Impact of umbilical cord length on fetal circulatory system by Doppler assessment
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ORIGINAL ARTICLE
Impact of umbilical cord length on fetal circulatory system by Doppler assessment Mercedes Olaya‑C1,6 · William Vargas2 · Rodolfo Andres Martinez3,6 · Ivan Felipe Peñaloza4,6 · Melissa Sanchez4,6 · Ithzayana Madariaga4,6 · Sergio Aldana4,6 · Jaime E. Bernal5 Received: 17 February 2020 / Accepted: 12 June 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Introduction Numerous studies have revealed the impact of umbilical cord (UC) length on fetal perfusion; abundant data implicate abnormal UC length to neurological delay and subsequent poor prognoses for fetuses and newborns. Indeed, our group previously developed theoretical approximations that contributed to formulas capable of explaining the impact of UC length on cardiac output. Methods We performed an observational study that measured the pulsatility index and flow velocity in umbilical arteries. A special Doppler measured proximal and distal indexes in both arteries. After birth, medical staff measured complete UC length. We obtained maternal and neonatal outcomes from clinical records. Results Our study enrolled 20 pregnant mothers. We found that flow velocities in the two edges were different: fetal edges exhibited greater velocity in the majority of cases; but, when we compared pressure differentials (ΔP), the pulsatility index was significantly related to umbilical cord length. Conclusions Fetal perfusion, welfare, and viability are related to UC function as the conveyor of all fetal volemia. Excessive UC length affects cardiac dynamics and increases peripheral vascular resistance. Further studies could validate routine use of the differential proximal and distal measurements proposed in this article, and their implications in in utero fetal heart function. We also hope that early diagnosis or UC alterations could alert neonatologists and obstetricians to clinical condi‑ tions of the fetus. Keywords Umbilical cord · Umbilical cord length · Stillbirth · Thrombosis · Physics
Introduction
* Mercedes Olaya‑C [email protected]; [email protected] 1
Pathology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
2
Forensic Physics Group, Instituto Nacional de Medicina Legal y Ciencias Forenses, Bogota, Colombia
3
Obstetrics and Gynecology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
4
Pontificia Universidad Javeriana, Bogota, Colombia
5
Instituto de Genetica Humana, Pontificia Universidad Javeriana, Bogota, Colombia
6
Hospital Universitario San Ignacio, Kra 7 40‑62, Bogota, Colombia
Umbilical cord length has been defined as the most impor‑ tant feature of the UC and is linked with unfavorable out‑ comes [1, 2] such as stillbirth [3, 4], miscarriage [5], neona‑ tal death, and neurological complications. Brain injury has been related to hypoxia and thrombosis [1, 2, 6], resulting in specific neurological alterations [7]. Fetal cardiac activity is greater than that of adults,
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