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Pediatric and Fetal Autopsies
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Stefano D’Errico, Angelo Montana, Giulio Di Mizio, Monica Salerno
Umbilical cord must be measured in length and diameter (average values: 55 cm in length, 1–1.5 cm in diameter), and the presence of spiraling of the umbilical cord must be recorded (right or left twist, excessive or minimal twisting or constriction). The insertion of the umbilical cord should be always noted (velamentous, paracentral, central, eccentric, marginal). In case of velamentous insertion, the distance from the insertion to the placental edge needs to be recorded as well as the presence of hemorrhage or thrombosis of vessels. Description of true knots should be carefully provided (the description should include the characteristics of the knots: number, tight or loose, etc.). After inspection, the umbilical cord can be removed from the placenta at the insertion site. Two or four umbilical vessels may occur (Figures 3.76 and 3.77).
Single Umbilical Artery
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
About 20%–30% of fetuses with a single umbilical artery have associated abnormalities. The commonly reported defects are cardiovascular abnormalities (especially ventricular septal defects and cono-truncal defects), abdominal wall defects, and urinary tract abnormalities. In addition, there is a higher incidence of marginal and velamentous insertion of the umbilical cord. There is also an increased risk of intrauterine or neonatal death, but most of these deaths occur in those with associated congenital abnormalities. Most (but not all) studies report higher risks—less so in apparently isolated single umbilical artery cases. Adverse outcomes relate to intrauterine growth restriction (IUGR) and pre-term birth, leading to a perinatal mortality rate which is 5–10 times higher. Reference ranges for umbilical artery Doppler do not apply to cases with a single umbilical artery, where the resistance is typically lower. Elevated umbilical artery pulsatility index (PI) in cases of a single umbilical artery is obviously abnormal, but a normal PI is not reassuring.
Placenta, Umbilical Cord, and Amniotic Membranes
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Using ultrasound, the insertion place can be located and approximately estimated in relation to the placental surface. However, there is no need for this, except in the patients with velamentous insertion. This data can be useful when performing the rupture of membranes and probably in the third stage during the maneuver of cord traction.
Value of Placental Examination in the Diagnostic Evaluation of Stillbirth
Published in Fetal and Pediatric Pathology, 2022
Funicular abnormalities, isolated or associated with placental lesions, were observed in 26/147 cases (18%) of our series and mainly corresponded to overcoiling and insertion abnormalities of the UC (velamentous insertion, trifurcation). A proportion of 15% is reported in the literature [9,10]. A single umbilical artery was observed in 3.4% of our cases. Pinar et al., [13] who studied a large series of stillbirths (518 cases) found a single umbilical artery in about 8% of cases. The clinical significance of this abnormality, which is usually associated with polymalformative syndromes, remains uncertain. It does not appear to be associated with an increased risk of IUGR, perinatal death or aneuploidy if it is isolated on prenatal screening [22].
Vasa praevia: cord vessels running through the foetal membranes from the uterine fundus to the internal os
Published in Journal of Obstetrics and Gynaecology, 2020
Satoshi Shinohara, Yasuhiko Okuda, Shuji Hirata
A 30-year-old primigravida was noted to have a velamentous insertion of the umbilical cord at her 18th gestational week ultrasound examination; the placenta was fundal. The in utero foetal position prevented detection of the umbilical cord attachment then, or subsequently during the second trimester, the most suitable period for vasa praevia diagnosis (Gagnon et al. 2009). A transvaginal ultrasound colour Doppler at 32 weeks of gestation showed multiple vessels running through the foetal membranes over the internal cervical os (Figure 1(a)) and the attached umbilical cord, 2 cm away from the internal cervical os in the posterior uterine wall. A high foetal heart rate was noted at the vasa praevia level and it distinguished the vasa praevia from maternal cervical vessels (Figure 1(b)). Thus, vasa praevia was diagnosed. We admitted her and administered intravenous ritodrine because of a threatened premature labour. Magnetic resonance imaging (MRI) post-hospitalisation showed cord vessels running parallel from the uterine fundus to the internal cervical os in the posterior uterine wall (Figure 1(c–f)). No vaginal bleeding or foetal distress was noted, and foetal growth was normal. We administered antenatal corticosteroids at 33 weeks. An elective caesarean section was performed at 34 weeks because of uterine contraction. A male neonate was delivered (weight: 2061 g; Apgar 1- and 5-minute scores: 8 and 9, respectively) without cord vessel injury. The examination of the placenta and the umbilical cord confirmed our diagnosis. Six main cord vessels originated from sites around the placental edge; the longest one measured >40 cm. The postpartum course was uneventful; the mother and baby were discharged on the 5th and 26th days, respectively.
Mutation of the TP53 Gene in Placental Chorangiomatosis
Published in Fetal and Pediatric Pathology, 2023
In the CM group, placental infarction was observed in 10 patients, intervillous thrombus in 4 patients, acute chorioamnionitis in 4 patients, and abnormal insertion of the umbilical cord in 2 patients (1 patient with marginal insertion, 1 patient with velamentous insertion).