Gross Umbilical Cord Abnormalities: Histologic Sequelae and Association with Hypoxia
JSY Chan, RN Baergen. NYP-Weill Cornell Medical Center, New York
Background: Umbilical cord complications (CC) such as true knots (TK), velamentous insertion (VEL), marginal insertion (MUC), entanglement (CE), excessive cord length (ELUC) or excessive coiling (ETUC) can lead to decreased umbilical blood flow and have been associated with adverse outcome and demise (IUFD). Few large series exist correlating CC with placental pathology. We present the largest series of CC at this time.
Design: Search of our database from 1998-2008 for 3rd trimester placentas with TK, VEL, MUC, CE, ELUC, or ETUC identified 840 cases. 200 gestational age matched controls were selected randomly. Lesions associated with circulatory stasis and thrombosis (CST) including villous congestion (VC), umbilical vessel distension (UVD), chorionic plate vessel distension (CPD), umbilical vessel thrombosis (UVT), fetal vascular thrombosis (FVT), villous stromal karyorrhexis (VSK) and avascular villi (AV) were scored as well as any other pathologic lesions. Data was analyzed by ANOVA and Chi square, with p<.05 statistically significant.
Results: CC as a group was associated with a significant increase in VC (p=.039), UVD (p=.005), UVT (p<.001), FVT (p<.001), and AV (p=.002). TK or ETUC alone showed significant increases in these lesions (all p<0.05). VUC, CE, or ELUC showed an increase for some but not all lesions (p<0.05). MUC was not associated with any lesion. Lesions associated with hypoxia, nucleated red blood cells (RBC) and chorangiosis (CHS), were increased in most groups and CC overall. Increased perivillous fibrin (IPVF) was increased in all but the TK group. CPD and VSK were not associated with any CC. Finally, the presence of any CC was significantly associated with IUFD (p=.002).
Conclusions: First, similar to previous smaller series, we found a significant correlation between CC and CST lesions. Second, unlike prior studies, UVD and VC were associated with CC, but not CPD.VC may be a superior indicator of venous stasis along with UPD when compared to CPD. There may also be differences in definition or specificity of these lesions. Third, MUC has often been included with CC but our data indicate it is not associated with sequelae of CC. Finally, RBC, CHS, and IPVF were associated with CC which has not been previously described. As RBC and CHS are associated with hypoxia, this suggests that CC lead to intrauterine hypoxia and subsequent adverse outcome. IPVF may develop due to villous damage from CST or a tendency for coagulation; an association requiring further elucidation.
Monday, March 22, 2010 1:00 PM
Poster Session II # 201, Monday Afternoon