Roles of venovenous anastomosis and umbilical cord insertion abnormalities in birthweight discordance in monochorionic-diamniotic twin pregnancies without twin-twin transfusion syndrome

2018 ◽  
Vol 44 (4) ◽  
pp. 623-629 ◽  
Author(s):  
Hiroko Konno ◽  
Takeshi Murakoshi ◽  
Akiko Yamashita ◽  
Mitsuru Matsushita
Keyword(s):  
Umbilical Cord ◽  
Twin Pregnancies ◽  
Umbilical Cord Insertion

scholarly journals Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046616
Author(s):  
Rokuhiro Asahina ◽  
Hiroyuki Tsuda ◽  
Yuki Nishiko ◽  
Kazuya Fuma ◽  
Momoko Kuribayashi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vaginal Delivery ◽  
Umbilical Cord ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Caesarean Delivery ◽  
Cord Prolapse ◽  
Umbilical Cord Insertion ◽  
Umbilical Cord Prolapse ◽  
Second Twin

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.

Relation of site of umbilical cord insertion and birth weight

1988 ◽  
Vol 9 (1) ◽  
pp. 34-35 ◽  
Author(s):  
N. Bruyniks ◽  
T. Y. Khong ◽  
R Leong
Keyword(s):  
Birth Weight ◽  
Umbilical Cord ◽  
Umbilical Cord Insertion

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

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

<b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.

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

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.

scholarly journals Effect of Chorionicity on Umbilical Cord Blood Acid-Base Analysis of the Second Twin

2020 ◽  
Vol 23 (3) ◽  
pp. 178-183
Author(s):  
Matthew J. Blitz ◽  
Burton Rochelson ◽  
Nontawan Benja-Athonsirikul ◽  
Weiwei Shan ◽  
Meir Greenberg ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Tertiary Hospital ◽  
Chronic Hypertension ◽  
Acid Base ◽  
Arterial Ph ◽  
Vaginal Deliveries ◽  
Twin Pregnancies ◽  
Second Twin

AbstractOur objective was to determine whether chorionicity affects umbilical cord blood acid-base parameters of the second twin. This was a retrospective cohort of twin pregnancies delivered at ≥23 weeks of gestation at a tertiary hospital from 2010 to 2016. Patients were included if arterial and venous umbilical cord gas results were available for both newborns and chorionicity was confirmed histologically. Exclusion criteria included intrauterine fetal demise of either twin prior to labor, major fetal anomalies, monoamnionicity, uncertain chronicity and twin-to-twin transfusion syndrome. The primary outcome evaluated was the umbilical artery (UA) pH of the second twin. A total of 593 dichorionic (DC) and 86 monochorionic (MC) twin pregnancies were included. No difference in UA pH was observed between MC and DC twins. Among vaginal deliveries (n = 97), the UA pH of the first twin was higher than the second twin (7.26 vs. 7.24; p = .01). Twin-to-twin delivery interval (TTDI) ≥20 min was associated with a higher UA pH in the first twin compared to the second twin (7.25 vs. 7.16, respectively; p = .006). Multivariable logistic regression was used to predict arterial pH < 7.20 for the second twin; the most predictive factors were arterial pH < 7.20 for the first twin, chronic hypertension and prolonged TTDI. Chorionicity was not associated with any acid-base parameter of umbilical cord blood in either the first or second twin. No differences in neonatal outcomes were observed based on chorionicity or birth order. Populations with a lower cesarean delivery rate may yield different findings.

scholarly journals Incidence of furcate umbilical cord

2015 ◽  
Vol 04 (04) ◽  
pp. 190-194
Author(s):  
Khan Mohd Anas ◽  
Sinha D N. ◽  
Singh AK ◽  
Deopa Deepa ◽  
Niranjan Richa
Keyword(s):  
Umbilical Cord ◽  
Full Term ◽  
Government Hospital ◽  
Term Pregnancy ◽  
Foetal Development ◽  
Medical College ◽  
Chorionic Plate ◽  
Foetal Outcome ◽  
Early Placenta ◽  
Umbilical Cord Insertion

Abstract Background : Placenta along with its umbilical cord is a vital organ for maintaining pregnancy and promoting normal foetal development. Foetal outcome can be adversely influenced by pathological changes in placenta and also by the variation in the site of attachment of umbilical cord. Aims and Objectives : To study the incidence of furcate umbilical cord insertion over placental chorionic plate in normal full term pregnancy. Materials and methods : This study was conducted in the department of Anatomy Government Medical College Haldwani. 100 freshly delivered placentae were collected from Dr. Sushila Tiwari Government hospital Haldwani. The sample was further categorized according to the parity of mother into two groups primipara (n=39) and multipara (n=61). Placentae included in the study were obtained from full term pregnancy without any complication like diabetes, hypertension etc. Results : The incidence of furcate umbilical cord in the present study was 2.6% in primipara group and 3.3% in multipara group. Conclusion : Variation in the site of insertion of umbilical cord are thought to result from process known as "Trophotropism" in which the chorionic frondosum or the early placenta migrates with advancing gestation to ensure better blood supply from more richly vascularised area. The overall incidence of furcate cord in this study is 3%. We have noticed one furcate cord (2.6%) in primipara group (n=39) and two furcate cords (3.3%) in multipara group (n=61). The neonates delivered were perfectly healthy without any evidence of congenital anomalies.

Abnormal Placentation and Umbilical Cord Insertion

2020 ◽  
Vol 41 (02) ◽  
pp. 120-137
Author(s):  
Markus Hoopmann ◽  
Karl Oliver Kagan
Keyword(s):  
Umbilical Cord ◽  
Correct Diagnosis ◽  
Cesarean Sections ◽  
Abnormal Placentation ◽  
Current Management ◽  
Mother And Child ◽  
Perinatal Management ◽  
Common Risk Factors ◽  
Management Recommendations ◽  
Umbilical Cord Insertion

AbstractIn the last decades, abnormal placentation and umbilical cord insertion have become an increasingly relevant and feared pathology in obstetrics with increased morbidity and mortality for mother and child. In addition to several increasingly common risk factors, such as assisted reproduction, the main reason for the increased occurrence is the greater frequency of Cesarean sections. Correct diagnosis, which is primarily determined sonographically, is essential for targeted perinatal management. In particular, the diagnostic criteria and current management recommendations are described in the following article.

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