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Gross Umbilical Cord Complications are Associated with Placental Lesions of Circulatory Stasis and Fetal Hypoxia.
MedLine Citation:
PMID:  22978619     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Umbilical cord complications (CC) such as true knots (TK), velamentous insertion (VEL), entanglement (CE), excessive cord length (ELUC), or excessive coiling (ETUC) can lead to decreased umbilical blood flow and have been associated with adverse fetal outcome and demise (IUFD). Few large series exist correlating CC with specific pathologic findings of the placenta. We present the largest series of CC at this time. 841 third trimester placentas with umbilical cord complications were identified, as well as 858 randomly selected gestational age matched placentas with grossly unremarkable umbilical cords. Lesions associated with circulatory stasis and thrombosis (CST) including villous congestion (VC), umbilical vessel distension (UVD), chorionic plate vessel distension (CPD), umbilical vessel thrombosis (UVT), fetal vascular thrombosis (FVT), and avascular villi (AV) were noted as well as any other pathologic lesions. Data was analyzed by ANOVA and Fisher's exact tests, with p<.05 statistically significant. Umbilical cord complications as a group was associated with a significant increase in placental circulatory stasis lesions. Lesions associated with hypoxia, namely nucleated red blood cells (RBC) and chorangiosis (CHS), were also increased. Finally, the presence of any CC was significantly associated with IUFD. We also found that multiple cord abnormalities are associated with non-reassuring fetal heart rate and chorangiosis, but the presence of a single cord abnormality was not. This indicates that cord complications may lead to intrauterine hypoxia and subsequent adverse fetal outcome, and multiple cord abnormalities may be cumulative in effect. Keywords: Fetal death, fetal hypoxia, placental circulation, placenta, umbilical cord.
Authors:
Joanna Sue Yee Chan; Rebecca Baergen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-14
Journal Detail:
Title:  Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society     Volume:  -     ISSN:  1093-5266     ISO Abbreviation:  Pediatr. Dev. Pathol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9809673     Medline TA:  Pediatr Dev Pathol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
a NYP - Weill Cornell Medical College, Pathology and Laboratory Medicine.
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