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A Rat Model of Mild Intrauterine Hypoperfusion with Microcoil Stenosis
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Umbilical Cord Abnormalities and Stillbirth.

Ibrahim A Hammad1, Nathan R Blue, Amanda A Allshouse

  • 1Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, University of Utah Healthcare, and Intermountain Healthcare, Salt Lake City, UT; the Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia; RTI International, Research Triangle Park, North Carolina; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; the Division of Perinatal and Pediatric Pathology, Women and Infants Hospital, the Warren Alpert School of Medicine of Brown University, Providence, Rhode Island; and the Division of Pediatric Pathology, Department of Pathology, Primary Children's Medical Center, Intermountain Healthcare and University of Utah Health, Salt Lake City, Utah.

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Summary

Umbilical cord abnormalities cause 19% of stillbirths. Rigorous criteria confirmed these links, with few associated maternal or clinical risk factors identified in this study.

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Area of Science:

  • Perinatal pathology
  • Obstetrics
  • Fetal medicine

Background:

  • Umbilical cord abnormalities are frequently implicated in stillbirth, yet detailed characterization remains limited.
  • Understanding the specific types and prevalence of cord abnormalities in stillbirth is crucial for risk assessment.

Purpose of the Study:

  • To rigorously characterize stillbirths linked to umbilical cord abnormalities.
  • To identify associated maternal and clinical risk factors for stillbirth due to cord issues.

Main Methods:

  • A case-control study analyzed 496 stillbirths using the INCODE classification system.
  • Defined umbilical cord abnormalities included entrapment, knots, torsions, strictures, prolapse, vasa previa, and compromised fetal microcirculation.
  • Demographic and clinical factors were compared between stillbirth groups and live births.

Main Results:

  • 19% of stillbirths were associated with umbilical cord abnormalities.
  • Compromised fetal microcirculation (48%) and cord entrapment (29%) were the most common abnormalities.
  • Maternal characteristics showed minimal differences between stillbirth groups and live births.

Conclusions:

  • Umbilical cord abnormalities represent a significant risk factor for stillbirth, accounting for 19% of cases.
  • Few specific maternal or clinical risk factors were identified for stillbirths associated with cord abnormalities.