Clinical and Morphological Features of the Umbilical Cord in Late Manifestation of Fetal Growth Restriction

Placental and umbilical cord abnormalities can lead to negative perinatal outcomes: fetal growth restriction, intrauterine fetal death, low birth weight for gestational age, and emergency caesarean section. Some publications focus in detail on the assessment of pathological changes in the umbilical cord, but the relationship between macromorphological changes in the umbilical cord and fetal growth restriction remains controversial and unresolved. The aim of the study was to investigate the clinical and macromorphological markers of umbilical cord blood flow disorders in late manifestations of fetal growth restriction through pathohistological examination of the umbilical cord. Materials and methods of the study. The study was conducted in two groups: the main group (89 patients with late manifestation of fetal growth restriction) and the comparison group (30 patients with normal fetometry parameters). Postnatally, umbilical cord tissue samples were collected for macroscopic and pathohistological examination: 32 samples in the main group and 10 samples in the comparison group. Results of the study. A comparative analysis of the course of pregnancy and its outcomes revealed a high proportion of complications and abdominal delivery (37–41.6%), in a larger proportion associated with preeclampsia (21–23.6%), and a combination of fetal growth restriction and preterm birth (14–15.7%). Macroscopic examination of the selected samples revealed excessive twisting/hypercoiling of the umbilical cord, excess of Wharton’s jelly with a dense structure or its aplasia, in 10 samples (31.3%) there were cysts of Wharton’s jelly, and in 5 (15.6%) increase in varicose umbilical vein with enlargement of the lumen and thinning of the wall was noted. In 26 (81.3%) samples of the umbilical cord of the main group, focal thinning of the umbilical vein wall, edema, vacuolar dystrophy of myocytes, myolysis and proliferation of connective tissue fibers in the muscular membrane of the umbilical vein were revealed. Venous thrombosis was common. Examination of the arteries revealed slit-like lumen and perivascular hemorrhages. Conclusions. A comparative analysis of the course of pregnancy revealed a high frequency of abdominal delivery (41.6%), mostly associated with preeclampsia (21–23.6%), a combination of fetal growth restriction and preterm birth (14–15.7%), and deterioration of the intrauterine condition of the fetus (33–37.1%) against the background of a high index of somatic pathology and placental dysfunction. The results of the study emphasize the dependence of umbilical cord abnormalities on the frequency of gestational complications and antenatal pathology, including those associated with fetal growth restriction. The characteristic pathohistological changes in the umbilical cord in such newborns were: short hypercoiled umbilical cord, aplasia and cysts of the Wharton’s jelly, thinning and destructive changes in the wall of the umbilical vein, perivascular hemorrhages, and decreased arterial flow capacity.