Umbilical cord length in singleton gestations: A Finnish population-based retrospective register study

Placenta (Impact Factor: 2.71). 04/2014; 35(4). DOI: 10.1016/j.placenta.2014.02.001


Many complications of pregnancy and delivery are associated with umbilical cord length. It is important to examine the variation in length, in order to identify normal and abnormal conditions. Moreover, the factors influencing cord growth and development are not precisely known.

The main objectives were to provide updated reference charts for umbilical cord length in singleton pregnancies and to evaluate potential factors affecting cord length.

Birth register data of 47 284 singleton pregnant women delivering in Kuopio University Hospital, Finland was collected prospectively. Gender-specific centile charts for cord length from 22 to 44 gestational weeks were obtained using generalized additive models for location, scale, and shape (GAMLSS). Gestational, fetal, and maternal factors were studied for their potential influence on cord length with single variable analysis and stepwise multiple linear regression analysis.

Cord length increased according to gestational age, while the growth decelerated post-term. Birth weight, placental weight, pregravid maternal body mass index, parity, and maternal age correlated to cord length. Gestational diabetes and previous miscarriages were associated with longer cords, while female gender and placental abruption were associated with shorter cords.

Discussion and Conclusions
Girls had shorter cords throughout gestation although there was substantial variation in length in both genders. Cord length associated significantly with birth weight, placental weight, and gestational age. Significantly shorter cords were found in women with placental abruption. This important finding requires further investigation.

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    • "Several hypotheses have been proposed to explain abnormally short cords, including fetal mobility disorders (mechanical or drug-induced) [6] [7], neurological disorders [8] [9], chromosomal disorders [10] and twin pregnancy, all suggesting a relationship between lack of fetal movement resulting in diminished UC tension and thereby a short UC. Theories related to long cords include: uterus size [11] [12], maternal parity of more than three children [5] [11], male gender [10] [11] and genetic [13] [14] and epigenetic components [15] [16] [17]. While widely accepted that UC length increases relatively linearly throughout pregnancy, abnormally long or short cords can be documented very early in the second trimester suggesting that factors determining cord length can be disrupted relatively early in pregnancy. "
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    ABSTRACT: Umbilical cord (UC) alterations are involved in fetal and neonatal complications, and even deaths. Abnormal length has been recognized as the most important UC feature linked to unfavorable results. However, how can the UC be accurately measured in cases in which there is an overriding need for intravenous intervention, urgent lab samples or segments for stem cell cultivation? We performed an observational study to describe our UC length measurement method at the San Ignacio University Hospital (HUSI). All HUSI obstetricians and pediatricians accepted the new rapid cord measurement method; no delays were reported for either maternal or neonatal care. In light of the association of abnormal UC length to complications, we recommend that complete UC length data be registered. Our new and rapid method allows for any UC intervention to be performed, while at the same time, providing precise UC length data under all circumstances.
    12/2014; 7(4). DOI:10.3233/NPM-14814023
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    • "The extent by which capillary branching is increased in T1D and GDM is similar, as reflected by a 2.0-fold versus a 1.8-fold increase in the number of redundant connections per villus, respectively [7, 8]. Further evidence for an impact of maternal diabetes on fetal vascular growth and angiogenesis is provided by findings on longer umbilical cord length in GDM [91] with higher risk for both hyper- and hypocoiled cords [92, 93]. "
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    BioMed Research International 09/2014; 2014:145846. DOI:10.1155/2014/145846 · 2.71 Impact Factor
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    ABSTRACT: Umbilical cord (UC) alterations are related to fetal and neonatal deaths and late neurological complications. Abnormal UC length has been recognized as the most significant abnormality linked to unfavorable outcomes. Despite its importance, causal factors resulting in abnormally long or short UCs have yet to be established. The factors that govern UC length are largely unknown. Furthermore, there is a paucity of studies that assess molecular processes involved in the establishment of UC length. We hypothesize that UC length abnormalities in UC length are associated with altered protein expression patterns of known cell growth and/or apoptosis regulators. In this study we analyze diverse protein expression patterns in different UC cell types found in UCs of normal and abnormal length. An analytical observational study was carried out on fetal autopsies; diagnosed abnormal length UCs were compared to normal controls by gestational age. Immunohistochemical analysis of expression levels of growth and pro- and anti-apoptotic factors was performed. We performed immunohistochemistry antibody tests against FAS, BAX, Ki67, cMyc, FGF2, TGFBR3, VEGF, Bcl2, p57 and IGF2 and analyzed UC cell expression patterns. We found significant differences in specific long and/or short cord cell types in comparison to those in normal cords. Factors that determine UC length are still largely unknown; however, this study demonstrates significant specific cell type differences in protein expression patterns of several genes related to cell proliferation. This preliminary study provides strong supporting data to continue the search for molecular factors that determine UC length. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Early human development 03/2015; 91(5):291-297. DOI:10.1016/j.earlhumdev.2015.03.001 · 1.79 Impact Factor