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Clinics in Perinatology Aug 2021Keeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of... (Review)
Review
Keeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of blood. A delay of at least 3 minutes improves neurodevelopmental outcomes in term infants. Although regarded as common sense and practiced by many midwives, implementation of delayed cord clamping into practice has been unduly slow, partly because of beliefs regarding theoretic risks of jaundice and lack of understanding regarding the long-term benefits. This article provides arguments for delaying cord clamping for a minimum of 3 minutes.
Topics: Blood Transfusion; Constriction; Female; Humans; Infant, Newborn; Placenta; Pregnancy; Time Factors; Umbilical Cord
PubMed: 34353575
DOI: 10.1016/j.clp.2021.05.002 -
American Journal of Obstetrics and... Oct 2015The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies.... (Review)
Review
The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.
Topics: Chorion; Female; Fetal Development; Humans; Hydatidiform Mole; Placenta; Placenta Diseases; Pregnancy; Pregnancy, Twin; Twins, Dizygotic; Twins, Monozygotic; Ultrasonography, Prenatal; Umbilical Cord; Vascular Fistula
PubMed: 26428508
DOI: 10.1016/j.ajog.2015.06.054 -
Archives of Pathology & Laboratory... Feb 2020Congenital mature teratomas of the umbilical cord are extremely rare and pose a challenge in prenatal diagnosis. Mature teratomas are defined as tumors composed of... (Review)
Review
CONTEXT.—
Congenital mature teratomas of the umbilical cord are extremely rare and pose a challenge in prenatal diagnosis. Mature teratomas are defined as tumors composed of mature tissues derived from more than 1 germ cell layer. The tumor often shows solid and cystic components, which adds to the difficulty of prenatal diagnosis. Although benign, mature teratomas of the umbilical cord are commonly associated with congenital malformations of the fetus with variable severity and rarely, with chromosomal abnormalities.
OBJECTIVE.—
To review the clinical, radiologic, gross, and histologic features of umbilical cord teratoma; its differential diagnosis; and to emphasize the increased risk of associated congenital malformations.
DATA SOURCES.—
Umbilical cord teratoma cases published in the literature
CONCLUSIONS.—
Umbilical cord teratomas are difficult to diagnose by imaging studies alone and require histopathologic examination for diagnosis. Given the increased risk of associated anomalies and malformations, the finding of umbilical cord teratoma should trigger a detailed and comprehensive evaluation of the neonate for additional abnormalities.
Topics: Female; Humans; Pregnancy; Teratoma; Ultrasonography, Prenatal; Umbilical Cord
PubMed: 31644321
DOI: 10.5858/arpa.2019-0161-RA -
BioMed Research International 2019Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed ("stripped") two to four times towards the newborn, in... (Review)
Review
INTRODUCTION
Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed ("stripped") two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume-of which they are deprived when early cord clamping is carried out-completing placental transfusion in a shorter time than delayed cord clamping. The aim of this narrative review is to analyse the literature regarding umbilical cord milking in term and late-preterm infants and to assess all possible benefits and limits of this procedure in clinical practice, especially in comparison to immediate and delayed cord clamping.
METHODS
We analysed literature data concerning maternal, as well as neonatal, outcomes for term and late-preterm (gestational age ≥ 34 weeks) newborns who received umbilical cord milking.
RESULTS
Most studies show comparable benefits for both umbilical cord milking and delayed cord clamping, especially in terms of haematological parameters when compared to immediate cord clamping. Umbilical cord milking may be a feasible procedure also for newborns requiring resuscitation.
CONCLUSIONS
Literature data concerning positive effects of umbilical cord milking are encouraging and suggest that umbilical cord milking may be a quick and effective method to provide placental transfusions to depressed infants. However, the lack of standardised procedures and the variation in evaluated outcomes as well as the limited number of patients enrolled in trials, along with the retrospective nature of some of them, prevent recommending umbilical cord milking as a routine procedure.
Topics: Blood Transfusion; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Pregnancy; Premature Birth; Term Birth; Umbilical Cord
PubMed: 30886867
DOI: 10.1155/2019/9185059 -
British Medical Journal Aug 1964
Topics: Congenital Abnormalities; Humans; Infant, Newborn; Umbilical Cord
PubMed: 14160202
DOI: No ID Found -
Stem Cell Research & Therapy Sep 2018In this review we present current evidence on the possibility of umbilical cord tissue cryopreservation for subsequent clinical use. Protocols for obtaining umbilical... (Review)
Review
In this review we present current evidence on the possibility of umbilical cord tissue cryopreservation for subsequent clinical use. Protocols for obtaining umbilical cord-derived vessels, Wharton's jelly-based grafts, multipotent stromal cells, and other biomedical products from cryopreserved umbilical cords are highlighted, and their prospective clinical applications are discussed. Examination of recent literature indicates we should expect high demand for cryopreservation of umbilical cord tissues in the near future.
Topics: Biological Specimen Banks; Blood Vessel Prosthesis; Cell Differentiation; Cell Proliferation; Cryopreservation; Cryoprotective Agents; Dimethyl Sulfoxide; Fetal Blood; Glycerol; Humans; Mesenchymal Stem Cells; Umbilical Cord; Wharton Jelly
PubMed: 30219095
DOI: 10.1186/s13287-018-0992-0 -
Current Opinion in Pediatrics Apr 2022For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of... (Review)
Review
PURPOSE OF REVIEW
For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM).
RECENT FINDINGS
DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation.
SUMMARY
Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.
Topics: COVID-19; Female; Hematocrit; Hemoglobins; Humans; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Complications, Infectious; Resuscitation; SARS-CoV-2; Time Factors; Umbilical Cord; Umbilical Cord Clamping
PubMed: 35125380
DOI: 10.1097/MOP.0000000000001117 -
Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord.Medicina (Kaunas, Lithuania) Nov 2022The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing... (Review)
Review
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton's jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.
Topics: Pregnancy; Female; Humans; Umbilical Cord; Umbilical Arteries; Umbilical Veins; Placenta; Fetus; Obstetric Labor Complications
PubMed: 36556956
DOI: 10.3390/medicina58121754 -
Journal of Cellular and Molecular... Sep 2021Transplantation of stem cells is a promising, emerging treatment for cardiovascular diseases in the modern era. Mesenchymal stem cells (MSCs) derived from the umbilical... (Review)
Review
Transplantation of stem cells is a promising, emerging treatment for cardiovascular diseases in the modern era. Mesenchymal stem cells (MSCs) derived from the umbilical cord are one of the most promising cell sources because of their capacity for differentiation into cardiomyocytes, endothelial cells and vascular smooth muscle cells in vitro/in vivo. In addition, umbilical cord-derived MSCs (UC-MSCs) secrete many effective molecules regulating apoptosis, fibrosis and neovascularization. Another important and specific characteristic of UC-MSCs is their low immunogenicity and immunomodulatory properties. However, the application of UC-MSCs still faces some challenges, such as low survivability and tissue retention in a harmful disease environment. Gene engineering and pharmacological studies have been implemented to overcome these difficulties. In this review, we summarize the differentiation ability, secretion function, immunoregulatory properties and preclinical/clinical studies of UC-MSCs, highlighting the advantages of UC-MSCs for the treatment of cardiovascular diseases.
Topics: Animals; Cardiovascular Diseases; Cell Differentiation; Cells, Cultured; Humans; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Myocytes, Cardiac; Umbilical Cord
PubMed: 34378345
DOI: 10.1111/jcmm.16830 -
Archives of Pathology & Laboratory... Nov 2017- Fetal vascular malperfusion, also known as fetal thrombotic vasculopathy, remains an underrecognized pathologic finding and should be noted during placental evaluation. (Review)
Review
CONTEXT
- Fetal vascular malperfusion, also known as fetal thrombotic vasculopathy, remains an underrecognized pathologic finding and should be noted during placental evaluation.
OBJECTIVE
- To review histologic findings, gain familiarity with the updated terminology, and to recognize important clinical associations with this entity.
DATA SOURCES
- University of Michigan cases, PubMed search, multiple review articles including recent placental workshop group consensus statement, and selected book chapters.
CONCLUSIONS
- Multiple histologic patterns of fetal vascular malperfusion have been described including thrombosis, avascular villi, villous stromal-vascular karyorrhexis, intramural fibrin thrombi, and stem villous vascular obliteration. Various underlying etiologies can be involved in fetal vascular malperfusion. Cord lesions including abnormal insertion, length, and coiling are important causes. Maternal vascular malperfusion such as preeclampsia, hypercoagulable states, lupus anticoagulant, and sometimes diabetes have been associated with this condition. Fetal cardiac dysfunction/malformations and severe fetal inflammatory response in the setting of ascending intrauterine infection have also been attributed to this important finding. Fetal vascular malperfusion has been implicated in several significant and sometimes devastating clinical associations; these include intrauterine growth restriction, poor perinatal outcome, fetal demise, and neurodevelopmental sequelae. A diagnostic challenge may be encountered in cases with prior intrauterine fetal death, since degenerative changes post demise result in a similar histomorphologic picture. The diffuse versus the focal nature of the lesions may help in the distinction.
Topics: Autopsy; Cardiovascular Abnormalities; Female; Fetal Death; Fetal Diseases; Humans; Placenta Diseases; Placental Circulation; Pregnancy; Pregnancy Complications, Infectious; Terminology as Topic; Thrombosis; Umbilical Cord; Vascular Diseases
PubMed: 29072954
DOI: 10.5858/arpa.2017-0212-RA