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Torvid Kiserud - One of the best experts on this subject based on the ideXlab platform.
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op21 08 relationship between Umbilical vein constriction intra abdominal dilatation and perinatal outcome
Ultrasound in Obstetrics & Gynecology, 2007Co-Authors: A C Schwarze, Svein Magne Skulstad, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA <24 weeks were related to birth weight <5th percentile (P < 0.05) and fetal death (P < 0.05). In subsequent observations UV constriction varied to values <90th percentile in seven of 13 fetuses. In the rest (6/13) the UV constriction resolved for the rest of pregnancy. In all cases a relatively large placental weight was seen. Furthermore, a UV distension that extended from the abdominal wall to the ductus venosus was related to increased placental weight (P < 0.05). Conclusions: UV stricture at the Umbilical Ring seems to be commonly linked to intra-abdominal UV distension. This supports the assumption that the UV distension is often a post-stenotic dilatation. We speculate that it is the venous constriction that restricts hemodynamic responsiveness and carries the risk of complications (rather than the distention).
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OP21.08: Relationship between Umbilical vein constriction, intra‐abdominal dilatation and perinatal outcome
Ultrasound in Obstetrics and Gynecology, 2007Co-Authors: A C Schwarze, Svein Magne Skulstad, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA
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OP21.09: Abnormal Umbilical venous drainage bypassing the fetal liver is associated with impaired fetal growth
Ultrasound in Obstetrics and Gynecology, 2007Co-Authors: Norbert Szunyogh, Svein Rasmussen, E. T. Jaeggi, G. Tulzer, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA
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Effect of Umbilical Ring constriction on Wharton's jelly.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006Co-Authors: Svein Magne Skulstad, M. Lysgård Ulriksen, Svein Rasmussen, Torvid KiserudAbstract:Objective The turgor of Wharton’s jelly depends on osmotic and hydrostatic pressures. We tested the hypothesis that Umbilical Ring constriction has an impact on Umbilical venous hemodynamics and thus on the volume of Wharton’s jelly. Methods In a cross-sectional study of 237 low-risk singleton pregnancies, the cross-sectional area of the fetal end of the Umbilical cord was determined using sonography at 20–41 weeks of gestation. The inner area of the two arteries and the vein was also measured and subtracted from the cord area to calculate the area of Wharton’s jelly. Based on the Bernoulli equation, the degree of vein constriction at the Umbilical Ring was assessed using the blood velocity increment at the abdominal inlet. Regression analysis and SD-score statistics were used to construct mean values and to assess the effects. The dataset was also analyzed for genderspecific effects. Results The Umbilical cord cross-sectional area increased with gestational age duRing the period 20–31 weeks, remaining essentially stable thereafter. The Wharton’s jelly increased with gestational age from 20 until 31–32 weeks of gestation and remained at the same level for the rest of the pregnancy. At mid-gestation, on average 70% of the cord cross-sectional area was occupied by Wharton’s jelly; at 31 weeks and later this value was 60%. Umbilical vein constriction was associated with reduced Umbilical cord cross-sectional area and Wharton’s jelly in female fetuses (P = 0.0007 and P = 0.003, respectively), but not in male fetuses. Conclusions Under physiological conditions, Umbilical Ring constriction affects Umbilical vein hemodynamics, with corresponding effects on the Umbilical cord crosssectional area and the amount of Wharton’s jelly. Interestingly, the effects are gender-specific. Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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Umbilical vein constriction at the Umbilical Ring: a longitudinal study.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006Co-Authors: Ganesh Acharya, Tom Wilsgaard, G. K. Rosvold Berntsen, Jan Martin Maltau, Torvid KiserudAbstract:Objective It has been suggested that constriction of the Umbilical vein (UV) at the Umbilical Ring has hemodynamic effects. We aimed to determine the occurrence and extent of such constriction in serial observations. Methods This was a prospective longitudinal study of UV velocities at the umbilicus measured at approximately 4-week intervals between 19 and 42 weeks' gestation in 129 low-risk singleton pregnancies. Each participant was examined three to five times. Multilevel modeling was used to construct the reference ranges and to test associations between variables. Results Gestational age-specific reference percentiles of UV velocities at the umbilicus were established based on 469 observations. Fetuses were able to alter the UV velocities considerably duRing the second half of pregnancy, signifying a varying degree of UV constriction. Of a total of 129 fetuses, 56 (43.4%) never had high UV blood velocity (i.e. > 46 cm/s, the highest quartile), 42 (32.6%) fetuses had high UV blood velocity on one occasion and 31 (24.0%) fetuses on two or more occasions. In 36 (27.9%) fetuses the UV velocity at the Umbilical Ring was > 300% of the mean gestational age-specific reference value at the intra-abdominal section on at least one occasion. Constriction of the UV at the Umbilical Ring did not affect the pulsatility of the Umbilical artery, and was not associated with adverse perinatal outcome in this study. Conclusions Low-risk fetuses may well constrict the UV at the abdominal wall with velocities extending over wide ranges on one or more occasions duRing the second half of pregnancy. Rather than being a risk for complications, the constriction seems to be part of physiological development and possibly a regulatory mechanism. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Svein Magne Skulstad - One of the best experts on this subject based on the ideXlab platform.
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op21 08 relationship between Umbilical vein constriction intra abdominal dilatation and perinatal outcome
Ultrasound in Obstetrics & Gynecology, 2007Co-Authors: A C Schwarze, Svein Magne Skulstad, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA <24 weeks were related to birth weight <5th percentile (P < 0.05) and fetal death (P < 0.05). In subsequent observations UV constriction varied to values <90th percentile in seven of 13 fetuses. In the rest (6/13) the UV constriction resolved for the rest of pregnancy. In all cases a relatively large placental weight was seen. Furthermore, a UV distension that extended from the abdominal wall to the ductus venosus was related to increased placental weight (P < 0.05). Conclusions: UV stricture at the Umbilical Ring seems to be commonly linked to intra-abdominal UV distension. This supports the assumption that the UV distension is often a post-stenotic dilatation. We speculate that it is the venous constriction that restricts hemodynamic responsiveness and carries the risk of complications (rather than the distention).
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OP21.08: Relationship between Umbilical vein constriction, intra‐abdominal dilatation and perinatal outcome
Ultrasound in Obstetrics and Gynecology, 2007Co-Authors: A C Schwarze, Svein Magne Skulstad, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA
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Effect of Umbilical Ring constriction on Wharton's jelly.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006Co-Authors: Svein Magne Skulstad, M. Lysgård Ulriksen, Svein Rasmussen, Torvid KiserudAbstract:Objective The turgor of Wharton’s jelly depends on osmotic and hydrostatic pressures. We tested the hypothesis that Umbilical Ring constriction has an impact on Umbilical venous hemodynamics and thus on the volume of Wharton’s jelly. Methods In a cross-sectional study of 237 low-risk singleton pregnancies, the cross-sectional area of the fetal end of the Umbilical cord was determined using sonography at 20–41 weeks of gestation. The inner area of the two arteries and the vein was also measured and subtracted from the cord area to calculate the area of Wharton’s jelly. Based on the Bernoulli equation, the degree of vein constriction at the Umbilical Ring was assessed using the blood velocity increment at the abdominal inlet. Regression analysis and SD-score statistics were used to construct mean values and to assess the effects. The dataset was also analyzed for genderspecific effects. Results The Umbilical cord cross-sectional area increased with gestational age duRing the period 20–31 weeks, remaining essentially stable thereafter. The Wharton’s jelly increased with gestational age from 20 until 31–32 weeks of gestation and remained at the same level for the rest of the pregnancy. At mid-gestation, on average 70% of the cord cross-sectional area was occupied by Wharton’s jelly; at 31 weeks and later this value was 60%. Umbilical vein constriction was associated with reduced Umbilical cord cross-sectional area and Wharton’s jelly in female fetuses (P = 0.0007 and P = 0.003, respectively), but not in male fetuses. Conclusions Under physiological conditions, Umbilical Ring constriction affects Umbilical vein hemodynamics, with corresponding effects on the Umbilical cord crosssectional area and the amount of Wharton’s jelly. Interestingly, the effects are gender-specific. Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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Umbilical vein constriction at the abdominal wall An ultrasound study in low risk pregnancies
2005Co-Authors: Svein Magne SkulstadAbstract:The Umbilical vein is the only vessel supplying the fetus with blood supplying oxygen and nutrients from the placenta. Case reports indicate that the fetal end of the Umbilical cord is susceptible to mechanical complications. Hypothesis: We assume that Umbilical Ring constriction may affect the Umbilical vein and have haemodynamic effects on fetal development and birth. Aims: To describe the occurrence and degree of Umbilical venous constriction in low risk–pregnancies. To establish reference ranges. To determine whether such a constriction has a haemodynamic effect, or any effect on fetal development or perinatal outcome. Material and methods: 384 low–risk singleton pregnancies were included in the cross–sectional studies after written consent and ethical approval. 2D–imaging, colour Doppler and pulsed Doppler were used to measure diameters and blood velocity in the Umbilical vein before, at or beyond the abdominal wall. All blood flow velocimetry was performed duRing fetal quiescence. Perinatal outcome was noted. Results: From 13 weeks onwards, after the period of physiological Umbilical herniation, Umbilical venous constriction was noted in increasing numbers and severity until 19 weeks of gestation (paper I). For the latter half of the pregnancy, duRing gestational weeks 20–40, the pattern remained constant; 41/191 (21%) had a venous constriction corresponding to a diameter reduction to the half, while the corresponding venous blood velocity increment was ≥300%, and 5% of the fetuses had velocities ≥107 cm/s, which is exceptionally high compared with other blood velocities in the body, whether arterial or venous (paper II). The reproducibility study showed that the measurements of venous blood velocity in the cord and at the Umbilical Ring had SD of 0.58 and 1.83 cm/s respectively and that the diameter measurements both at the Umbilical Ring and at the cord had a mean SD of 0.07 mm (paper II). The incidence of Umbilical venous pulsation was higher at the Umbilical Ring in the abdominal wall, 242/279 (87%) than in the cord, 43/198 (22%) or intra–abdominally, 84/277 (30%). When pulsation was observed intra–abdominally, the pulsatility was not different from that at the Umbilical Ring. The lowest pulsatility was found in the cord vein, where the largest vein diameter was found (paper III). Umbilical venous constriction had a significant negative correlation to the birthweight/placental weight ratio in male but not in female fetuses. Umbilical venous constriction was also associated with and increased length of the cord, but only in female fetuses. Constriction was also associated with Apgar score ≤7 at one minute after birth but not after five, and was not associated with emergency delivery (paper IV). Conclusions: The Umbilical Ring seams to tighten in the following weeks after the period of physiological herniation, causing an increasing number and degree of Umbilical vein constriction. After 19 weeks of gestation, the occurrence of Umbilical vein constriction is constant until term. The degree of constriction can be considerable, and in 20% of the fetuses the Umbilical vein diameter is ≤50% of that in the cord. We have established reference ranges. Within physiological ranges, i.e. in a low–risk population, such constrictions have a haemodynamic effect leading to increased incidence of pulsations and gender specific effects on fetal, cordal and placental growth. The significant effect on Apgar score at one minute warrants further studies of the effect of extreme constriction on perinatal morbidity.
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The effect of vascular constriction on Umbilical venous pulsation.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2003Co-Authors: Svein Magne Skulstad, Torvid Kiserud, Svein RasmussenAbstract:Objectives Umbilical venous pulsation is an important sign of hemodynamic compromise, but is also found under normal physiological conditions. Mathematical modeling suggests that vascular compliance is a determinant for pulsation, and we tested this by studying velocity pulsation at three sites on the Umbilical vein. Methods In a cross-sectional study of 279 low-risk pregnancies (20–40 weeks' gestational age) blood flow velocity in the Umbilical vein was determined before, within and after the Umbilical Ring in the fetal abdominal wall, and the incidence and magnitude of pulsation (the difference between the maximum and minimum velocity duRing a pulse, and pulsatility index) were noted. Based on the fact that the vessel cross-sectional area is an important determinant of compliance, we measured the diameter and time-averaged maximum velocity to reflect variation in diameter and compliance at the three sites. Results The incidence of Umbilical venous pulsation was higher at the Umbilical Ring in the abdominal wall (242/279, 87%, 95% CI 82–90) than in the cord (43/198, 22%, 95%CI 16–27) or intra-abdominally (84/277, 30%, 95% CI 25–36) (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the Umbilical Ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found. Conclusion The high incidence of venous pulsation at the Umbilical Ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Svein Rasmussen - One of the best experts on this subject based on the ideXlab platform.
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OP21.09: Abnormal Umbilical venous drainage bypassing the fetal liver is associated with impaired fetal growth
Ultrasound in Obstetrics and Gynecology, 2007Co-Authors: Norbert Szunyogh, Svein Rasmussen, E. T. Jaeggi, G. Tulzer, Torvid KiserudAbstract:Objectives: Intra-abdominal Umbilical vein (UV) distension is sometimes seen in cases of fetal demise. We hypothesize that such a UV distension may be a post-stenotic dilatation due to an Umbilical Ring constriction. Here we explore whether a stricture of the UV is related to UV distension and to adverse outcome. Methods: Referred high-risk pregnancies underwent Doppler assessment that included assessment of the UV at the Umbilical Ring. UV blood velocity >90th percentile at this site and gestational age (GA) was defined as a UV constriction. An intra-abdominal UV diameter >90th percentile was defined as distension. Pregancies were followed up with repeat observations. Placental weight and fetal outcome were noted. Results: Thirteen fetuses (11 singletons and two twins) that had UVstricture but no major anomalies were included. Median GA at first examination for 10 survivors was 27 (19–36) weeks and for three fetal deaths 24 (19–24) weeks. There was a median of 5 (range, 2–9) observations in each fetus (total 66). Nine of 13 fetuses had both UV constriction and dilatation at first examination. UV constriction >97.5th percentile and GA
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Effect of Umbilical Ring constriction on Wharton's jelly.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2006Co-Authors: Svein Magne Skulstad, M. Lysgård Ulriksen, Svein Rasmussen, Torvid KiserudAbstract:Objective The turgor of Wharton’s jelly depends on osmotic and hydrostatic pressures. We tested the hypothesis that Umbilical Ring constriction has an impact on Umbilical venous hemodynamics and thus on the volume of Wharton’s jelly. Methods In a cross-sectional study of 237 low-risk singleton pregnancies, the cross-sectional area of the fetal end of the Umbilical cord was determined using sonography at 20–41 weeks of gestation. The inner area of the two arteries and the vein was also measured and subtracted from the cord area to calculate the area of Wharton’s jelly. Based on the Bernoulli equation, the degree of vein constriction at the Umbilical Ring was assessed using the blood velocity increment at the abdominal inlet. Regression analysis and SD-score statistics were used to construct mean values and to assess the effects. The dataset was also analyzed for genderspecific effects. Results The Umbilical cord cross-sectional area increased with gestational age duRing the period 20–31 weeks, remaining essentially stable thereafter. The Wharton’s jelly increased with gestational age from 20 until 31–32 weeks of gestation and remained at the same level for the rest of the pregnancy. At mid-gestation, on average 70% of the cord cross-sectional area was occupied by Wharton’s jelly; at 31 weeks and later this value was 60%. Umbilical vein constriction was associated with reduced Umbilical cord cross-sectional area and Wharton’s jelly in female fetuses (P = 0.0007 and P = 0.003, respectively), but not in male fetuses. Conclusions Under physiological conditions, Umbilical Ring constriction affects Umbilical vein hemodynamics, with corresponding effects on the Umbilical cord crosssectional area and the amount of Wharton’s jelly. Interestingly, the effects are gender-specific. Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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P07.01: Gender‐specific effect of Umbilical Ring constriction on Wharton's jelly of the Umbilical cord
Ultrasound in Obstetrics and Gynecology, 2004Co-Authors: S. V. Skulstad, M. Lysgård Ulriksen, Svein Rasmussen, Torvid KiserudAbstract:Objective: To test the hypothesis that the Umbilical Ring constriction has a hemodynamic effect on the Umbilical venous transmural pressure and thus on the development of Wharton’s jelly (WJ) in the second half of pregnancy. Methods: In a cross-sectional study of 283 low-risk pregnancies (20–40 weeks), the cross-sectional area of the Umbilical cord, arteries and Umbilical vein (UV) was measured in the fetal end of the cord using ultrasound. The average of ≥5 repeat measurements was entered into the statistics. The WJ area was calculated by subtracting the total vessel area from the Umbilical cord area. The maximum time averaged blood velocity was recorded at the same site and at the Umbilical Ring in the abdominal wall. The increase of the blood velocity (calculated in percents) was used to express the degree of Umbilical Ring constriction. Regression models and standard deviation score was used for the statistical analysis. Results: Increasing degree of Umbilical Ring constriction was associated with decreasing WJ area in female fetuses (Slope: −0.287, P = 0.013, 95%CI −0.511; −0.063), but not in male (Slope: 0.153, P = 0.181, 95%CI −0.073; 0.379). Similarly, the Umbilical cord area was affected in female fetuses (Slope: −0.281, P = 0.003, 95%CI −0.464; −0.098) but not in male (Slope: 0.059, P = 0.626, 95%CI −0.181; 0.299). An association between increasing degree of Umbilical Ring constriction was associated with decreasing UV cross sectional area (CSA) in males (Slope: −0.271, P = 0.015, 95%CI −0, 489; −0.053), but not in females (Slope: −0.027, P = 0.734, 95%CI −0.182; 0.128). Conclusion: Physiological Umbilical Ring constriction at the abdominal wall affects the Umbilical cord CSA and the WJ formation in female but not male fetuses. In male fetuses the UV CSA decreases with increasing degree of Umbilical Ring constriction, but UV CSA seems unaffected. This implies that such a constriction exerts hemodynamic, gender specific effects on the cord.
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p07 01 gender specific effect of Umbilical Ring constriction on wharton s jelly of the Umbilical cord
Ultrasound in Obstetrics & Gynecology, 2004Co-Authors: S. V. Skulstad, Svein Rasmussen, Lysgard M Ulriksen, Torvid KiserudAbstract:Objective: To test the hypothesis that the Umbilical Ring constriction has a hemodynamic effect on the Umbilical venous transmural pressure and thus on the development of Wharton’s jelly (WJ) in the second half of pregnancy. Methods: In a cross-sectional study of 283 low-risk pregnancies (20–40 weeks), the cross-sectional area of the Umbilical cord, arteries and Umbilical vein (UV) was measured in the fetal end of the cord using ultrasound. The average of ≥5 repeat measurements was entered into the statistics. The WJ area was calculated by subtracting the total vessel area from the Umbilical cord area. The maximum time averaged blood velocity was recorded at the same site and at the Umbilical Ring in the abdominal wall. The increase of the blood velocity (calculated in percents) was used to express the degree of Umbilical Ring constriction. Regression models and standard deviation score was used for the statistical analysis. Results: Increasing degree of Umbilical Ring constriction was associated with decreasing WJ area in female fetuses (Slope: −0.287, P = 0.013, 95%CI −0.511; −0.063), but not in male (Slope: 0.153, P = 0.181, 95%CI −0.073; 0.379). Similarly, the Umbilical cord area was affected in female fetuses (Slope: −0.281, P = 0.003, 95%CI −0.464; −0.098) but not in male (Slope: 0.059, P = 0.626, 95%CI −0.181; 0.299). An association between increasing degree of Umbilical Ring constriction was associated with decreasing UV cross sectional area (CSA) in males (Slope: −0.271, P = 0.015, 95%CI −0, 489; −0.053), but not in females (Slope: −0.027, P = 0.734, 95%CI −0.182; 0.128). Conclusion: Physiological Umbilical Ring constriction at the abdominal wall affects the Umbilical cord CSA and the WJ formation in female but not male fetuses. In male fetuses the UV CSA decreases with increasing degree of Umbilical Ring constriction, but UV CSA seems unaffected. This implies that such a constriction exerts hemodynamic, gender specific effects on the cord.
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The effect of vascular constriction on Umbilical venous pulsation.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2003Co-Authors: Svein Magne Skulstad, Torvid Kiserud, Svein RasmussenAbstract:Objectives Umbilical venous pulsation is an important sign of hemodynamic compromise, but is also found under normal physiological conditions. Mathematical modeling suggests that vascular compliance is a determinant for pulsation, and we tested this by studying velocity pulsation at three sites on the Umbilical vein. Methods In a cross-sectional study of 279 low-risk pregnancies (20–40 weeks' gestational age) blood flow velocity in the Umbilical vein was determined before, within and after the Umbilical Ring in the fetal abdominal wall, and the incidence and magnitude of pulsation (the difference between the maximum and minimum velocity duRing a pulse, and pulsatility index) were noted. Based on the fact that the vessel cross-sectional area is an important determinant of compliance, we measured the diameter and time-averaged maximum velocity to reflect variation in diameter and compliance at the three sites. Results The incidence of Umbilical venous pulsation was higher at the Umbilical Ring in the abdominal wall (242/279, 87%, 95% CI 82–90) than in the cord (43/198, 22%, 95%CI 16–27) or intra-abdominally (84/277, 30%, 95% CI 25–36) (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the Umbilical Ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found. Conclusion The high incidence of venous pulsation at the Umbilical Ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
V. Patrikakos - One of the best experts on this subject based on the ideXlab platform.
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A new tension-free technique for the repair of Umbilical hernia, using the Prolene Hernia System — early results from 48 cases
Hernia, 2003Co-Authors: E. Perrakis, G. Velimezis, A. Vezakis, J. Antoniades, G. Savanis, V. PatrikakosAbstract:Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for Umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free Umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the Umbilical Ring. The median operating time was 35 min (range, 28–40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1–24). Our early results indicate that the described tension-free technique could become the standard treatment for Umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure.
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A new tension-free technique for the repair of Umbilical hernia, using the Prolene Hernia System--early results from 48 cases.
Hernia : the journal of hernias and abdominal wall surgery, 2003Co-Authors: E. Perrakis, G. Velimezis, A. Vezakis, J. Antoniades, G. Savanis, V. PatrikakosAbstract:Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for Umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free Umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the Umbilical Ring. The median operating time was 35 min (range, 28–40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1–24). Our early results indicate that the described tension-free technique could become the standard treatment for Umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure.
E. Perrakis - One of the best experts on this subject based on the ideXlab platform.
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A new tension-free technique for the repair of Umbilical hernia, using the Prolene Hernia System — early results from 48 cases
Hernia, 2003Co-Authors: E. Perrakis, G. Velimezis, A. Vezakis, J. Antoniades, G. Savanis, V. PatrikakosAbstract:Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for Umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free Umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the Umbilical Ring. The median operating time was 35 min (range, 28–40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1–24). Our early results indicate that the described tension-free technique could become the standard treatment for Umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure.
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A new tension-free technique for the repair of Umbilical hernia, using the Prolene Hernia System--early results from 48 cases.
Hernia : the journal of hernias and abdominal wall surgery, 2003Co-Authors: E. Perrakis, G. Velimezis, A. Vezakis, J. Antoniades, G. Savanis, V. PatrikakosAbstract:Tension-free repair using the Prolene Hernia System (PHS) has been widely adopted for inguinal hernias with excellent results. In our department, a new technique for Umbilical hernia repair, using the PHS, has been developed. Between 2000 and 2002, 48 patients underwent tension-free Umbilical hernia repair, using the PHS. There were 20 male and 28 female patients, with a mean age of 54 years. The preperitoneal space was dissected to accumulate the underlay patch of the PHS. The onlay patch was placed on the anterior rectus sheath and the connector in the Umbilical Ring. The median operating time was 35 min (range, 28–40). Postoperative pain was minimal, and there were no complications associated with the mesh, except a seroma, which required needle aspiration. There were no recurrences after a median follow-up of 13 months (1–24). Our early results indicate that the described tension-free technique could become the standard treatment for Umbilical hernia repair, but long-term results are required to establish the efficacy of the procedure.