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Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study
R N Baergen1, D Malicki, C Behling
1Department of Pathology, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY 10021, USA.
Insights
Excessively long umbilical cords (ELUCs) are linked to maternal health issues, fetal distress, and placental abnormalities. Infants with ELUCs face higher risks of neurological problems and brain imaging abnormalities.
Area of Science:
- Perinatology
- Obstetrics
- Neonatology
Background:
- Umbilical cord length is a critical factor in fetal development and pregnancy outcomes.
- Excessively long umbilical cords (ELUCs) are rare but may be associated with adverse neonatal outcomes.
Purpose of the Study:
- To compare fetal, maternal, and placental factors, as well as neonatal outcomes, between infants with ELUCs and those with normal-length umbilical cords (UCs).
Main Methods:
- Retrospective chart review of 926 infants with ELUCs and 200 infants with normal-length UCs over 18 years.
- Analysis of maternal and fetal factors, neonatal outcomes, and placental pathology.
- Statistical comparison using univariate and multivariate analyses.
Main Results:
- ELUCs were associated with increased maternal age, systemic diseases, delivery complications, non-reassuring fetal status, respiratory distress, cord entanglement, fetal anomalies, male sex, and increased birth weight.
- Placental findings in ELUCs included increased weight, right-twisted and markedly twisted cords, true knots, congestion, nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, and single umbilical artery.
- Infants with ELUCs showed a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up.
- Mothers with a history of ELUC have an increased risk of a second long cord.
Conclusions:
- ELUCs are associated with a spectrum of adverse maternal, fetal, and placental factors, some linked to fetal hypoxia and altered placental blood flow.
- ELUCs pose a significant risk for neonatal neurological complications.
- Recurrence of ELUCs in subsequent pregnancies is a possibility.
Abstract:
The purpose of this study was to compare specific fetal, maternal, and placental factors, including neonatal morbidity and mortality, in infants with umbilical cords (UCs) of normal length to the same factors in infants with excessively long umbilical cords (ELUCs). We performed an 18-year retrospective chart review of the medical records of mothers and infants with ELUCs (926 cases) and normal-length UCs (200 cases) and recorded maternal factors, fetal factors, and neonatal outcomes. Corresponding placental pathologic reports and slides were reviewed. Statistical analysis comparing the two groups included univariate and multivariate analyses. ELUCs were significantly associated with certain maternal factors (systemic diseases, delivery complications, increased maternal age), fetal factors (non-reassuring fetal status, respiratory distress, vertex presentation, cord entanglement, fetal anomalies, male sex, increased birth weight), gross placental features (increased placental weight, right-twisted cords, markedly twisted cords, true knots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, single umbilical artery). Some of these histopathologic features have previously been associated with fetal hypoxia and/or altered blood flow in the placenta. Infants with ELUCs were found to be at a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up. In addition, mothers with a history of an ELUC are at increased risk of a second long cord.