Structural and morphological changes of the human umbilical cord in complicated pregnancy

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Abstract

The close interaction between two circulatory systems separated by the placental barrier determines the sensitivity of the fetoplacental circulation to critical disturbances of maternal blood flow within the intervillous space of the placental cotyledon and to activation of hemostatic processes on the surface of chorionic villi. Maternal somatic diseases manifesting as by hypertension and metabolic disorders during pregnancy affect the development and function of the placenta and umbilical cord. Because structural alterations in the umbilical cord vessel walls appear earlier than in fetal vessels and are associated with placental vascular resistance, detailed morphological assessment of the umbilical cord may improve prediction of neonatal health outcomes.

The aim of this study is to review published data describing the morphological and functional features of the umbilical cord in infants born to mothers with complicated obstetric histories.

Studies of umbilical cords from infants born to mothers with preeclampsia have demonstrated narrowed umbilical artery lumen associated with thickening or edema of the vascular smooth muscle layer. Reduced Wharton jelly has not been consistently observed; in only one study was it accompanied by thickening of the vascular muscular layer. In contrast, another study reported an increased volume of Wharton jelly. No morphological changes in the umbilical vein wall were detected in all studies. Thickening of the umbilical vein wall may have compensatory significance, whereas thinning appears to be pathological. Morphological changes of the umbilical vein in fetuses with intrauterine growth restriction and in preterm infants have not been described. Furthermore, detailed investigation is required to clarify the role of tissue factors, including matrix metalloproteinases and vascular endothelial growth factor, in shaping the morphological characteristics of the umbilical cord.

Comprehensive evaluation of morphological and structural alterations of the umbilical cord and its components in large cohorts of pregnant women with various somatic diseases may improve the predictive accuracy of neonatal health outcomes and the risk of fetal developmental abnormalities.

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About the authors

Albina A. Kondratenko

Saint Petersburg State Pediatric Medical University; Kirov Military Medical Academy

Author for correspondence.
Email: kondraa24@gmail.com
ORCID iD: 0000-0002-8511-5864
SPIN-code: 1668-3497

Cand. Sci. (Biology)

Russian Federation, Saint Petersburg; Saint Petersburg

Anna O. Drobintseva

Saint Petersburg State Pediatric Medical University

Email: ao.drobintseva@gpmu.org
ORCID iD: 0000-0002-6833-6243
SPIN-code: 4277-0122

Cand. Sci. (Biology), Assistant Professor

Russian Federation, Saint Petersburg

Saulesh A. Apbasova

Semey State Medical University

Email: saulesh.apbasova@smu.edu.kz
ORCID iD: 0000-0001-6650-4971

MD, Cand. Sci. (Medicine)

Kazakhstan, Semey

Ruslan A. Nasyrov

Saint Petersburg State Pediatric Medical University

Email: rrmd99@mail.ru
ORCID iD: 0000-0001-8120-2816
SPIN-code: 5446-0950

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Maria A. Kalinina

Saint Petersburg State Pediatric Medical University

Email: mariakalinina0044@gmail.com
ORCID iD: 0009-0009-4922-1422
SPIN-code: 1953-3453
Russian Federation, Saint Petersburg

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