PhD Scientific Days 2024

Conservative Medicine

The mysterious twists of the umbilical cord

Text of the abstract

Introduction
Perinatal complications are leading causes of loss of disability-adjusted life years (DALYs). Previous observations suggest that umbilical cord (UC) pathology, including hypo-coiling (HC-) and hyper-coiling (HC+), are associated with stillbirth and neonatal morbidity. However, the epidemiology and associations of these are poorly understood.
Aims
To describe the epidemiology of macroscopic characteristics of the UC based on the observation of 2000 placentas. To investigate the associations between UC parameters and placental morphology, and clinical data.
Method
This is an interim, preliminary analysis. Macroscopic examination of 180 placentas and UCs was performed based on the Amsterdam consensus criteria, during a 3-month period (2024), from singleton live births at the Dep. of Obs. and Gyn. of Semmelweis University. Out of these, 30(16,7%) were referred to routine pathological examination (high-risk pregnancies). HC- and HC+ were defined as less than 1 or more than 3 coils per 10 cm respectively, based on measurement of the whole cord. Related clinical data and results of pathological examination were collected and stored in REDCap. Statistics: Independent-Samples T Test, Chi square test, and Spearman correlation.
Results
Mean (±SD) gestational age was 38,3 (±2,5), min.=23, max.=41 weeks. Vaginal delivery was in 99(55,0%), while caesarean section in 81(45,0%) cases. We observed HC+ in n=20(11,1%), HC- in n=34(18,9%), true knot in n=1(0,6%), single umbilical artery in n=2(2,1%), abnormal cord insertion in n=39(21,7%) cases. As expected, gestational age, placental weight, birth weight and length of the cord positively correlated, and there was association between birth weight percentile and placental weight. HC+ was associated with focal placental lesions (p=0,004). HC+ was twice as frequent (20% vs. 9%) in high-risk pregnancies than in lower risk pregnancies. There was a tendency of association between IUGR and HC+.
Conclusion
This preliminary data suggests that hyper-coiled umbilical cords are associated with higher rate of macroscopic placental lesions and may have an adverse impact on fetal growth. This data supports our basic hypothesis that HC+ is a clinically relevant phenomenon.
Funding
RRF-2.3.1-21-2022-00011 (Translational Neuroscientific National Laboratory project within the framework of Széchenyi Terv Plusz Program)