Furcate insertion of the umbilical cord: pathological and clinical characteristics in 132 cases.

Objectives Furcate cord insertion is a rare abnormality affecting approximately 0.1% of all pregnancies. Macroscopically, the umbilical vessels separate before reaching the placenta, lose their Wharton's jelly, and insert at the placenta centrally, eccentrically, or marginally. The aim of this retrospective study was to determine the prevalence of furcate cord insertion more accurately, the pathological characteristics, and clinical outcomes. Methods We conducted a retrospective study of 132 cases of furcate insertion of the umbilical cord using the pathological database of the Charité University Hospital Berlin, Germany, between 1993 and 2016. This included 99 cases, including one termination of pregnancy within our institution and 33 cases from external hospitals. An analysis of the pathological features of the 132 cases and the perinatal outcome of the 98 cases within our institution were performed. Results Furcate cord insertion occurred in 0.16% pregnancies. Of the 132 cases, seven cases of intrauterine fetal deaths were observed. Three of those could be linked to the furcate cord insertion. In two of those cases, single umbilical vessel rupture was identified as the cause of fetal death. Conclusions In most cases of furcate cord insertion, the outcome is good; however, intrauterine fetal death occurs in approximately 1.02% of cases.

Collective memory of umbilical cord stump care: an educational experience.

OBJECTIVE: To report the educational experience with pregnant women considering the recovery of collective memory inherited from the care for the umbilical cord stump provided by grandmothers. METHOD: This case study was based on collective memory and resulted from a workshop with 20 pregnant women from a Basic Health Unit in a city in the inland of Bahia. RESULTS: The study showed that pregnant women's grandmothers are significant in the stump care process because they transmit their memories pervaded by beliefs, myths and superstitions that, although should be respected by nurses and other health professionals, can sometimes contribute to the occurrence of omphalitis and neonatal tetanus. FINAL CONSIDERATIONS: The results indicated the need for raising awareness and education of all persons involved in this care, especially grandmothers, so that they can reflect on the risks and damage that certain empirical knowledge can cause to the health of the umbilical cord.

Collective memory of umbilical cord stump care: an educational experience / Memoria colectiva del cuidado del muñón umbilical: una experiencia educativa / Memória coletiva de cuidado ao coto umbilical: uma experiência educativa

ABSTRACT Objective: To report the educational experience with pregnant women considering the recovery of collective memory inherited from the care for the umbilical cord stump provided by grandmothers. Method: This case study was based on collective memory and resulted from a workshop with 20 pregnant women from a Basic Health Unit in a city in the inland of Bahia. Results: The study showed that pregnant women's grandmothers are significant in the stump care process because they transmit their memories pervaded by beliefs, myths and superstitions that, although should be respected by nurses and other health professionals, can sometimes contribute to the occurrence of omphalitis and neonatal tetanus. Final considerations: The results indicated the need for raising awareness and education of all persons involved in this care, especially grandmothers, so that they can reflect on the risks and damage that certain empirical knowledge can cause to the health of the umbilical cord.

RESUMEN Objetivo: Relatar la experiencia educativa con gestantes a partir del rescate de la memoria colectiva sobre el cuidado del muñón umbilical realizado por sus abuelas. Método: Relato de experiencia con base en la memoria colectiva de 20 gestantes participantes en un taller de una Unidad Básica de Salud, en un municipio del interior de Bahía (Brasil). Resultados: Se observó que las gestantes consideran a sus abuelas personas significativas en el cuidado del muñón umbilical, y transmitieron sus memorias repletas de creencias, mitos y supersticiones que, aunque deben ser respetados por el enfermero y los demás profesionales de salud, a veces pueden colaborar con la ocurrencia de onfalitis y tétano neonatal. Consideraciones finales: Es necesaria la sensibilización y educación de todos los involucrados en ese cuidado, principalmente las abuelas, para que puedan reflexionar sobre los riesgos y daños que pueden causar ciertos conocimientos empíricos a la salud del muñón umbilical.

RESUMO Objetivo: Relatar a experiência educativa com gestantes a partir do resgate da memória coletiva herdada de cuidado ao coto umbilical realizado pelas avós. Método: Relato de experiência fundamentado na memória coletiva, oriundo de uma oficina com 20 gestantes de uma Unidade Básica de Saúde em um município do interior baiano. Resultados: Observou-se que as gestantes têm as avós como pessoas significativas no cuidado ao coto, as quais transmitem suas memórias permeadas de crenças, mitos e crendices que, embora devam ser respeitados pelo enfermeiro e demais profissionais de saúde, por vezes, podem contribuir para a ocorrência de onfalites e tétano neonatal. Considerações finais: Percebeu-se a necessidade de sensibilização e educação de todos os envolvidos nesse cuidado, principalmente as avós, no sentido de que possam refletir sobre os riscos e danos que certos conhecimentos empíricos podem causar à saúde do coto umbilical.

Serial plasma metabolites following hypoxic-ischemic encephalopathy in a nonhuman primate model.

Biomarkers that indicate the severity of hypoxic-ischemic brain injury and response to treatment and that predict neurodevelopmental outcomes are urgently needed to improve the care of affected neonates. We hypothesize that sequentially obtained plasma metabolomes will provide indicators of brain injury and repair, allowing for the prediction of neurodevelopmental outcomes. A total of 33 Macaca nemestrina underwent 0, 15 or 18 min of in utero umbilical cord occlusion (UCO) to induce hypoxic-ischemic encephalopathy and were then delivered by hysterotomy, resuscitated and stabilized. Serial blood samples were obtained at baseline (cord blood) and at 0.1, 24, 48, and 72 h of age. Treatment groups included nonasphyxiated controls (n = 7), untreated UCO (n = 11), UCO + hypothermia (HT; n = 6), and UCO + HT + erythropoietin (n = 9). Metabolites were extracted and analyzed using comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry and quantified by PARAFAC (parallel factor analysis). Using nontargeted discovery-based methods, we identified 63 metabolites as potential biomarkers. The changes in metabolite concentrations were characterized and compared between treatment groups. Further comparison determined that 8 metabolites (arachidonic acid, butanoic acid, citric acid, fumaric acid, lactate, malate, propanoic acid, and succinic acid) correlated with early and/or long-term neurodevelopmental outcomes. The combined outcomes of death or cerebral palsy correlated with citric acid, fumaric acid, lactate, and propanoic acid. This change in circulating metabolome after UCO may reflect cellular metabolism and biochemical changes in response to the severity of brain injury and have potential to predict neurodevelopmental outcomes.

Umbilical cord avulsion in waterbirth.

Umbilical cord avulsion (or "cord snapping") is often cited as a risk associated with waterbirth. This article discusses a case study in which a cord avulsed during a waterbirth and uses it as a basis to explore the incidence, etiology, and associated risk factors of umbilical cord avulsion. The diagnosis, clinical presentation, and management of cord avulsion in waterbirth is presented along with a thorough review of the literature and relevant professional standards. This article offers recommendations for clinical practice to minimize the risk of a cord avulsion and highlights the need for additional research and provider education to ensure optimal care of women and newborns.

Umbilical cord transection to induce fetal demise prior to second-trimester D&E abortion.

OBJECTIVE: Induction of fetal demise via transabdominal injection has been used to facilitate second-trimester abortion but requires a second procedure and has associated risks. The method of amniotomy, cord transection and documentation of fetal asystole immediately prior to dilation and evacuation (D&E) is an alternative approach; however, characteristics of this method have not been described. STUDY DESIGN: This descriptive report from a single center involves a large case series of D&Es ranging from 16 to 23 weeks of gestation. Umbilical cord transection (UCT) was attempted immediately prior to D&E in 407 cases, which were reviewed to determine success, time to fetal asystole and complications. RESULTS: Both UCT and asystole were achieved in 100% of cases. Mean time from UCT to asystole was 3.35±2.11 min. When compared to cases performed at less than 20 weeks of gestation, mean time to asystole was slightly longer in the ≥20-week group (3.7±2.4 min vs. 3.1±1.9 min; p=.008). Few patients had minor (4.6%) or major (0.3%) complications; time to asystole was not associated with complications. CONCLUSIONS: Umbilical cord transection immediately prior to D&E is a feasible, efficacious and safe way to induce fetal demise without performing additional procedures. IMPLICATION STATEMENT: This study demonstrates the feasibility, effectiveness and safety of utilizing umbilical cord transection to induce fetal demise in a large cohort. This method is an alternative to other feticidal procedures.

Patterns of breaks in umbilical cords by different mechanisms.

Investigations of perinatal deaths often result in discrepancies between autopsy findings and witness accounts. The mechanism by which the umbilical cord is severed after delivery is a common quandary. Confirming or refuting the mother's stated method frequently has significant investigative importance; however, a surprising paucity of data currently exists to allow an objective opinion about the likely mechanism. Ninety-nine placentas with umbilical cords were examined. By random selection, each cord was severed by one of the following tools or mechanisms: knives, scissors, traction, or crush. Each break was examined and photographed, and a tissue section from the broken end examined microscopically. Differentiation of mechanism was best done grossly based on specific pattern recognition. Umbilical cords severed by blunt force have distinctly different morphology from those severed by sharp force. Even similar-appearing sharp force transections frequently have mechanism-specific distinctive patterns of injury.

Rotura de vasa previa: comunicación de un caso y revisión de la literatura / Rupture of vasa previa: case report and review of the literature

La vasa previa es una situación que se produce cuando vasos fetales intramembranosos aberrantes, procedentes de la placenta o del cordón umbilical, atraviesan el orificio cervical interno y se sitúan por delante de la presentación fetal. Su incidencia es de 1/2.000-1/3.000 embarazos, y la mortalidad perinatal asociada es del 52-66%, aproximadamente. La reducción de esta elevada mortalidad se basa en su diagnóstico prenatal. Exponemos a continuación el caso clínico de una gestante, con controles obstétricos correctos, que acude a urgencias a las 34,5 semanas por rotura prematura de membranas, objetivándose un líquido amniótico hemático y bradicardia fetal severa, por lo que se realiza una cesárea urgente, naciendo una niña con anemia severa, que ingresa en la unidad de neonatología, presentando buena evolución posterior. Presentamos también una revisión de la literatura de los años 1980 al 2008, a través de Medline, usando las palabras «vasa previa» (AU)

Vasa previa is a condition in which the intramembranous fetal blood vessels within the placenta or umbilical cord cross the internal os and become trapped between the fetus and the opening of the birth canal. The incidence of this entity varies from 1/2000 to 1/3000 pregnancies and the associated perinatal mortality rate has been reported to be as high as 52-66%. Reduction of this high perinatal mortality depends on prenatal diagnosis. We report the case of a pregnant woman with no abnormalities in antenatal visits who presented to the emergency service at 34.5 weeks of pregnancy due to premature rupture of membranes, at which time blood-stained amniotic fluid and severe fetal bradycardia were noted. An emergency cesarean section was performed. A female neonate was delivered with severe anemia. The neonate was admitted into the neonatology unit and subsequent outcome was favorable. We also provide a review of the literature published between 1980 and 2008 using Medline, with the key words "vasa previa" (AU)

[Severe neonatal blood loss due to umbilical cord rupture in an underwater birth]. / Hämorrhagischer Schock eines Neugeborenen aufgrund Nabelschnurruptur während Unterwassergeburt.

BACKGROUND: We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. CASE REPORT: A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. DISCUSSION: Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. CONCLUSION: Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.

Hematoma del cordón umbilical: a propósito de un caso interesante / Umbilical cord hematoma: an interesting case

Se presenta el caso de un recién nacido que presentó tumoración del cordón umbilical, de 3 x 4 cm, coloración rojo violácea, consistencia blanda, no dolorosa, a 1 cm de la pared abdominal. En su evolución se observó disminución gradual de tamaño, sangramiento escaso y como complicación se presentó un granuloma umbilical, con retardo en la caída del cordón (21 días). A los 45 días de edad el ombligo estaba normal. Se realiza una caracterización clínica de la patología y se ofrece una revisión actualizada sobre el tema.

Authors present the case of a newborn presenting a 3 x 4 cm umbilical cord tumor of red-violet color, soft consistency and painless located at 1 cm of abdominal wall. During its evolution there was a gradual decrease size, low bleeding, and as a complication the presence of an umbilical granuloma and delay of fall cord (21 days). At 45 days the navel was normal. We performed a clinical catheterization of the pathology and also offer updated review on this matter.

Hematoma del cordón umbilical: a propósito de un caso interesante / Umbilical cord hematoma: an interesting case

Se presenta el caso de un recién nacido que presentó tumoración del cordón umbilical, de 3 x 4 cm, coloración rojo violácea, consistencia blanda, no dolorosa, a 1 cm de la pared abdominal. En su evolución se observó disminución gradual de tamaño, sangramiento escaso y como complicación se presentó un granuloma umbilical, con retardo en la caída del cordón (21 días). A los 45 días de edad el ombligo estaba normal. Se realiza una caracterización clínica de la patología y se ofrece una revisión actualizada sobre el tema(AU)

Authors present the case of a newborn presenting a 3 x 4 cm umbilical cord tumor of red-violet color, soft consistency and painless located at 1 cm of abdominal wall. During its evolution there was a gradual decrease size, low bleeding, and as a complication the presence of an umbilical granuloma and delay of fall cord (21 days). At 45 days the navel was normal. We performed a clinical catheterization of the pathology and also offer updated review on this matter(AU)

Amniotic band syndrome following septostomy in management of twin-twin transfusion syndrome: a case report.

Septostomy, a rupture of the diamniotic membrane separating monozygotic twins essentially creating a monoamniotic gestation, is a potential therapeutic modality for twin-twin transfusion syndrome (TTTS). This may be associated with complications including cord entanglement or complete rupture of the membranes. We report a case of severe amniotic band syndrome with cord amputation after septostomy. A 33-year-old woman with a Mo-Di twin pregnancy was diagnosed with TTTS at 18 weeks of gestation. Septostomy as well as amnioreduction were performed at 24 weeks of gestation. A repeat cesarean delivery was performed at 31 weeks resulting in a live recipient baby of 1340 g and a dead donor with amniotic band syndrome. The donor showed pieces of membrane tightening both legs. The right thigh became entangled in the bands connecting to the umbilical cord of the live fetus. The umbilical cord of the dead twin was completely amputated, whereas the umbilical cord of the live infant was also entrapped within the amniotic band resulting in small diameter and some degree of stricture. This is the first report of a rare but serious complication following septostomy.

Prenatal cord clamping in newborn Macaca nemestrina: a model of perinatal asphyxia.

Our objective was to establish a nonhuman primate model of perinatal asphyxia appropriate for preclinical evaluation of neuroprotective treatment strategies under conditions that closely resemble human neonatal emergencies, and to begin testing the safety and efficacy of erythropoietin neuroprotective treatment. Prior to delivery by hysterotomy, the umbilical cords of near term Macaca nemestrina (n = 8) were clamped for times ranging between 12 and 15 min. Animals received erythropoietin (5,000 U/kg/dose x 2 i.v., n = 3), or vehicle (n = 5) after resuscitation. We assessed physiologic parameters, continuous electroencephalogram, magnetic resonance imaging/spectroscopy, safety parameters and behavior. Animals were euthanized at 4 months of age. Mean birth weight was 507 +/- 62 g. Initial arterial pH ranged from 6.75 to 7.12, with base deficits of 17-25 mEq. Animals were flaccid at birth, with attenuated electroencephalograms, and seizures occurred in 3 of 8 animals. We demonstrated magnetic resonance imaging/spectroscopy changes consistent with hypoxia (elevated lactate levels were present in some animals), significant motor and behavioral abnormalities (particularly with 15 min of cord clamping), and evidence of gliosis at the time of death. We have established a reproducible model of moderate to severe perinatal hypoxic-ischemic injury in M. nemestrina newborns. This model, which combines structural, biochemical, and behavioral assessments over time can be used to assess the safety and efficacy of neuroprotective strategies.

[Umbilical cord rupture and vasa previa: a report of a case]. / Rotura del cordón umbilical y vasa previa: comunicación de un caso.

Vasa previa is a rare condition, frequently lethal, in which fetal blood vessels coming from the placenta or the umbilical cord cross the entrance of the childbirth channel before presentation. The abnormal blood vessels are result of a velamentous cord insertion or a placental alteration. It happens in 1:3000 births, with a high perinatal mortality. A 16 years-old primigest patient, at 34.6 week of gestation, was admitted to the labor, which has a good evolution, without any complication. A male new born was obtained without hearth rate or vitality, Apgar scale 0-0, weight 2800 grams, who presented an umbilical cord rupture 3 centimeters from its abdominal insertion, no where the fetal blood vessels are unprotected. It is necessary an adequate prenatal care, diagnosis and accurate management, to avoid the mortality by this rare clinical entity.

Inserción velamentosa de cordón umbilical y rotura de un vaso previo con evolución neonatal favorable / Velamentous umbilical cord insertion and laceration of a vasa previa with favorable perinatal outcome

La presencia de un vaso previo es una variante anatómica poco frecuente. La rotura de un vaso previo se asocia a una alta tasa de mortalidad fetal, que oscila entre el 58 y el 100% de los casos. En nuestro centro, se ha producido recientemente un caso de exanguinación fetal debida a la laceración de un vaso previo de una inserción velamentosa de cordón umbilical sin diagnosticar. A pesar de que la evolución del neonato ha sido favorable, se considera la necesidad del diagnóstico precoz y la finalización de la gestación de forma programada, mediante una cesárea, para evitar este dramático suceso (AU)

Vasa previa is an unusual anatomical variant. Rupture of a vasa previa is associated with a high rate of fetal mortality oscillating between 58 and 100% of cases. We report a recent case of fetal exsanguination that occurred in our hospital due to vasa previa laceration of an undiagnosed velamentous umbilical cord insertion. Although neonatal outcome was favorable, we stress the need for early diagnosis and cesarian section to avoid this dramatic event (AU)