Chan Joanna S Y, Baergen Rebecca N
Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
Pediatr Dev Pathol. 2012 Nov-Dec;15(6):487-94. doi: 10.2350/12-06-1211-OA.1. Epub 2012 Sep 14.
Umbilical cord complications (UCC), such as true knots (TK), velamentous (VEL) insertion, marginal umbilical cord (MUC) insertion, umbilical cord entanglement (UCE) (both nuchal and non-nuchal), excessively long umbilical cord (ELUC), and excessively twisted umbilical cord (ETUC), can lead to decreased UC blood flow and have been associated with adverse fetal outcome and intrauterine fetal demise (IUFD). Few large series exist that correlate UCC with specific pathologic findings of the placenta. We present the largest series of UCC at this time. Eight hundred forty-one 3rd-trimester placentas with UCC were identified, as well as 858 randomly selected gestational age-matched placentas with grossly unremarkable UC. Lesions associated with circulatory stasis and thrombosis, including villous capillary congestion (VC), umbilical vessel distension (UVD), chorionic plate vessel distension (CPD), umbilical vessel thrombosis (UVT), fetal vascular thrombosis (FVT), intimal fibrin cushions (IFC), and avascular villi (AV), were noted, as well as other pathologic lesions. Data were analyzed by analysis of variance and Fisher exact tests, with P < 0.05 statistically significant. Umbilical cord complications as a group was associated with a significant increase in placental circulatory stasis lesions. Lesions associated with hypoxia, namely nucleated red blood cells and chorangiosis, were also increased. Finally, the presence of any UCC was significantly associated with IUFD. We also found that multiple UCC are associated with nonreassuring fetal heart rate and chorangiosis but that the presence of a single UCC was not. This indicates that UCC may lead to intrauterine hypoxia and subsequent adverse fetal outcome and that multiple UCC may be cumulative in effect.
脐带并发症（UCC），如真结（TK）、帆状（VEL）附着、边缘性脐带（MUC）附着、脐带缠绕（UCE）（包括颈部和非颈部）、脐带过长（ELUC）和脐带过度扭转（ETUC），可导致脐血流减少，并与不良胎儿结局和宫内胎儿死亡（IUFD）相关。很少有大型系列研究将脐带并发症与胎盘的特定病理表现相关联。我们目前呈现了最大规模的脐带并发症系列研究。我们识别出841例有脐带并发症的孕晚期胎盘，以及858例随机选取的、胎龄匹配且脐带外观无明显异常的胎盘。观察到了与循环淤滞和血栓形成相关的病变，包括绒毛毛细血管充血（VC）、脐血管扩张（UVD）、绒毛膜板血管扩张（CPD）、脐血管血栓形成（UVT）、胎儿血管血栓形成（FVT）、内膜纤维蛋白垫（IFC）和无血管绒毛（AV），以及其他病理病变。通过方差分析和Fisher精确检验对数据进行分析，P<0.05具有统计学意义。作为一个整体，脐带并发症与胎盘循环淤滞性病变的显著增加相关。与缺氧相关的病变，即有核红细胞和绒毛膜血管病，也有所增加。最后，任何脐带并发症的存在都与宫内胎儿死亡显著相关。我们还发现，多种脐带并发症与胎儿心率异常和绒毛膜血管病相关，但单一脐带并发症的存在则不然。这表明脐带并发症可能导致宫内缺氧及随后的不良胎儿结局，且多种脐带并发症可能具有累积效应。
