Versican provides the provisional matrix for uterine spiral artery dilation and fetal growth.

The extracellular matrix (ECM) in the endometrium plays a crucial role in mammalian pregnancy. We have shown that versican secreted from the endometrial epithelium promotes embryo implantation. Versican is a proteoglycan, a major player in the provisional matrix, and versikine, its N-terminal fragment cleaved by ADAMTS proteinases, serves as a bioactive molecule. Here, since versican expression in the placenta was dynamically altered in humans and mice, we investigated the role of versican in pregnancy using uterine-specific Vcan deletion mice (uKO mice) and ADAMTS-resistant versican expressing mice (V1R mice). uKO mice exhibited insufficient spiral artery dilation, followed by fetal growth restriction and maternal hypertension. Further analysis revealed impaired proliferation of tissue-resident natural killer cells required for spiral artery dilation. V1R mice showed the same results as the control, eliminating the involvement of versikine. Our results provide a new concept that versican, one factor of ECM, contributes to placentation and following fetal growth.

A Case Report of Umbilical Vein Varix with Thrombosis: Prenatal Ultrasonographic Diagnosis and Management.

Umbilical vein varix (UVV) is a very rare cord anomaly associated with intrauterine fetal death and fetal anomaly. We describe a case of extra-abdominal UVV with thrombosis. UVV was diagnosed at 23 weeks of gestation for the first time by ultrasonographic screening. Peak systolic velocity (PSV) near the UVV was partially increased up to about 100 cm/s, and blood flow was not detected in one of the umbilical arteries at 28 weeks of gestation. Therefore, the mother was hospitalized to monitor alterations of the PSV of the UVV frequently. Because the PSV of the UVV showed a sudden rapid increase up to about 150 cm/s at 32 weeks of gestation, she underwent emergent cesarean section on the same day to avoid sudden umbilical cord occlusion. The infant's birth weight was 1,744 g, and the Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The pathological examination showed UVV with thrombosis and an occlusion in one of the umbilical arteries. The neonatal laboratory data showed no coagulopathy. Based on our experience with this case, frequent ultrasonographic examination should be performed to detect the acute thrombosis in the case of extra-abdominal UVV, especially during the preterm period.