INTERTWIN MEMBRANE VELAMENTOUS UMBILICAL CORD INSERTION IN A BICHORIONIC TWIN PREGNANCY

ObjectiveThis study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.DesignRetrospective cohort study.SettingSingle institution.ParticipantsThis study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.ResultsThe rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).ConclusionsAbnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin’s umbilical cord insertion using ultrasonography would be beneficial.

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P03.05: Umbilical cord insertion into a central amniotic band: imaging, evolution and outcome

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.15333 ◽

2015 ◽

Vol 46 ◽

pp. 129-130

Author(s):

M. Gingras-Charland ◽

M. Roy-Lacroix ◽

A. Ouellet

Keyword(s):

Umbilical Cord ◽

Amniotic Band ◽

Umbilical Cord Insertion

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Relation of site of umbilical cord insertion and birth weight

Journal of Obstetrics and Gynaecology ◽

10.3109/01443618809151339 ◽

1988 ◽

Vol 9 (1) ◽

pp. 34-35 ◽

Cited By ~ 2

Author(s):

N. Bruyniks ◽

T. Y. Khong ◽

R Leong

Keyword(s):

Birth Weight ◽

Umbilical Cord ◽

Umbilical Cord Insertion

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Three-Dimensional Sonographic Evaluation of the Position of the Fetal Conus Medullaris at First Trimester

Fetal Diagnosis and Therapy ◽

10.1159/000516516 ◽

2021 ◽

pp. 1-8

Author(s):

Ruben Ramirez Zegarra ◽

Nicola Volpe ◽

Evelina Bertelli ◽

Greta Michela Amorelli ◽

Luigi Ferraro ◽

...

Keyword(s):

Abdominal Wall ◽

Umbilical Cord ◽

Interobserver Agreement ◽

Interobserver Variability ◽

First Trimester ◽

3D Ultrasound ◽

Conus Medullaris ◽

Consecutive Series ◽

Fetal Life ◽

Umbilical Cord Insertion

Objective: The objective of this study was to assess the position of the conus medullaris (CM) at the first trimester 3D ultrasound in a cohort of structurally normal fetuses. Methods: This was a multicenter prospective study involving a consecutive series of structurally normal fetuses between 11 and 13 weeks of gestation (CRL between 45 and 84 mm). All fetuses were submitted to 3D transvaginal ultrasound using a sagittal view of the spine as the starting plane of acquisition. At offline analysis, the position of the CM was evaluated by 2 independent operators with a quantitative and a qualitative method: (1) the distance between the most caudal part of the CM and the distal end of the coccyx (CMCd) was measured; (2) a line perpendicular to the fetal spine joining the tip of the CM to the anterior abdominal wall was traced to determine the level of this line in relation to the umbilical cord insertion (conus to abdomen line, CAL). Interobserver agreement for the CCMd was evaluated. Linear regression analysis was used to determine the association between the CMCd and CRL, and a normal range was computed based on the best-fit model. The absence of congenital anomalies was confirmed in all cases after birth. Results: In the study period between December 2019 and March 2020, 143 fetuses were recruited. In 130 fetuses (90.9%), the visualization of the CM was feasible. The mean value of the CMCd was 1.09 ± 0.16 cm. The 95% limits of agreement for the interobserver variability in measurement of the CMCd were 0.24 and 0.26 cm. The interobserver variability based on the intra-class correlation coefficient (ICC) for the CCMd was good (ICC = 0.81). We found a positive linear relationship between the CCMd and CRL. In all these fetuses, the CAL encountered the abdominal wall at or above the level of the cord insertion. Conclusion: In normal fetuses, the assessment of the CM position is feasible at the first trimester 3D ultrasound with a good interobserver agreement. The CM level was never found below the fetal umbilical cord insertion, while the CMCd was noted to increase according to the gestational age, confirming the “ascension” of the CM during fetal life.

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Monoamniotic Twin Pregnancy; is There a Need for Frequent Fetal-Doppler Surveillance?

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v9i2.722 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Suhaiza A ◽

Che Anuar CY ◽

Nik Zuky NL ◽

Mokhtar A

Keyword(s):

Sudden Death ◽

Pregnancy Outcome ◽

Umbilical Cord ◽

Twin Pregnancy ◽

Rare Type ◽

Ultrasound Doppler ◽

Fetal Doppler

Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.

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A study of histological changes of human placenta in rural population of eastern India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183331 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3280

Author(s):

Mrinal Kanti Karmakar ◽

Sambit Kar ◽

S. M. Kumar ◽

Subir Kumar Chattopadhyay ◽

L. K. Vaid ◽

...

Keyword(s):

Umbilical Cord ◽

Cellular Proliferation ◽

Histological Study ◽

Normal Growth ◽

Normal Pregnancy ◽

Eastern India ◽

Histological Changes ◽

Endothelial Proliferation ◽

Umbilical Cord Insertion ◽

Normal Placenta

Background: Placenta is essential for maintenance of pregnancy and for promoting normal growth and development of fetus. It forms the morphological record of anatomical condition, intrauterine events and intrapartum events of gestation. Present study has been undertaken to record the data on the morphology and histology of placenta from mothers with hypertension and diabetes.Methods: This study showed several significant morphological and histological differences in the placenta of the mother with GDM and hypertensive placenta. The histological study of the placenta was done under microscope and number of syncytial knots, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, calcified and hyalinised villous spots were noted per low power field in the diabetics and hypertensive group in comparison to control group.Results: All other parameters including area, thickness, diameter, and circumference of GDM placenta show a significant increase when compared with normal placenta. The gross anatomic features of placentae e.g infarcted areas, calcified areas and marginal insertion of the umbilical cord in the study group show significant increase in value (p>0.01) in diabetic and hypertensive groups when compared to that of the control or normal group.Conclusions: In present study we found that hypertensive placentae tend to be slightly smaller in size, weight, volume, area, thickness, diameter, circumference and feto-placental ratio than normal placentae but the parameters were found to be significantly greater than that of normal placentae in case of diabetic placentae. No significant differences were found in umbilical cord insertion. In normal pregnancy cases we found several histological findings which were increased in hypertensive and diabetic cases.

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