Histomorphometry of umbilical cord and perinatal outcome in intrauterine growth restriction

  • Dr Sangeeta S Kotrannavar M.Sc (Medical Anatomy) Research scholar, Department of Anatomy, J N Medical College, KLE University, Belagavi, Karnataka, India
  • Dr Hema A Dhumale MD, Professor, Department of Obstetrics & Gynecology, J N Medical College, KLE University, Belagavi, Karnataka, India
  • Dr Veereshkumar S Shirol MS, Professor, Department of Anatomy, J N Medical College, KLE University, Belagavi, Karnataka, India
  • Dr Rajendra S Humbarwadi M S, Professor, Department of Anatomy, USM- KLE International Medical Programme, Belagavi, Karnataka, India
  • Dr Shivalingappa B Javali M.Sc (Stat), M Phil, Ph D, Associate Professor, Department of Community Medicine, USM- KLE International Medical Programme, Belagavi, Karnataka, India
  • Dr Suresh P Desai M S, Professor, Department of Anatomy, J N Medical College, KLE University, Belagavi, Karnataka, India
DOI: https://doi.org/10.17511/ijmrr.2015.i10.227
Keywords: Histomorphometry, IUGR, Perinatal outcome, Umbilical cord area, Umbilical cord circumference, Umbilical cord diameter

Abstract

Objective: To evaluate the histomorphometry of umbilical cord (UC) in intrauterine growth restricted (IUGR) newborns compared to appropriate for gestational age (AGA) newborns, and secondly to assess its impact on the intrapartum and perinatal outcome.

Materials and Methods: A prospective observational study was conducted at Obstetrics and Gynecology unit of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. Study involved total 130 UCs of AGA and IUGR newborns. Tissues were fixed in formalin and paraffin embedded sections were examined. For each UC; UC cross sectional area (CSA), UC diameter and UC circumference parameters were measured under microscope with the help of digital image analyzer. Perinatal outcome like gestational age (GA) at delivery, birth weight, mode of delivery, sex of newborn, neonatal outcome and intrapartum complications were recorded. Independent t test was used to compare means and chi-square test for categorical variables.

Results: UC of IUGR newborns had significantly reduced UC area, diameter and circumference as compared to AGA newborns. IUGR newborns were associated with significant difference in GA at delivery, birth weight, neonatal intensive care unit admissions (NICU) and fetal distress. No significant difference was found in mode of delivery, sex of newborn and meconium stained liquor among AGA and IUGR groups.

Conclusion: Assessment of CSAs of UC and its components can be used as early screening tool for fetal growth and it may provide useful information about pregnancy at risk and help in averting poor perinatal outcome.

Downloads

Download data is not yet available.

References

1. Tantbirojn P, Saleemuddin A, Sirois K, Crum C, Boyd T, Tworoger S, et al. Gross abnormalities of the umbilical cord: related placental histology and clinical significance. Placenta. 2009 Dec;30(12):1083-8. DOI: 10.1016/j.placenta.2009.09.2005.

2. Bruch JF, Sibony O, Benali K, Challier JC, Blot P, Nessmann C. Computerized microscope morphometry of umbilical vessels from pregnancies with intrauterine growth retardation and abnormal umbilical artery Doppler. Hum Pathol. 1997 Oct;28(10):1139-45. DOI: 10.1016/50046-8177(97)90251-3.

3. Raio L, Ghezzi F, Di Naro E, Duwe DG, Cromi A, Schneider H. Umbilical cord morphologic characteristics and umbilical artery doppler parameters in intrauterine growth–restricted fetuses. J Ultrasound Med. 2003 Dec;22(12):1341-7. PMID: 14682422.

4. Raio L, Ghezzi F, Di Naro E, Franchi M, Maymon E, Mueller M, et al. Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth. Ultrasound Obstet Gynecol. 1999 Mar;13(3):176-80. DOI: 10.1046/j.1469-0705.1999.13030176.x

5. Cromi A, Ghezzi F, Di Naro E, Siesto G, Bergamini V, Raio L. Large cross‐sectional area of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol. 2007 Nov;30(6):861-6. DOI: 10.1002/uog.5183.

6. Sankaran S, Kyle PM. Aetiology and pathogenesis of IUGR. Best Pract Res Clin Obstet Gynaecol. 2009 Dec;23(6):765-77. DOI: 10.1016/j.bpobgyn.2009.05.003 [PubMed]

7. Barker DJ. In utero programming of chronic disease. Clin Sci. 1998 Aug;95(2):115-28. DOI: 10.1042/cs0950115 [PubMed]

8. Somprasit C, Chanthasenanont A, Nuntakomon T. The change of umbilical cord components in intrauterine growth restriction comparative with normal growth fetuses by using sonographic measurement. J Med Assoc Thai. 2010 Dec;93(7):S15-S20. PMID: 21294395.

9. Mandruzzato G, Antsaklis A, Botet F, Chervenak FA, Figueras F, Grunebaum A, et al. Intrauterine restriction (IUGR). J Perinat Med. 2008;36(4):277. DOI: 10.1515/JPM.2008.050 [PubMed]

10. Takechi K, Kuwabara Y, Mizuno M. Ultrastructural and immunohistochemical studies of Wharton's jelly umbilical cord cells. Placenta. 1993 Mar-Apr;14(2):235-45. DOI: 10.1016/50143-4004(05)80264-4. [PubMed]

11. Filiz AA, Rahime B, Keskin HL, Esra AK. Positive correlation between the quantity of Wharton’s jelly in the umbilical cord and birth weight. Taiwanese J Obstet Gynecol. 2011 Mar;50(1):33-6. DOI: 10.1016/j.tjog.2009.11.002.

12. Labarrere C, Sebastiani M, Siminovich M, Torassa E, Althabe O. Absence of Wharton's jelly around the umbilical arteries: an unusual cause of perinatal mortality. Placenta. 1985 Nov-Dec;6(6):555-9. DOI: 10.1016/50143-4004(85)80010-2.

13. Burkhardt T, Matter C, Lohmann C, Cai H, Lüscher T, Zisch A, et al. Decreased umbilical artery compliance and IGF-I plasma levels in infants with intrauterine growth restriction–implications for fetal programming of hypertension. Placenta. 2009 Feb;30(2):136-41. DOI: 10.1016/j.placenta.2008.11.005.

14. Christou H, Connors JM, Ziotopoulou M, Hatzidakis V, Papathanassoglou E, Ringer SA, et al. Cord blood leptin and insulin-like growth factor levels are independent predictors of fetal growth. J Clin Endocrinol & Metab. 2001Feb;86(2):935-8. PMID: 11158070.

15. Proctor L, Fitzgerald B, Whittle W, Mokhtari N, Lee E, Machin G, et al. Umbilical cord diameter percentile curves and their correlation to birth weight and placental pathology. Placenta. 2013 Jan;34(1):62-6. DOI: 10.1016/j.placenta.2012.10.015.

16. Peyter A-C, Delhaes F, Baud D, Vial Y, Diaceri G, Menétrey S, et al. Intrauterine growth restriction is associated with structural alterations in human umbilical cord and decreased nitric oxide-induced relaxation of umbilical vein. Placenta. 2014 Nov;35(11):891-9. DOI: 10.1016/j.placenta.2014.08.090.

17. Ferrazzi E, Rigano S, Bozzo M, Bellotti M, Giovannini N, Galan H, et al. Umbilical vein blood flow in growth‐restricted fetuses. Ultrasound Obstet Gynecol. 2000 Oct;16(5):432-8. PMID: 11169327. [PubMed]

18. Boito S, Struijk P, Ursem N, Stijnen T, Wladimiroff J. Umbilical venous volume flow in the normally developing and growth‐restricted human fetus. Ultrasound Obstet Gynecol. 2002 Apr;19(4):344-9. DOI: 10.1046/j.1469-0705.2002.0067.1x

19. Krause B, Carrasco-Wong I, Caniuguir A, Carvajal J, Farias M, Casanello P. Endothelial eNOS/arginase imbalance contributes to vascular dysfunction in IUGR umbilical and placental vessels. Placenta. 2013 Jan;34(1):20-8. DOI: 10.1016/j.placenta.2012.09.015.

20. Manning FA, Hill LM, Platt LD. Qualitative amniotic fluid volume determination by ultrasound: antepartum detection of intrauterine growth retardation. Am J Obstet Gynecol. 1981 Feb;139(3):254-8. PMID: 7468691.

21. Ghezzi F, Raio L, Günter Duwe D, Cromi A, Karousou E, Dürig P. Sonographic umbilical vessel morphometry and perinatal outcome of fetuses with a lean umbilical cord. J Clin Ultrasound. 2005 Jan;33(1):18-23. PMID: 15690443.

22. Baschat A, Gembruch U, Reiss I, Gortner L, Weiner C, Harman C. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol. 2000 Oct;16(5):407-13. PMID: 11169323.

23. Li W-C, Zhang H-M, Wang P-J, Xi G-M, Wang H-Q, Chen Y, et al. Quantitative analysis of the microstructure of human umbilical vein for assessing feasibility as vessel substitute. Anna of Vasc Surg. 2008 May-Jun;22(3):417-24. DOI: 10.1016/j.avsg.2007.12.02. [PubMed]

24. Sepulveda W. Time for a more detailed prenatal examination of the umbilical cord? Ultrasound Obstet Gynecol. 1999 Mar;13(3):157-60. PMID: 10204204.
CITATION
DOI: 10.17511/ijmrr.2015.i10.227
Published: 2015-11-30
How to Cite
1.
S Kotrannavar S, A Dhumale H, S Shirol V, S Humbarwadi R, B Javali S, P Desai S. Histomorphometry of umbilical cord and perinatal outcome in intrauterine growth restriction. Int J Med Res Rev [Internet]. 2015Nov.30 [cited 2024Dec.22];3(10):1251-6. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/397
Issue
Vol 3 No 10 (2015): NOVEMBER
Section
Original Article