scholarly journals Discordant umbilical arteries in the umbilical cord entanglement: a light microscope study

2021 ◽  
Vol 29 (3) ◽  
pp. 231-237
Author(s):  
İrem Şenyuva ◽  
Şirin Küçük
Keyword(s):  
Umbilical Cord ◽  
Gestational Age ◽  
Apgar Score ◽  
Umbilical Artery ◽  
Apgar Scores ◽  
Multiple Group ◽  
Significant Difference ◽  
Umbilical Arteries ◽  
Minute Apgar Score ◽  
Umbilical Cord Entanglement

Objective The present study aimed to examine the histopathological diagnosis of the umbilical artery discordance in cases with single or multiple umbilical cord entanglement and pregnancy outcomes. Methods The vascular structure of the umbilical cord, histopathological findings of the placenta and obstetric outcomes were retrospectively examined in 50 cases. The cases were divided into two groups by the number of cord entanglement (single-multiple) and their histopathological findings and neonatal Apgar scores were assessed. Results Out of 50 cases, 38 (76%) had single and 12 (24%) had multiple cord entanglement. In 50 cases, the mean gestational age was 39.16±1.06 weeks, neonatal Apgar scores were 8.7±0.58 at 1 minute and 9.64±0.56 at 5 minute. No statistically significant difference was detected between single and multiple groups in terms of gestational age (p=0.79), 1-minute Apgar score (p=0.832) and 5-minute Apgar score (p=0.656). In histopathological examination, the diameters of umbilical arteries 1 and 2 were found to be 0.11±0.12, 0.09±0.05 µm, respectively in the single group (p=0.756) and 0.13±0.14, 0.06±0.02 µm, respectively in the multiple group (p=0.131). When the umbilical arterial diameters were compared by group, the diameter of the umbilical artery 2 was detected 0.09±0.05 µm in the single and 0.06±0.02 µm in the multiple group and statistically significant difference was detected (p=0.037). Out of 50 cases, placental hypoxia finding was detected as chorangiosis only in 10 cases (2 multiple, 8 single). Conclusion Umbilical artery discordance was detected in cases with multiple umbilical cord entanglement. However, poor pregnancy outcome was not observed in any of the cases. When multiple cord entanglement is seen during obstetric examination, umbilical artery discordance must be remembered and investigated, and also maternal-fetal condition should be considered.

scholarly journals Effect of Umbilical Cord Entanglement and Position on Pregnancy Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Natsuko Kobayashi ◽  
Shigeru Aoki ◽  
Mari S. Oba ◽  
Tsuneo Takahashi ◽  
Fumiki Hirahara
Keyword(s):  
Pregnant Women ◽  
Umbilical Cord ◽  
Pregnancy Outcomes ◽  
Umbilical Artery ◽  
The Body ◽  
Delivery Mode ◽  
Apgar Scores ◽  
Nuchal Cord ◽  
Umbilical Cord Entanglement ◽  
Singleton Pregnancies

Introduction.To investigate the effect of complex umbilical cord entanglement primarily around the trunk on pregnancy outcomes.Methods. We studied 6307 pregnant women with singleton pregnancies who underwent vaginal delivery of an infant at ≥37 weeks of gestation. Cases were classified into no cord, nuchal cord, and body cord groups and defined as cases without umbilical cord entanglement, one or more loops of the umbilical cord around the neck only, and umbilical cord around the trunk only, respectively. Pregnancy outcomes were compared among these three groups.Results. The no cord, nuchal cord, and body cord group included 4733, 1451, and 123 pregnancies, respectively. Although delivery mode was not significantly different among the three groups, 1-minute Apgar scores <7 and umbilical artery (UA) pH <7.10 were significantly more common in the umbilical cord entanglement groups than in the no cord group. In particular, the frequency of 5-minute Apgar scores <7 was significantly higher (P=0.004), whereas that of UA pH <7.10 tended to be higher (P=0.057) in the body cord group than in the nuchal cord group.Conclusion. Compared to nuchal cord, umbilical cord entanglement around the trunk was associated with a higher risk of low Apgar scores and low UA pH.

scholarly journals Correlations between the Status of the Umbilical Cord and Neonatal Health Status

2020 ◽  
Vol 26 (3) ◽  
pp. 348-356
Author(s):  
Sun Min Lee ◽  
Dong Yeon Kim ◽  
Seongmin Cho ◽  
Sun Mi Noh ◽  
Hye Ly Park ◽  
...  
Keyword(s):  
Health Status ◽  
Soft Tissue ◽  
Umbilical Cord ◽  
Apgar Score ◽  
Personal Information ◽  
Neonatal Health ◽  
Test Analysis ◽  
Significant Difference ◽  
The Status ◽  
Minute Apgar Score

Purpose: This study aimed to identify correlations between the status of the umbilical cord and neonatal health status.Methods: In total, 172 newborns were enrolled who were admitted to the newborn nursery with a gestational age of 35 weeks or older and a body weight of 2 kg or above. Data were collected on the basic personal information of the newborns, the diameter and soft tissue status of the umbilical cord, and neonatal health status after birth. Analyses were performed using t-test, analysis of variance, <i>x</i><sup>2</sup> test, and Fisher exact test.Results: Umbilical cord diameter exhibited a statistically significant difference by sex (t=2.71, <i>p</i>=.007). A thin umbilical cord diameter was associated with a 1-minute Apgar score less than 8 points (t=2.47, <i>p</i>=.015) and with being transferred to the intensive care unit (t=2.45, p=.015). Poor soft tissue status of the umbilical cord was associated with a 1-minute Apgar score of less than 8 points (<i>x</i><sup>2</sup>=16.68, <i>p</i><.001) and with oxygen being supplied (<i>x</i><sup>2</sup>=4.81, <i>p</i>=.028).Conclusion: Assessing the umbilical cord diameter and status in newborns is an important tool for evaluating neonatal health status after birth, and this point also underscores the importance of professionals' careful observations in the newborn nursery.

scholarly journals The Association between the Five-Minute Apgar Score and Neurodevelopmental Outcomes among Children Aged 8−66 Months in Australia

2021 ◽  
Vol 18 (12) ◽  
pp. 6450
Author(s):  
Tahir Ahmed Hassen ◽  
Catherine Chojenta ◽  
Nicholas Egan ◽  
Deborah Loxton
Keyword(s):  
Apgar Score ◽  
Generalized Estimating Equations ◽  
Entire Range ◽  
Neurodevelopmental Outcomes ◽  
Apgar Scores ◽  
Neurodevelopmental Delay ◽  
Australian State ◽  
Perinatal Data ◽  
Data Collections ◽  
Minute Apgar Score

This study aimed to evaluate the association of the five-minute Apgar score and neurodevelopmental outcomes in children by taking the entire range of Apgar scores into account. Data from the Australian Longitudinal Study of Women’s Health (ALSWH) and Mothers and their Children’s Health (MatCH) study were linked with Australian state-based Perinatal Data Collections (PDCs) for 809 children aged 8−66 months old. Generalized estimating equations were used to model the association between the five-minute Apgar scores and neurodevelopmental outcomes, using STATA software V.15. Of the 809 children, 614 (75.3%) had a five-minute Apgar score of 9, and 130 (16.1%) had an Apgar score of 10. Approximately 1.9% and 6.2% had Apgar scores of 0−6 and 7−8, respectively. Sixty-nine (8.5%) of children had a neurodevelopmental delay. Children with an Apgar score of 0−6 (AOR = 5.7; 95% CI: 1.2, 27.8) and 7−8 (AOR = 4.1; 95% CI: 1.2, 14.1) had greater odds of gross-motor neurodevelopment delay compared to children with an Apgar score of 10. Further, when continuously modelled, the five-minute Apgar score was inversely associated with neurodevelopmental delay (AOR = 0.75; 95% CI: 0.60, 0.93). Five-minute Apgar score was independently and inversely associated with a neurodevelopmental delay, and the risks were higher even within an Apgar score of 7−8. Hence, the Apgar score may need to be taken into account when evaluating neurodevelopmental outcomes in children.

scholarly journals Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome

2018 ◽  
Vol 40 (12) ◽  
pp. 740-748 ◽  
Author(s):  
Cátia Ferreira ◽  
Ângela Melo ◽  
Ana Fachada ◽  
Helena Solheiro ◽  
Nuno Nogueira Martins
Keyword(s):  
Umbilical Cord Blood ◽  
Apgar Score ◽  
Umbilical Artery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Neonatal Hypoxia ◽  
Total Cohort ◽  
Group A ◽  
Minute Apgar Score

Objective To analyze if umbilical artery pH (pHua) ≤7.00 and umbilical artery blood deficit (BDua) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. Methods This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A—women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B—all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pHua ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21–37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35–21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03–6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29–177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20–99.60; p = 0.006). Conclusion The pHua and the BDua are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia.

scholarly journals Changes in Umbilical and Cerebral Blood Flow in Pregnancies Diagnosed with Clinical Chorioamnionitis. Is Chorioamnionitis Predictable?

2019 ◽  
pp. 1
Author(s):  
Berfin Okmen Ozkan ◽  
Emre Ekmekci
Keyword(s):  
Umbilical Artery ◽  
Demographic Data ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Significant Difference ◽  
Umbilical Artery Doppler ◽  
Doppler Evaluation ◽  
Umbilical Arteries

<p><strong>Objective:</strong> To evaluate the predictability of clinical chorioamnionitis by Doppler changes in fetal middle cerebral and umbilical arteries, at hospitalized patients due to preterm premature rupture of membranes.</p><p><strong>Study Design:</strong> Patients who were admitted and hospitalized due to preterm premature rupture of membranes between 24 weeks and 33 weeks and 6 days pregnancies are included in the study. Demographic data of patients, gestational age at referring to hospitalization, fetal presentation at admission, delivery time, delivery indications and total follow-up time until delivery of each case were recorded.</p><p><strong>Results:</strong> A total of 108 patients were evaluated retrospectively. The rate of clinical chorioamnionitis was 5.55% (6/108). There was no significant difference between pregnancies terminated with the diagnosis of clinical chorioamnionitis and pregnancies terminated with other indications in terms of the maximum systolic velocity at middle cerebral artery and umbilical artery pulsatility indices.</p><p><strong>Conclusion:</strong> Clinical chorioamnionitis is a serious complication and is more common in patients being followed up after preterm premature rupture of membranes. Although it is crucial to be predicted due to neonatal worse prognosis, it cannot be predicted by middle cerebral and umbilical artery Doppler evaluation.</p>

Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy

2020 ◽  
Author(s):  
Sabine Bousleiman ◽  
Dwight J. Rouse ◽  
Cynthia Gyamfi-Bannerman ◽  
Yongmei Huang ◽  
Mary E. D'Alton ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Apgar Score ◽  
Hypoxic Ischemic Encephalopathy ◽  
Apgar Scores ◽  
Fetal Heart Rate Monitoring ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Secondary Outcomes ◽  
Ischemic Encephalopathy ◽  
Umbilical Cord Ph

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

scholarly journals Comparison between the Effects of Thiopental Sodium and Propofol on Maternal Hemodynamics during Cesarean Section Under General Anesthesia and Apgar score of the newborns

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
E Elshaer ◽  
H Omar ◽  
A Elshaer ◽  
T Youssif ◽  
W Abdelmoneim
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Umbilical Cord ◽  
Apgar Score ◽  
Well Being ◽  
Elective Cesarean Section ◽  
Anesthetic Drugs ◽  
Significant Difference ◽  
Thiopental Sodium

Abstract Background Cesarean delivery is one of the most current surgeries in women and one of the most significant challenges of anesthesiologists in this kind of surgery is the fetuses' exposure to anesthetic drugs. Regional anesthesia is generally preferred during cesarean section, but general anesthesia may be the only option under certain circumstances such as patient preference, back deformities. The most common drugs which are used in cesarean section to induce general anesthesia are thiopental sodium and propofol. Aim compare the effect of sodium thiopental induction versus propofol induction on hemodynamics of mothers undergoing elective cesarean section under general anesthesia and their effect on Apgar score of their newborns. Materials and Methods A total 260 healthy patients were included in an open randomized study, among whom 130 patients received Thiopentone and 130 received Propofol. These patients were premedicated with granisetron and ranitidine, after induction dose the maintenance was similar for both groups. APGAR scoring and umbilical cord venous gas analysis were among the parameters used for determining the general well-being of newborns. There were no significant difference between the two groups regarding Apgar scoring in 1st, 2nd and 5th minutes. Umbilical cord blood gas values were similar . There was no metabolic acidosis in newborns of mothers receiving thiopental or propofol as anesthetic agents during cesarean section. Results Group (T) received general anesthesia with thiopental at a dose of ( 4-6 mg/kg) while patients in group (P) received general anesthesia with propofol at a dose of (2mg/kg). As regards hemodynamic changes, there were no significant difference in maternal heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure during their measurement throughout the procedure-preoperatively, after delivery of the baby,15 minutes after delivery, after extubation and in recovery room- but after intubation, there were significantly lower in propofol group which suppressed hemodynamic response to intubation . Conclusion Thiopental and propofol can be safely used in cesarean sections, but the use of propofol is more advantageous than thiopental because it provides adequate anesthetic suppression of pressor response of intubation without any depressive effect on newborns.

The concentration of insulin-like growth factor-I and insulin-like growth factor-binding protein-1 in human umbilical cord serum at delivery: relation to fetal weight

1991 ◽  
Vol 129 (3) ◽  
pp. 459-464 ◽  
Author(s):  
H. S. Wang ◽  
J. Lim ◽  
J. English ◽  
L. Irvine ◽  
T. Chard
Keyword(s):  
Growth Factor ◽  
Umbilical Cord ◽  
Fetal Growth ◽  
Gestational Age ◽  
Umbilical Artery ◽  
Binding Protein ◽  
Insulin Like Growth Factor ◽  
Factor Binding ◽  
Factor I ◽  
Igf I

ABSTRACT Serum levels of insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-1 (IGFBP-1) have been determined by radioimmunoassay in the maternal circulation (n = 91) and in the umbilical artery (n = 56) and vein (n = 90) of man. In both the umbilical artery and vein, the concentration of serum IGF-I showed an inverse correlation with birthweight (P < 0·005 and P < 0·001 respectively); the mean serum IGF-I levels in the small-for-gestational-age (SGA) group were significantly higher than those in average-for-gestational-age (AGA) neonates (P <0·01 and P < 0·001 respectively). However, maternal serum IGF-I showed no association with birthweight and there was no significant difference between the SGA and AGA groups. These observations imply that the production of IGF-I in the maternal and fetal compartments is independent and that there is unlikely to be transfer of IGF-I across the placenta. Serum IGFBP-1 levels in both maternal and umbilical cord blood (artery and vein) showed an inverse relation to birthweight (P <0·001, P<0·005 and P<0·001 respectively). Increased IGFBP-1 levels in the umbilical artery and vein were observed in the SGA group. These findings suggest that IGFBP-1 might inhibit the action of IGF-I in both the maternal and the fetal compartments and that the rise in IGFBP-1 could be a primary factor in retardation of fetal growth. Alternatively, circulating IGF-I and IGFBP-1 levels may only be a secondary reflection of local tissue events involved in fetal growth. Journal of Endocrinology (1991) 129, 459–464

scholarly journals Prediction of Foetal Well-being with Non-stress Test

2016 ◽  
Vol 33 (2) ◽  
pp. 65-69
Author(s):  
Jahanara Rahman ◽  
Hosne Ara Begum
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Apgar Score ◽  
Stress Test ◽  
The Other ◽  
P Value ◽  
Mild Depression ◽  
Other Hand ◽  
Significant Difference

Introduction: Non-stress test (NST) is the most common antenatal test performed to assess the foetus at risk of intrauterine hypoxia. On the other hand non-reactivity detected by NST increases the interferences of pregnancy by Caesarean section.Methodology: A cross sectional descriptive study was carried out in the department of Obstetrics and Gynaecology at Dhaka National Medical College between July2007 and June 2008.Objectives: The objectives of the study were (1) To observe the mode of delivery in cases of non-reactive non stress test (NST) and (2) To evaluate perinatal outcome of non-reactive NST.Results: A total 137 high risk pregnant women were included in the study. Age of the women ranges from 16 to 32 years. The mean age of the women was 23.74 ± 3.71 year. Among them 44.53% were primaegravida and 55.47% were multigravida. Gestational age was between 35 and 42 weeks and mean gestational age was 38.34±1.42 weeks. Regarding foetal reactivity 61.3% (n=84) were reactive and 38.7 % (n=53) were non-reactive. Among the babies of non reactive NST 98.11% and 1.89% were delivered by caesarean section and vaginal delivery respectively. Whereas, 48.81% and 51.19% babies of reactive NST were delivered by caesarean section and vaginal delivery respectively. The percentage of caesarean section was much higher in non-reactive NST cases in comparison to that of reactive NST which was statistically highly significant (p value 0.0000). One minute after birth APGAR scoring revealed that 56.6% and 43.4% newborn of non-reactive NST had no depression( APGAR score 7-10) and mild depression ( APGAR score 4-6) respectively. On the other hand 65.47% and 34.5% newborn of reactive NST had no depression and mild depression respectively at one minute after birth. Therefore, small difference was noticed in the neonatal status between the reactive and non-reactive NST which had no statistical significance (p value 0.507). Evaluation of the neonates with APGAR scoring done 5 minutes after birth revealed mild depression (APGAR score 4-6) in 24.53% and 20.24% of non-reactive and reactive NST cases respectively and no depression (APGAR score 7- 10) was found in 75.47% and 70.76% in reactive and nonreactive NST respectively. So, 5 minutes after birth the neonatal status among reactive and non-reactive NST made no significant difference (p value 0.9266).Conclusion: Neonatal evaluation revealed that all foetuses were not compromised as detected by NST. Relying on NST the rate of Caesarean section has been increased. Reassessment of the foetal conditions was needed with the help of other techniques. Therefore NST alone is insufficiently predictive of neonatal outcome.J Bangladesh Coll Phys Surg 2015; 33(2): 65-69

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