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The role of a healthy placenta as the interface between mother and fetus, which regulates the intrauterine environment and affects fetal and pregnancy outcomes, points to placental examination as a potentially useful diagnostic tool. Placental macroscopic and microscopic patterns are routinely evaluated when pregnancy complications occur. Moreover, placental measures particularly the ratio between fetal and placental weight have been reported to correlate with maternal characteristics, such as BMI as well as with birth-weight and fetal gender. Our pilot study evaluates the feasibility of the placental measures' reproducibility intra-operators. We enrolled 50 consecutive singleton pregnancies including physiological pregnancies and any pre-existing maternal disease or maternal and fetal complication. We conducted a macroscopic analysis of fetal adnexa with four different operators assessing pathological findings or other abnormalities. Intra-class correlation coefficient (ICC) and Cohen and Fleiss kappa coefficient were used to assess the degree of consistency between operators. The results of our study show that the placental morphometric analysis is a reproducible method.

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 conditions of the fetus.

Purpose: The purpose of this study was to compare the sizes of the placenta and umbilical cord in women with natural pregnancy versus those undergoing in vitro fertilization (IVF)., Methods: Overall, 1610 cases of uncomplicated single pregnancies with vaginal delivery at ≥ 37 weeks of gestation were included in this study. The patients were divided into two groups: natural pregnancy group (n = 1453) and IVF pregnancy not including intracytoplasmic sperm injection (ICSI) treatment (n = 157). The groups were compared in terms of gestational week, maternal age, parity, maternal weight gain, prepregnancy maternal BMI, infant weight at birth, infant head circumference, placental weight, cross section of the placenta, cross section of the umbilical cord, insertion site of the umbilical cord, and umbilical cord length. Stepwise selection and multivariate logistic regression were used for statistical analysis to correct the result as an independent factor., Results: There was no difference in the size of the placenta and umbilical cord between women with natural pregnancy and with IVF, but the incidence of velamentous insertion of the cord was significantly increased in women with IVF pregnancy (adjusted odd ratio [AOR] 1.72, 95% confidence interval [CI] 1.08-2.72, p = 0.026)., Conclusions: Although there is no difference in placental weight and cord size, velamentous insertion of the umbilical cord increases in IVF pregnancy and needs careful observation during the delivery process.

The most significant anatomical structure of the umbilical cord is its level of coiling. The coiled geometry of the umbilical cord largely affects umbilical blood flow that is vital for fetus's well-being and normal development. In this study, we developed a computational model of steady blood flow through the coiled structure of an umbilical artery. The results showed that the driving pressure for a given blood flow rate is increasing as the number of coils in cord structure increases. The driving gradient pressures also vary with the pitch that dictates the coils' spreading. The coiled structure is resulting in interwoven streamlines along the helix and wall shear stresses (WSS) with significant spatial gradients along the cross-sectional perimeter anywhere within the helical coil. These gradients may have an adverse effect on the development of the fetus cardiovascular system in cases with over coiling (OC) or under coiling (UC) characteristics. The number of coils does not affect the distribution and levels of WSS. However, when the coils are more spread (eg, larger pitch number), the maximal WSS is significantly smaller. Cases with twisted and OC cords seem to yield very large values and gradients of WSS, which may place the fetus into high risk of abnormal development.

Our previous study reported that TGF-beta may be isolated from human Wharton's jelly (WJ) in a form of soluble, high molecular complex(es). We decided to study the effect of extracellular matrix degradation and reduction of disulphide bridges reduction on the release of TGF-beta from WJ. The WJ prepared from the umbilical cords of newborns delivered at term by healthy mothers was homogenised and treated with hyaluronidase, collagenase, heparinase, chondroitinase and beta-mercaptoethanol, the resulting extracts were then submitted to TGF-beta immunoassay and SDS/PAGE followed by Western immunoblotting. The effect of metalloproteinase activation on TGF-beta was also studied. Pre-treatment of WJ homogenates with hyaluronidase or collagenase markedly increased the extractability of TGF-beta, but did not dissociate the complexes. In contrast, the action of beta-mercaptoethanol resulted in the release of free TGF-beta; but activation of metalloproteinases resulted in the disappearance of this factor. We conclude that TGF-beta1 is bound through disulphide bonds to an extracellular matrix component of WJ. The large amount of collagen fibrils and hyaluronate molecules which surround the cells scattered in WJ may prevent the access of extracting solution to TGF-beta causing a low extractability of this factor. Although hyaluronate and collagen do not bind TGF-beta directly, they may present a barrier that prevents the diffusion of TGF-beta in WJ and results in its concentration around the cells thereby facilitating its interaction with membrane receptors and subsequent stimulation of cell division and synthesis of extracellular matrix components.

Neonatal and placental factors and compartment volumes of placental parenchyma in relation to variations of cord insertions in normal human placentae were examined. The results of our investigation suggest that the mode of umbilical cord insertion has no significant effect on examined components. Stated differences are probably the effect of biological variations during normal placental and fetal development.