy baby was born with a 150-cm umbilical cord, a true knot, and double-looped nuchal cords; the formation of the loops and the knot had been attributed to the elongated cord. Besides, ultrasound imaging could sometimes be deceptive and lead to unnecessary interventions; therefore, cord anomalies should always be kept in mind because they do not always represent a justification for a C-section.

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Impact of umbilical cord length on fetal circulatory system by Doppler assessment

Cited by 5 publications

References 32 publications

Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates

Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates

Giant umbilical cord with impending heart failure—Prognostic significance of prenatal ultrasound

A misdiagnosed case of a 150-cm umbilical cord coiled twice around the fetal neck with a true cord knot: A rare Syrian case report

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