Abnormal Umbilical Cord Coiling is Associated with Adverse Perinatal Outcomes

2000 ◽  
Vol 3 (5) ◽  
pp. 462-471 ◽  
Author(s):  
Geoffrey A. Machin ◽  
Jeanne Ackerman ◽  
Enid Gilbert-Barness
Keyword(s):  
Umbilical Cord ◽  
Growth Retardation ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Neurological Status ◽  
Adverse Outcomes ◽  
Placental Pathology ◽  
Fetal Demise ◽  
Fetal Death Rate ◽  
Clinical Correlations

The normal umbilical cord coil index is one coil/5 cm, i.e., 0.2 ±0.1 coils completed per cm. We report the frequency and clinical correlations of abnormally coiled cords among 1329 cases referred to our placental pathology services. Twenty-one percent of cords were over-coiled and 13% were undercoiled. Abnormal cord coiling was seen at all gestational ages. Principal clinical correlations found in overcoiled cords were fetal demise (37%), fetal intolerance to labor (14%), intrauterine growth retardation (10%), and chorioamnionitis (10%). For undercoiled cords, the frequencies of these adverse outcomes were 29%, 21%, 15%, and 29%, respectively. Abnormal cord coiling was associated with thrombosis of chorionic plate vessels, umbilical venous thrombosis, and cord stenosis. Thus, abnormal cord coiling is a chronic state, established in early gestation, that may have chronic (growth retardation) and acute (fetal intolerance to labor and fetal demise) effects on fetal well-being. The cause of abnormal cord coiling is not known. Its effects on neurological status of survivors are also unknown. Antenatal detection of abnormal cord coil index by ultrasound could lead to elective delivery of fetuses at risk, thereby reducing the fetal death rate by about one-half. We recommend that the cord coil index become part of the routine placental pathology examination.

Intrauterine Fetal Demise

2020 ◽  
Author(s):  
Gianna L Wilkie ◽  
Sarah E Little
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Umbilical Cord ◽  
Fetal Death ◽  
Genetic Evaluation ◽  
Placental Pathology ◽  
Fetal Demise ◽  
Maternal History ◽  
Intrauterine Fetal Demise ◽  
Delivery Planning

Intrauterine fetal demise (IUFD) and stillbirth are interchangeable terms to describe a fetal death in the second half of pregnancy. IUFD is defined as the delivery of a fetus showing no signs of life as indicated by the absence of heart rate, breathing, umbilical cord pulsation, or voluntary muscle movements. A thorough evaluation of maternal history and risk factors, fetal evaluation involving autopsy and genetic evaluation, and placental pathology should be offered at the time of IUFD diagnosis. Significant counseling should be provided to patients regarding future pregnancies and the risk of recurrence as well as the need for increased antenatal testing and delivery planning in subsequent pregnancies.  This review contains 5 tables, 10 figures and 55 references.  Keywords: fetal kick counts, intrauterine fetal demise (IUFD), management of intrauterine fetal demise, microarray, placental pathology, risk factors for intrauterine fetal demise

scholarly journals Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review

2017 ◽  
Vol 39 (11) ◽  
pp. 622-631 ◽  
Author(s):  
José Guida ◽  
Fernanda Surita ◽  
Mary Parpinelli ◽  
Maria Costa
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Randomized Clinical Trials ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Well Being ◽  
Adverse Outcomes ◽  
Severe Preeclampsia ◽  
Maternal Complications ◽  
Pubmed Database

Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developing maternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, the maternal outcomes were similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal well-being, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.

scholarly journals Umbilical cord coiling index as a marker of perinatal outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 323-327
Author(s):  
Pragati Jain ◽  
Monika Aggarwal ◽  
Meenu V Ahuja ◽  
Surbhi Gupta
Keyword(s):  
Umbilical Cord ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Ponderal Index ◽  
Amniotic Fluid Index ◽  
Meconium Staining ◽  
Nicu Admission ◽  
In Pregnancy

The umbilical cord is very important for the well-being and survival of the fetus, however this is susceptible to compressions, kinking, traction and torsion which may influence the perinatal outcome and an abnormal umbilical coiling index has been related to adverse fetal and pregnancy outcomes. To determine the umbilical cord coiling index (UCI) and compare its association with perinatal outcome in normal and complicated pregnancies.It was a prospective observational study done on 200 patients at term (after 37 weeks) pregnancy, delivered either vaginally or by cesarean section. The umbilical cord coiling index was calculated. The mean coiling index of our study was 0.256+0.07 per cm. The outcomes measured were maternal age, parity, body mass index, hypertension in pregnancy, diabetes in pregnancy, amniotic fluid index, meconium staining of liquor, neonatal birth weight, Apgar score at birth, ponderal index, NICU admission. The coils were then divided into three categories on the basis of UCI and their association with the maternal and fetal outcomes were analyzed. Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers exact test and the t test where applicable. Hypocoiled cords (UCI &#60;10th centile) were associated with pregnancy induced hypertension (PIH), diabetes mellitus, meconium staining of liquor, low Apgar score, growth restricted fetus and NICU admission. Hypercoiled cords were associated with liquor abnormalities and low ponderal index. Abnormal umbilical cord coiling index was associated with adverse perinatal outcomes.

Organizational Justice enhances Subjective Well-being

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Ms. Anjali Sahai ◽  
Prof. (Dr). Abha Singh
Keyword(s):  
Organizational Justice ◽  
Satisfaction With Life ◽  
Interactional Justice ◽  
Well Being ◽  
Adverse Outcomes ◽  
Satisfaction With Life Scale ◽  
Subjective Well Being ◽  
Negative Experience ◽  
Life Scale ◽  
The Relationship

Organizational Justice has the potential to create major impact on organizations and employees alike. These include greater commitment, trust, enhanced job performance, more citizenship behaviors and less number of conflicts. It has been reported that employees seem to have a universal concern for Justice that transcends the self and that many are subject to biases at various point of time in their work life. Sometimes these biases lead to adverse outcomes including decreased level of subjective well-being. Subjective well-being is a broad category that includes life satisfaction, positive affect, and low negative affect, such as anger, sadness and fear. Thus to study the relationship between Organizational justice and subjective well-being, a sample of 88 employees working in Private Universities of NCR region were examined. For this purpose, the Organizational Justice scales consisting of Measure of Procedural & Interactional Justice and Distributive Justice Index scale by Moorman, Blakely & Niehoff (1998) and Subjective Wellbeing Scales inclusive of the Satisfaction with Life Scale(SWLS),Scale of Positive and Negative Experience(SPANE) and Flourishing Scale (FS) by Ed Diener (2004)were used. Results indicate significant relationship between the three types of Organizational justice and subjective well-being of employees.

HPV Prevalence and its Association with Perinatal Outcomes among Singleton Mothers: Analysis of Pregnancy Risk Assessment and Monitoring System (PRAMS) Data, 2004-2011

2019 ◽  
Vol 15 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Harpriya Kaur ◽  
Delf Schmidt-Grimminger ◽  
Baojiang Chen ◽  
K.M. Monirul Islam ◽  
Steven W. Remmenga ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Monitoring System ◽  
Large Population ◽  
Perinatal Outcomes ◽  
Hpv Infection ◽  
Adverse Outcomes ◽  
P Value ◽  
Pregnancy Risk

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

scholarly journals Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanxia Xie ◽  
Xiaodong Wang ◽  
Yi Mu ◽  
Zheng Liu ◽  
Yanping Wang ◽  
...  
Keyword(s):  
Adolescent Pregnancy ◽  
Gestational Age ◽  
Rural Areas ◽  
Reference Group ◽  
Perinatal Outcomes ◽  
Severe Anaemia ◽  
Adverse Outcomes ◽  
Near Miss ◽  
Adolescent Women ◽  
Adolescent Pregnancies

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

scholarly journals Necrotizing funisitis and calcification of umbilical vein: case report and review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wendi Wang ◽  
Miao Zhang ◽  
Liyun Gong ◽  
Qingqing Wu
Keyword(s):  
Umbilical Cord ◽  
Umbilical Vein ◽  
Supportive Therapy ◽  
Vascular Wall ◽  
Adverse Outcomes ◽  
Prenatal Ultrasonography ◽  
Severe Inflammation ◽  
Umbilical Blood ◽  
Emergency Cesarean ◽  
Wall Calcification

Abstract Background Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography. Case presentation Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy. Conclusion NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.

Massive Extra-Abdominal Umbilical Vein Varix: A Case Report

2021 ◽  
pp. 1-4
Author(s):  
Josef Jackson ◽  
Eumenia Castro ◽  
Michael A. Belfort ◽  
Alireza A. Shamsirshaz ◽  
Ahmed A. Nassr ◽  
...  
Keyword(s):  
Case Report ◽  
Umbilical Cord ◽  
Neonatal Period ◽  
Umbilical Vein ◽  
Fetal Distress ◽  
Fetal Anemia ◽  
Pathologic Examination ◽  
Fetal Demise ◽  
Increased Risk ◽  
Umbilical Vein Varix

Umbilical vein varices are rare umbilical cord anomalies that typically occur intra-abdominally. Extra-abdominal umbilical vein varices are exceedingly rare and usually diagnosed postnatally on gross pathologic examination. Umbilical vein varices have been associated with increased risk of fetal anemia, cardiac abnormalities, and intrauterine fetal demise. This case report discusses a patient who presented with a massive extra-abdominal umbilical vein varix, whose infant was ultimately delivered due to fetal distress and died in the neonatal period. This report also discusses associated fetal conditions and guidelines for antenatal testing and surveillance of known umbilical vein varices.

scholarly journals Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review

2019 ◽  
Vol 165 (5) ◽  
pp. 363-370 ◽  
Author(s):  
Lauren Rose Godier-McBard ◽  
L Ibbitson ◽  
C Hooks ◽  
M Fossey
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Scoping Review ◽  
Healthcare Providers ◽  
Well Being ◽  
Perinatal Period ◽  
Poor Mental Health ◽  
Adverse Outcomes ◽  
Military Spouses ◽  
Perinatal Mental Health

BackgroundPoor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems.MethodsA scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O’Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE.ResultsThirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support.ConclusionsUS literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.

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