OBJECTIVE: To evaluate the association between velamentous cord insertion and adverse pregnancy outcome in singleton pregnancies, and to assess the diagnostic usefulness of nonstress testing (NST) and Doppler ultrasound in this condition. METHODS: We retrospectively reviewed 12,750 consecutive singleton, chromosomally normal pregnancies from July 1989 through December 1993 at the University Hospital of Kuopio, Finland. Of these, 216 were complicated by velamentous umbilical cord insertion, whereas the remaining 12,534 were normal controls. Using multiple regression analysis, we evaluated the risks by noting adverse infant outcomes: low birth weight (LBW), small for gestational age (SGA), preterm delivery, fetal death, admission to a specific infant care unit, low Apgar scores, neonatal acidemia, and abnormal intrapartum fetal heart rate (FHR) patterns. At prenatal visits, NST and Doppler ultrasound examinations were carried out as a routine part of obstetric care. RESULTS: Even after we controlled for confounding factors, velamentous umbilical cord insertion was associated with higher risk of LBW (odds ratio [OR] 2.32), SGA (OR 1.54), preterm delivery (OR 2.12), low Apgar scores at 1 and 5 minutes (ORs 1.76 and 2.47, respectively), and abnormal intrapartum FHR pattern (OR 1.59). Only 5% of the patients with abnormal insertion showed pathologic NST results at prenatal visits. Ultrasonographic examination was carried out on 80 patients with velamentous umbilical cord insertion as a routine part of obstetric care, and in only one case was direct visualization of the abnormal insertion successful. After we excluded pregnancies with preeclampsia, abnormal umbilical artery Doppler velocimetry was found in none of the cases examined (n = 48). CONCLUSION: There were substantial differences in pregnancy outcome measures between the subjects with velamentous umbilical cord insertion and controls. Current antepartum methods of tracing uteroplacental problems are not effective in the prenatal detection of abnormal insertion. Therefore, in future studies, the use of other diagnostic tools, such as color Doppler imaging of cord insertion, should be evaluated in high-risk pregnancies followed-up because of fetal growth restriction.
OBJECTIVE: To evaluate the association between velamentous cord insertion and adverse pregnancy outcome in singleton pregnancies, and to assess the diagnostic usefulness of nonstress testing (NST) and Doppler ultrasound in this condition. METHODS: We retrospectively reviewed 12,750 consecutive singleton, chromosomally normal pregnancies from July 1989 through December 1993 at the University Hospital of Kuopio, Finland. Of these, 216 were complicated by velamentous umbilical cord insertion, whereas the remaining 12,534 were normal controls. Using multiple regression analysis, we evaluated the risks by noting adverse infant outcomes: low birth weight (LBW), small for gestational age (SGA), preterm delivery, fetal death, admission to a specific infant care unit, low Apgar scores, neonatal acidemia, and abnormal intrapartum fetal heart rate (FHR) patterns. At prenatal visits, NST and Doppler ultrasound examinations were carried out as a routine part of obstetric care. RESULTS: Even after we controlled for confounding factors, velamentous umbilical cord insertion was associated with higher risk of LBW (odds ratio [OR] 2.32), SGA (OR 1.54), preterm delivery (OR 2.12), low Apgar scores at 1 and 5 minutes (ORs 1.76 and 2.47, respectively), and abnormal intrapartum FHR pattern (OR 1.59). Only 5% of the patients with abnormal insertion showed pathologic NST results at prenatal visits. Ultrasonographic examination was carried out on 80 patients with velamentous umbilical cord insertion as a routine part of obstetric care, and in only one case was direct visualization of the abnormal insertion successful. After we excluded pregnancies with preeclampsia, abnormal umbilical artery Doppler velocimetry was found in none of the cases examined (n = 48). CONCLUSION: There were substantial differences in pregnancy outcome measures between the subjects with velamentous umbilical cord insertion and controls. Current antepartum methods of tracing uteroplacental problems are not effective in the prenatal detection of abnormal insertion. Therefore, in future studies, the use of other diagnostic tools, such as color Doppler imaging of cord insertion, should be evaluated in high-risk pregnancies followed-up because of fetal growth restriction.
Authors: Sari Räisänen; Arja Sokka; Leena Georgiadis; Maija Harju; Mika Gissler; Leea Keski-Nisula; Reetta Kälviäinen; Seppo Heinonen Journal: PLoS One Date: 2013-02-13 Impact factor: 3.240
Authors: Yoshie Yokoyama; Aline Jelenkovic; Reijo Sund; Joohon Sung; John L Hopper; Syuichi Ooki; Kauko Heikkilä; Sari Aaltonen; Adam D Tarnoki; David L Tarnoki; Gonneke Willemsen; Meike Bartels; Toos C E M van Beijsterveldt; Kimberly J Saudino; Tessa L Cutler; Tracy L Nelson; Keith E Whitfield; Jane Wardle; Clare H Llewellyn; Abigail Fisher; Mingguang He; Xiaohu Ding; Morten Bjerregaard-Andersen; Henning Beck-Nielsen; Morten Sodemann; Yun-Mi Song; Sarah Yang; Kayoung Lee; Hoe-Uk Jeong; Ariel Knafo-Noam; David Mankuta; Lior Abramson; S Alexandra Burt; Kelly L Klump; Juan R Ordoñana; Juan F Sánchez-Romera; Lucia Colodro-Conde; Jennifer R Harris; Ingunn Brandt; Thomas Sevenius Nilsen; Jeffrey M Craig; Richard Saffery; Fuling Ji; Feng Ning; Zengchang Pang; Lise Dubois; Michel Boivin; Mara Brendgen; Ginette Dionne; Frank Vitaro; Nicholas G Martin; Sarah E Medland; Grant W Montgomery; Patrik K E Magnusson; Nancy L Pedersen; Anna K Dahl Aslan; Per Tynelius; Claire M A Haworth; Robert Plomin; Esther Rebato; Richard J Rose; Jack H Goldberg; Finn Rasmussen; Yoon-Mi Hur; Thorkild I A Sørensen; Dorret I Boomsma; Jaakko Kaprio; Karri Silventoinen Journal: Twin Res Hum Genet Date: 2016-04 Impact factor: 1.587
Authors: Jeanne Hortence Fouedjio; Florent Ymele Fouelifack; Maximilien Deutcho; Philip Nana Njotang; Robinson Mbu Enow; Robert John Ivo Leke Journal: Pan Afr Med J Date: 2014-01-27