Clinical-sonographical and dopplerometric criteria of determining the obstetrician's tactics in cases of the umbilical cord entanglement of the fetal body

The complex method of antenatal diagnostics of the cord entanglement round the body of the fetus is elaborated. It includes echography, color Doppler mapping, dopplerometry and actocardiography. On the basis of the data received the system of prognosing and estimating the severity of feta l hypoxia in the end of the third trimester pregnancy is suggested, that allows to choose the correct tactics of pregnancy and delivery management in different rates ofcord entanglement. The use o f this method made it possible to rise the effectiveness of antenatal diagnostics of this gestational complication from 23,5% to 79,4%, to decrease the frequency of postnatal asphyxia to 46,1% and, therefore, to avoid intra- and postnatal loss.

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

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.

Causes of intrauterine fetal death are changing in recent years

Objective:To investigate, how causes of intrauterine fetal death (IUFD) have changed in recent years with the advancement of prenatal diagnosis at a single perinatal center in Japan.Methods:Medical records were retrospectively reviewed for all cases of IUFDs that occurred between 2001 and 2014. The most commonly associated causes of fetal deaths were compared between 2001–2007 and 2008–2014.Results:The number of IUFD after 20 weeks’ gestation/all deliveries in our center was 38/6878 cases (0.53%) in 2001–2007 and 35/7326 (0.48%) in 2008–2014. The leading cause of IUFD in 2001–2007 was fetal abnormalities (43.2%), the prevalence of which was only 8.6% in 2008–2014 (P<0.01). Meanwhile, the prevalence of umbilical cord abnormalities was relatively increased from 30.0% in 2001–2007 to 54.5% in 2008–2014 (P=0.06). In 2001–2007, chromosomal abnormalities were frequently observed (56% of IUFDs due to fetal abnormalities). Hyper-coiled cord (HCC) and umbilical ring constrictions were the most frequent cause of IUFD in both periods. The relatively decreased prevalence of IUFD due to velamentous cord insertion and umbilical cord entanglement, HCC and umbilical cord constriction was increased.Conclusions:The prevalence of IUFD due to fetal abnormalities was reduced, but IUFD associated with umbilical cord abnormalities tended to increase relatively.