Overestimation of Umbilical Cord Coiling Index with Segmental versus Total Length Assessment

Peres, Luíz César; Taylor, Deborah

doi:10.2350/12-03-1172-oa.1

Cited by 15 publications

(12 citation statements)

References 10 publications

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“…We included some cases with a cord segment of less than 10 cm. 36 Both of these factors were limitations in our study. Hypocoiled cords have been associated with meconium staining, parity interventions, low Apgar score, fetal pH alterations and chromosomal abnormalities, 14,22,37 and with possible need for neonatal intervention.…”

Section: Discussionmentioning

confidence: 86%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 86%

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

et al. 2018

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“…Peres and Taylor showed that shrinkage after formalin fixation and segmental measurement of the umbilical cords (as in our investigation) may result in an overestimation of the UCI. 19 For this reason, we chose a high cutoff level for determination of hypercoiling in our study group rendering better reproducibility. Segemental investigation of the umbilical cords was performed because many placentas are not sent with the whole umbilical cord for pathological investigation.…”

Section: Discussionmentioning

confidence: 99%

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition

et al. 2019

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This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.

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“…The association in our case of MFI with a hypercoiled umbilical cord containing a single artery prompted us to consider whether this was just a chance association or whether a mechanism could be envisioned in which these cord abnormalities might be linked to MFI. Umbilical cord coiling can be sonographically demonstrated by as early as 10 weeks of gestation [16]. The number of coils along the cord (umbilical coiling index) has a mean r The embedded chorionic villi show persistence of villous stromal cells and villous outlines (hematoxylin and eosin, original magnification 3200).…”

Section: Discussionmentioning

confidence: 99%

Maternal Floor Infarction/Massive Perivillous Fibrin Deposition Associated with Hypercoiling of a Single-Artery Umbilical Cord: A Case Report

Taweevisit

Thorner

2016

Pediatr Dev Pathol

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Maternal floor infarction is a rare and idiopathic placental disorder associated with adverse obstetric outcomes and a high rate of recurrence in subsequent pregnancies. The pathogenesis of maternal floor infarction is unclear but has been linked to diverse underlying maternal conditions, including gestational hypertension/preeclampsia, immune-mediated diseases, and thrombophilia. Few reports link maternal floor infarction to fetoplacental conditions. We report a 34-week, macerated, growth-restricted male fetus for which the placenta showed maternal floor infarction. The umbilical cord showed excessive coiling and a single umbilical artery. These cord changes are postulated to have resulted in increased placental villous resistance and decreased fetal blood flow, creating a hydrostatic pressure gradient between the villous stroma and the intervillous space. The pressure changes could then lead to trophoblast damage and fibrinoid deposition, contributing to the maternal floor infarction in this case.

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Overestimation of Umbilical Cord Coiling Index with Segmental versus Total Length Assessment

Cited by 15 publications

References 10 publications

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

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

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition

Maternal Floor Infarction/Massive Perivillous Fibrin Deposition Associated with Hypercoiling of a Single-Artery Umbilical Cord: A Case Report

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