Umbilical cord anomalies in high-risk pregnancy and its association with the perinatal outcome: A cross-sectional study
DOI:
https://doi.org/10.15218/zjms.2023.033Keywords:
Umbilical cord, Abnormalities, High risk pregnancyAbstract
Background and objective: There are no local investigation on the role of the abnormal umbilical cord on neonatal and maternal outcomes in this region. This study aimed to examine the association of umbilical cord abnormalities on neonatal and maternal outcomes in Iraqi Kurdistan.
Methods: This is a cross-sectional study, the patients who attended the Duhok Obstetrics and Gynecology Teaching Hospital in Duhok city were examined between 1/11/2020 and 1/11/2021. The sample size is 500 women, inclusion criteria are age>18 years, acceptance to participate, gestational age >24 weeks and singleton pregnancy. The exclusion criteria are women who refused to participate, multiple pregnancy and stillbirth.
Results: The mean age of the pregnant women was 29.0 (16 - 45 years old). The most prevalent maternal complications were placenta Previa (7.06%), Polyhydramnios (9.88%), and post-partum hemorrhage (7.06%). In this study the most common abnormalities of UC were abnormal diameter of UC (29.4%), decreased Wharton jelly content (15.5%) and short UC (11.9%).Most of the patients’ babies had normal weight (79.64%), (16.94%) had low birth weight and (3.43%) had very low birth weight. A percentage of the babies died either early neonatal (1.41%) or stillbirth (5.24%). The study found that the patients with abnormal diameter of UC cord were more likely to have babies with low birth weight (35.62% vs. 9.14%, P <0.0001) and were more likely to suffer from stillbirth (9.59% vs. 3.43%). Patients with short UC were more prone to have abruptio placenta (20.34% vs. 2.75%) and PROM (13.56% vs. 3.66%) ,and neonates with short UC were more likely to be LBW, VLBW and suffer from early neonatal death.
Conclusion: This study showed that the patients with abnormal umbilical cord have significantly higher rates of adverse neonatal and maternal outcomes.
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References
Ranga S, Mallika V. Morphological Variations of Umbilical Cord in Human Placenta. Int J Anat Res 2019; 7(3.1):6786‒9. https://www.ijmhr.org/ijar.7.3/IJAR.2019.226.pdf
Moshiri M, Zaidi S, Robinson T, Bhargava P, Siebert J, Dubinsky, et al. Comprehensive Imaging Review of Abnormalities of the Umbilical Cord. Radio Graphics 2014; 34(1):179‒96. https://doi.org/10.1148/rg.341125127
Barrios-Arpi LM, Rodríguez Gutiérrez JL, Lopez-Torres B. Histological characterization of umbilical cord in alpaca (Vicugna pacos). Anat Histol Embryol 2017; 46(6):533‒8. doi:10.1111/ahe.12298.
Bohîlțea R, Dima V, Ducu I, Iordache A, Mihai B, Munteanu O, et al. Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology. Diagnostics 2022; 12(2):236. https://doi.org/10.3390/diagnostics12020236
Nicole WU. What to Know About a Nuchal Cord? 2022. https://www.webmd.com/baby/what-to-know-about-nuchal-cord.
Peesay M. Nuchal Cord and Its Implications. Maternl Health Neonatol Perinatol 2017; 3:28. doi:10.1186/s40748-017-0068-7
MłodawskaM ,Młodawski J, Swiercz G, Zielinski R. The Relationship between Nuchal Cord and Adverse Obstetric and Neonatal Outcomes: Retrospective Cohort Study. Pediat Repo 2022; 14(1):40‒7. doi:10.3390/pediatric14010007
Abdallah A, Eldorf A, Sallam S, Ahmed S, Shawky M, Nawara M, et al. Nuchal cord: Impact of Umbilical Artery Doppler Indices on Intrapartum and Neonatal outcomes: A Prospective Cohort Study. J Matern Fetal Neonatal Med 2019; 32(20):3367‒78. doi:10.1080/14767058.2018.1463984.
Vasa R, Dimitrov R, Patel Sh. Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance Pediatr Neonatol 2018; 59(5):439‒47. https://doi.org/10.1016/j.pedneo.2018.03.002
Hua M, Odibo A, Macones G, Roehl K, Crane J, Cahill A. Single Umbilical Artery and Its Associated Findings. Obstet Gynecol 2010; 115(5):930‒4. https://doi.org/10.1097/aog.0b013e3181da50ed
Friebe-Hoffmann U, Hiltmann A, Friedl T, Lato K, Hammer R, Janni W, et al. Prenatally Diagnosed Single Umbilical Artery (SUA) – Retrospective Analysis of 1169 Fetuses. Ultraschall in der Medizin - European Journal of Ultrasound 2018; 40(02):221‒9. https://pubmed.ncbi.nlm.nih.gov/29590672/
Voskamp B, Fleurke-Rozema H, Oude-Rengerink K, Snijders R, Bilardo C, Mol B, et al. Relationship of Isolated Single Umbilical Artery to Fetal Growth, Aneuploidy and Perinatal Mortality: Systematic Review and Meta-Analysis. Ultrasound in Obstetrics & Gynecology 2013; 42(6):622–8. https://doi.org/10.1002/uog.12541
Luo X, Zhai S, Shi N, Li M, Cui S, Xu Y, et al. The Risk Factors and Neonatal outcomes of Isolated Single Umbilical Artery in Singleton Pregnancy: A Meta-analysis. Scientific Reports 2017; 7(1). https://doi.org/10.1038/s41598-017-07053-7
Balkawade N, Shinde M. Study of Length of Umbilical Cord and Fetal Outcome: A Study of 1,000 Deliveries. J Obstet Gynaecol India 2012; 62(5):520–5. doi: 10.1007/s13224-012-0194-0
Vahanian S, Lavery J, Ananth C, Vintzileos A. Placental Implantation Abnormalities and Risk of Preterm Delivery: A Systematic Review and Metaanalysis. American Journal of Obstetrics and Gynecology 2015; 213(4):S78–S90. https://doi.org/10.1016/j.ajog.2015.05.058
Ranga MKS, Mallika VMC. Morphological Variations of Umbilical Cord in Human Placenta. Int J Anat Res 2019; 7(3.1):6786–9. https://www.researchgate.net/publication/334264238_MORPHOLOGICAL_VARIATIONS_OF_UMBILICAL_CORD_IN_HUMAN_PLACENTA
Proctor L, Fitzgerald B, Whittle W, Mokhtari N, Lee E, Machin G, et al. Umbilical Cord Diameter Percentile Curves and Their Correlation to Birth Weight and Placental Pathology. Placenta 2013; 34(1):62–6. https://doi.org/10.1016/j.placenta.2012.10.015
Ismail K, Hannigan A, O’Donoghue K, Cotter A. Abnormal Placental Cord Insertion and Adverse Pregnancy outcomes: A Systematic Review and Meta-Analysis. Systematic Reviews 2017; 6(1). https://doi.org/10.1186/s13643-017-0641-1
Moshiri M, Zaidi S, Robinson T, Bhargava P, Siebert J, Dubinsky T, et al. Comprehensive Imaging Review of Abnormalities of the Umbilical Cord. Radio Graphics 2014; 34(1):179–96. https://doi.org/10.1148/rg.341125127
Jauniaux E, Alfirevic Z, Bhide A, Burton G, Collins S, Silver R. Vasa Praevia: Diagnosis and Management. BJOG: An International Journal of Obstetrics & Gynaecology 2018; 126(1):e49–61. https://doi.org/10.1111/1471-0528.15307
Jauniaux E, Alfirevic Z, Bhide A, Burton G, Collins S, Silver R. Vasa Praevia: Diagnosis and Management. BJOG 2018; 126(1):e49–61. https://doi.org/10.1111/1471-0528.15307
Chebsey C, Fox R, Draycott T, Siassakos D, Winter C. Umbilical Cord Prolapse: Green-top Guideline No. 50. 2nd ed. Royal College of Obstetricians and Gynaecologists 2014. https://www.rcog.org.uk/media/3wykswng/gtg-50-umbilicalcordprolapse-2014.pdf
Defining Adult Overweight & Obesity. Centers for Disease Control and Prevention. 2021. https://www.cdc.gov/obesity/adult/defining.html
Dulay A. Abruptio Placentae. MSD Manual Professional Edition. 2020. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/abruptio-placentae
Jauniaux ERM, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. 4th ed. Royal College of Obstetricians and Gynecologists; 2018. https://www.rcog.org.uk/media/r1cpqapm/bjog-2018-jauniaux-placenta-praevia-and-placenta-accreta-diagnos.pdf
Tanya T, Medina M, Ashley Hill D. Preterm Premature Rupture of Membranes: Diagnosis and Management. Am Fam Physician 2006; 73(4):659–64. https://www.aafp.org/afp/2006/0215/afp20060215p659.pdf
Beloosesky R, Ross M. Polyhydramnios: Etiology, Diagnosis, and Management. Uptodate. 2022. https://www.uptodate.com/contents/polyhydramnios-etiology-diagnosis-and-management#H1
Dulay A. Oligohydramnios. MSD Manual Professional Edition. 2020. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/oligohydramnios
RCOG Green-top Guideline. Prevention and Management of Postpartum Haemorrhage. BJOG: An International Journal of Obstetrics & Gynecology 2016; 124(5):e106–49. https://doi.org/10.1111/1471-0528.14178
NICE Guideline. Hypertension in Pregnancy: Diagnosis and Management. The National Institute for Health and Care Excellence. 2019. https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancy-diagnosis-and-management-pdf-66141717671365
Diagnosing Preeclampsia - Key Definitions and ACOG Guidelines. The ObG Project 2022. https://www.obgproject.com/2017/01/08/diagnosing-preeclampsia-key-definitions/
NICE. Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. Guidelines. 2020. https://www.guidelines.co.uk/diabetes/nice-diabetes-in-pregnancy-guideline/252595.article
Stillbirth: Definition, Causes & Prevention. Cleveland Clinic. 2020. https://my.clevelandclinic.org/health/diseases/9685-stillbirth
Lehtonen L, Gimeno A, Parra-Llorca A, Vento M. Early Neonatal Death: A Challenge Worldwide. Seminars in Fetal and Neonatal Medicine 2017; 22(3):153–60. https://doi.org/10.1016/j.siny.2017.02.006
Classification of Prematurity Categorized by Birth Weight or Gestational Age. Uptodate 2022. https://www.uptodate.com/contents/image?imageKey=PEDS%2F119362&topicKey=PEDS%2F4997&source=see_link
Udoh B, Erim A, Anthony E. Sonographic Assessment of Umbilical Cord Diameter as an Indicator of Fetal Growth and Perinatal outcome. Journal of Diagnostic Medical Sonography 2020; 37(1):41–5. https://journals.sagepub.com/doi/full/10.1177/8756479320963041
Soysal C, Şişman H, Bıyık İ, Erten Ö, Deliloğlu B, GeçkalanSoysal D, et al. The Relationship Between Umbilical Cord Measurements and Newborn outcomes. Perinatal Journal 2021; 29(3):22530. https://www.perinataljournal.com/Files/Archive/en-US/Articles/PJ-ed55bfd4-89dd-415f-b8e1-16ef853975b9.pdf
Ryo E, Kamata H, Seto M, Morita M, Yatsuki K. Correlation between umbilical cord length and gross fetal movement as counted by a fetal movement acceleration measurement recorder. European Journal of Obstetrics & amp; Gynecology and Reproductive Biology: X. 2019; 1:100003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683969/
Njoku C, Odusolu P, Cajetan E, Ekanem E, Njoku A. Umbilical Cord Length and Cord Abnormalities in Term Singleton Pregnancy: A Review of Pregnancy outcome in A Tertiary Health Institution in Nigeria. JCMC 2019; 5(5):242–7. https://doi.org/10.22317/jcms.v5i5.620
Algreisi F, Brown R, Shrim A, Albasri S, Shamarani H, AlZoubiadi A. Effect of Long and Short Umbilical Cord on Perinatal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2016; 5(12):4228–31. http://dx.doi.org/10.18203/2320-1770.ijrcog20164042
Filiz A, Rahime B, Keskin H, Esra A. Positive Correlation Between the Quantity of Wharton’s Jelly in the Umbilical Cord and Birth Weight. Taiwanese Journal of Obstetrics and Gynecology 2011; 50(1):33–6. https://doi.org/10.1016/j.tjog.2009.11.002
Barbieri C, Cecatti J, Surita F, Costa M, Marussi E, Costa J. Area of Wharton's Jelly as An Estimate of The Thickness of The Umbilical Cord and Its Relationship with Estimated Fetal Weight. Reproductive Health 2011; 8(32). https://doi.org/10.1186/1742-4755-8-32
Ngowa J, Kasia J, Nsangou I, Zedjom C, Domkan I, Morfaw F, et al. Nuchal Cord and Perinatal outcome at the Yaounde General Hospital, Cameroon. Clinics in Mother and Child Health 2011; 8:1–4. https://www.ajol.info/index.php/cmch/article/download/71481/60425
Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S. True Umbilical Cord Knot and Obstetric outcome. International Journal of Gynecology & Obstetrics 2013; 122(1):18–21. https://doi.org/10.1016/j.ijgo.2013.02.012
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