Peres Luiz Cesar
Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, England, UK.
Pediatr Dev Pathol. 2012 Jan-Feb;15(1):62-4. doi: 10.2350/11-03-1013-CR.1. Epub 2011 Sep 6.
There is an increasing interest in the physiology and pathology of the umbilical cord because it is recognized as an important source of placental and, consequently, fetal problems. During the postmortem examination of a severely macerated 13-week-old fetus, a split umbilical cord was noted. This rare finding was seen in the middle segment of the cord, the fetal and placental ends both being normal. The pathogenesis of this lesion is not fully understood, and it is possible that it results through focal degeneration of previously formed Wharton's jelly or secondary loss of Wharton's jelly due to incomplete fusion or hypoplasia of the amniotic covering. Whatever the pathogenesis, it is assumed that an umbilical vessel devoid of its protective Wharton's jelly is more prone to compression and thrombosis with all its deleterious effects. Death in this case was probably associated with the congenital heart defect also presented by the fetus. The rarity of this lesion is probably explained by the fact that it represents the end of the spectrum of longitudinal deficiency of Wharton's jelly, a relatively common finding.
由于脐带被认为是胎盘问题进而也是胎儿问题的重要来源,人们对其生理学和病理学的兴趣与日俱增。在对一名13周大的严重浸软胎儿进行尸检时,发现了一条分裂的脐带。这一罕见发现出现在脐带的中间段,胎儿端和胎盘端均正常。这种病变的发病机制尚未完全明了,有可能是由于先前形成的华通胶局部变性,或者是由于羊膜覆盖不完全融合或发育不全导致华通胶继发性缺失所致。无论发病机制如何,人们认为缺乏保护性华通胶的脐血管更容易受到压迫和血栓形成,从而产生所有有害影响。该病例中的死亡可能与胎儿同时存在的先天性心脏缺陷有关。这种病变的罕见性可能是因为它代表了华通胶纵向缺乏谱系的末端,而华通胶纵向缺乏是一个相对常见的发现。