Umbilical Cord

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Jason H Collins - One of the best experts on this subject based on the ideXlab platform.

  • Umbilical Cord accidents
    BMC Pregnancy and Childbirth, 2012
    Co-Authors: Jason H Collins

    The Stillbirth Collaborative Research Network recently reported on the probable or possible cause of death of 512 stillbirths whose mothers consented to complete postmortem examination [1]. Umbilical Cord accidents (UCA) represented 10% of stillbirths [1]. In Caucasians the UCA associated stillbirth rate was 13% and 4% in non-Hispanic black. 9% of stillbirths were due to hypertension and 8% due to other maternal medical disorders. A literature review places the UCA associated stillbirth rate at 15% [2]. These data bases do not include stillbirth due to several UCA pathologies such as: torsion, multiple Cord entanglement and abnormal placental Cord insertion. The main reason for these absences is the belief by some that these abnormalities do not cause actual death or recurrent stillbirth. One of the first published accounts of an UCA in western medical writings was by William Smellie his Treatise on Midwifery in 1750, London, England: a nuchal Cord associated stillbirth. One of the first published drawings of an UCA was by Andrew Bell in the Encyclopedia Britanica 1st edition 1769 Edinburgh, Scotland, depicting a fetal death with a combination of one nuchal Cord, a body loop and a true knot (currently on the cover of the Royal College of Obstetricians and Gynaecologists (UK) brochure). As UCA is a significant cause of death, JC argues it is now time for the focus to be on screening for UCA, managing UCA prenatally and delivery of the baby in distress defined by the American Congress of Obstetricians and Gynecologists as a heart rate of 90 beats per minute for 1 minute on a reCorded non-stress test. The ability of ultrasound and magnetic resonance imaging (MRI) to visualize UCA is well documented. The 18-20 week ultrasound review should include the Umbilical Cord, its characteristics and description of its placental and fetal attachment. The American Association of Ultrasound Technologists has defined these parameters for Umbilical Cord abnormalities: • Abnormal insertion • Vasa previa • Abnormal composition • Cysts, hematomas and masses • Umbilical Cord thrombosis • Coiling, collapse, knotting and prolapse Umbilical Cord evaluation with sonography includes the appearance, composition, location and size of the Cord [3]. A normal Cord has a single vein and 2 arteries that have a twisted, rope-like appearance. Absence of twisting often is associated with a decrease in fetal movement and a poor pregnancy prognosis. Umbilical Cord pathology is separate from placental pathology [4]. Developmentally the Umbilical Cord is fetal in origin not placental [5]. The Umbilical Cord originates from the “primitive ridge” of the embryo. There are paternal genetic elements influencing growth and development. To date there have been no reports of mosaicism in the human Umbilical Cord. The Human Genome Project has not reviewed Cord genetics. There are eight different Umbilical Cord designs. None of these issues have been incorporated into a detailed prospective study of pregnancy and outcomes. Our current knowledge of the human Umbilical Cord and its influence on the fetus is limited. Interactions between the fetus and Umbilical Cord are becoming apparent due to studies of fetal behavior. Hyperactivity is a fetal response associated with Umbilical Cord compression risk factors [6]. This fetal behavior may be related to intrauterine Umbilical blood flow disturbance which stimulate the fetus to react reflexively and excessively. Animal studies (in rats and sheep) have reproduced forms of hyperactivity with Cord compression. Hyperactivity may be a prenatal behavior capable of repositioning the fetus and relieving the compression. In the rat model, Umbilical Cord compression triggered lateral trunk curls, head tosses and foreleg extensions. In the sheep model intermittent Umbilical Cord compression triggered fetal hiccups. Hiccups occurring daily after 28 weeks, and greater than 4 times per day requires fetal evaluation. UCA should be looked for no matter how trivial it seems on ultrasound. Fetal body movements have been studied with ultrasound over 24 hour periods [7]. These movements are unique between midnight and 6 a.m. Time of fetal behavioral observation (bedtime and midnight to 6 a.m.) may need to be included in any future stillbirth study. Fetal jerking movements and fetal hiccups may also be related to fetal blood flow disturbances especially Cord compression. These maternal observations should be taken seriously and prompt an ultrasound review of the fetus looking for UCA. Recent research into circadian rhythms may help explain why UCA stillbirth is an event between 2 a.m. and 4 a.m. Melatonin has been described as stimulating uterine contractions through the M2 receptor [8]. Melatonin secretion from the pineal gland begins around 10 p.m. and peaks to 60 pg at 3 a.m. Serum levels decline to below 10 pg by 6 a.m. Uterine stimulation intensifies and may be overwhelming to a compromised fetus, especially one experiencing intermittent Umbilical Cord compression due to UCA. Pregnancy Institute has documented over 1000 UCA stillbirths through patient interview that occurred during maternal sleep. UCA are an important cause of stillbirth. It is now possible to identify UCA on ultrasound and test for the compromised fetus. As with gestational hypertension, screening for UCA is needed to possibly avoid thousands of stillbirths worldwide. If UCA is detected, the mother should be hospitalized and evaluated with ultrasound and fetal heart rate monitoring for at least 24 hours. If fetal behavior or the fetal heart rate is abnormal, the observation period should be extended and if necessary deliver the baby.

  • Umbilical Cord accidents: human studies.
    Seminars in perinatology, 2002
    Co-Authors: Jason H Collins

    Research is needed to determine the cause of unexplained stillbirth. Sudden antenatal death syndrome is an important national issue that requires more scrutiny. Umbilical Cord accidents as a causative factor of stillbirth need intensive investigation. Evidence supports a role of the Umbilical Cord in a portion of stillbirth cases, and theory suggests additional causes. This article summarizes the known information relating Umbilical Cord accidents and stillbirth and highlights the research needs.

Gennady T. Sukhikh - One of the best experts on this subject based on the ideXlab platform.

  • Umbilical Cord tissue cryopreservation: a short review.
    Stem cell research & therapy, 2018
    Co-Authors: I. V. Arutyunyan, Timur Fatkhudinov, Gennady T. Sukhikh

    In this review we present current evidence on the possibility of Umbilical Cord tissue cryopreservation for subsequent clinical use. Protocols for obtaining Umbilical Cord-derived vessels, Wharton’s jelly-based grafts, multipotent stromal cells, and other biomedical products from cryopreserved Umbilical Cords are highlighted, and their prospective clinical applications are discussed. Examination of recent literature indicates we should expect high demand for cryopreservation of Umbilical Cord tissues in the near future.

  • Umbilical Cord blood mesenchymal stem cells.
    Bulletin of experimental biology and medicine, 2007
    Co-Authors: R. A. Musina, E. S. Bekchanova, A. V. Belyavskii, Tatyana Grinenko, Gennady T. Sukhikh

    We studied Umbilical Cord blood mesenchymal stem cells and compared mesenchymal stem cells derived from Umbilical Cord blood, adipose tissue, and skin. Umbilical Cord blood mesenchymal stem cells were characterized morphologically, cytofluorometrically, and by their differentiation potential. Umbilical Cord blood mesenchymal stem cells did not differ from cells isolated from adipose tissue and skin by the main parameters (by morphology, expression of surface markers, and differentiation potential). A specific feature of Umbilical Cord blood mesenchymal stem cells is their low count per volume of the initial material and very low proliferative activity.

Franco Locatelli - One of the best experts on this subject based on the ideXlab platform.

  • Umbilical Cord blood transplants.
    Current opinion in hematology, 2000
    Co-Authors: Eliane Gluckman, Franco Locatelli

    With the establishment of Cord blood banks, the number of related and unrelated Umbilical Cord blood transplants is increasing worldwide. Close links have been established with the Cord blood banks. Available data showed that Umbilical Cord blood transplants offer overall results comparable to those obtained with related or unrelated bone marrow transplants. Several differences were found: engraftment with Cord blood was delayed, resulting in an increased incidence of early transplant complications, and the incidence of acute and chronic graft-versus-host disease was significantly reduced with Cord blood grafts, even in HLA-mismatched transplants and in adults. In patients with leukemia, the rate of relapse appeared to be similar to that documented in bone marrow transplant recipients. These data confirm the potential benefit of using Umbilical Cord blood hematopoietic stem cells for allogeneic transplants.

John E. Wagner - One of the best experts on this subject based on the ideXlab platform.

  • Umbilical Cord blood transplantation
    Transfusion, 1995
    Co-Authors: John E. Wagner

    Interest in Umbilical Cord blood as an alternative source of hematopoietic stem cells is growing rapidly. Umbilical Cord blood offers the clinician a source of hematopoietic stem cells that are readily available and rarely contaminated by latent viruses. Moreover, the collection of Umbilical Cord blood poses no risk to the donor; there is no need for general anesthesia or blood replacement, and the procedure causes no discomfort. Whether Cord blood lymphocytes are as likely to cause GVHD as lymphocytes from older individuals is unknown. Current clinical experience would suggest that the incidence may be low. Few of the patients who have thus far received Umbilical Cord blood, including recipients of HLA-disparate grafts, have developed clinically significant GVHD. These results and associated laboratory findings pose intriguing possibilities for the future of Umbilical Cord blood stem cells in the setting of unrelated-donor transplantation. With the marked incidence of Grade 2 to 4 acute GVHD that is currently observed after unrelated-donor bone marrow transplantation, a reduction in incidence or severity would be a major advance in this field. In the setting of autologous marrow transplantation, there are other intriguing possibilities; for example, Cord blood may be an optimal source of pluripotential stem cells for use in gene therapy. As detailed in Broxmeyer's review, the large-scale collection and storage of Cord blood stem cells is no longer just a concept; it has become a reality. Pilot programs for the banking of unrelated-donor Umbilical Cord blood have already begun in the United States and Europe.(ABSTRACT TRUNCATED AT 250 WORDS)

Robert F. Casper - One of the best experts on this subject based on the ideXlab platform.

  • Umbilical Cord blood stem cells
    Best practice & research. Clinical obstetrics & gynaecology, 2004
    Co-Authors: Ian Rogers, Robert F. Casper

    The Umbilical Cord contains a rich source of haematopoietic stem cells that can be used to reconstitute the blood system and can easily be extracted and cryopreserved, thus allowing for the establishment of HLA-typed stem cell banks. Recently, it has been demonstrated that Umbilical Cord stem cells have the potential to give rise to non-haematopoietic cells, such as bone, neural and endothelial cells. It is not clear whether these multipotential cells are mesenchymal-like cells or blood cells. Currently, the number of these specialized cells capable of undergoing the differentiation process into non-haematopoietic cells is low and remains a block to the clinical development of Umbilical Cord stem cells for non-haematopoietic cell therapy. Further research will allow us to overcome these hurdles. This expanded potential for Umbilical Cord stem cells might replace embryonic stem cells and other fetal cells for some cell and tissue therapies.