Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies
Descripción
Acta Medica Okayama Volume 56, Issue 4
2002
Article 2
AUGUST 2002
Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies. Sevinc Inan∗
Muzaffer Sanci†
Deniz Can‡
Seda Vatansever∗∗
Ozgur Oztekin††
Sivekar Tinar‡‡
∗
Celal Bayar University, Aegean Social Security Hospital, ‡ Aegean Social Security Hospital, ∗∗ Celal Bayar University, †† Tepecik Social Security Hospital, ‡‡ Aegean Social Security Hospital, †
c Copyright 1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.
Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies.∗ Sevinc Inan, Muzaffer Sanci, Deniz Can, Seda Vatansever, Ozgur Oztekin, and Sivekar Tinar
Abstract To compare morphological changes in the umbilical cords from chronic hypertensive and preeclamptic patients having normal or pathological umbilical artery Doppler ultrasonographic results. Umbilical cords from 34 normotensive, 31 chronic hypertensive and 70 preeclamptic women with normal and abnormal Doppler flow velocity waveforms (FVW) at 35-40 gestational weeks were studied. Morphological changes in the umbilical cords were examined on formalin-fixed, paraffin-embedded sections. The total umbilical cord area, total vessel area, and wall thickness of umbilical vessels were measured in systematic random samples using unbiased stereology methods. An ANOVA test was used for statistical analysis. In the chronic hypertensive and preeclamptic groups with normal Doppler FVW, the thickness of the umbilical cord vessels remained nearly constant, whereas both the total area and the lumen area were reduced. These changes correlate with the histopathological findings, suggesting a mainly vasoconstrictive effect. By contrast, analysis of the preeclamptic group with pathologic Doppler FVW showed a comparable reduction of all parameters of the umbilical cord. Histopathological findings were related to smaller, contracted smooth muscle cells of the vessel wall, which is suggestive of a predominant hypoplastic mechanism. As a result of reduced uteroplacental perfusion, fetal hypoxia and intrauterine growth retardation become unavoidable in preeclampsia. The histopathological changes in the umbilical cord between the chronic hypertensive and preeclamptic patients depend on the Doppler results. In conclusion, the umbilical artery Doppler FVW indices provide good values for predicting intrauterine growth retardation in preeclamptic patients. KEYWORDS: umbilical cord, morphometry, hypertensive induced pregnancy
∗
PMID: 12199522 [PubMed - indexed for MEDLINE] Copyright (C) OKAYAMA UNIVERSITY MEDICAL SCHOOL
Inan et al.: Comparative morphological differences between umbilical
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Compar at i veMor phol ogi calDier encesbet weenUmbi l i calCor ds f r om Chr oni cHyper t ensi veandPr eecl ampt i cPr egnanci es Se vi ncI nan ,Muz ae rSanc ı,De ni zCan,Se daVat ans e ve r, Oz gurOz t e ki n,andSi ve karTi nar De p a r t me n to fHi s t o l o g y& Emb r y o l o g y ,Ce l a lBa y a rUn i v e r s i t y ,Fa c u l t yo fMe d i c i n e ,Ma n i s a ,Tu r k e y , De p a r t me n to fOb s t e t r i c s& Gy n e c o l o g y ,Ae g e a nSo c i a lSe c u r i t yHo s p i t a l ,I z mi r ,Tu r k e y ,a n d De p a r t me n to fRa d i o l o g y ,Te p e c i kSo c i a lSe c u r i t yHo s p i t a l ,I z mi r ,Tu r k e y
Toc ompar emor phol ogi c alc hange si nt heumbi l i c alc or dsf r om c hr oni chype r t e ns i veandpr e e c l ampt i cpat i e nt shavi ngnor malorpat hol ogi c alumbi l i c alar t e r yDoppl e rul t r as onogr aphi cr e s ul t s . Umbi l i c alc or dsf r om 3 4nor mot e ns i ve ,3 1c hr oni chype r t e ns i veand7 0pr e e c l ampt i cwome nwi t h -4 nor malandabnor malDoppl e rflow ve l oc i t ywave f or ms( FVW)at3 5 0ge s t at i onalwe e kswe r e s t udi e d.Mor phol ogi c alc hange si nt heumbi l i c alc or dswe r ee xami ne donf or mal i nfixe d,par a ne mbe dde ds e c t i ons .Thet ot alumbi l i c alc or dar e a,t ot alve s s e lar e a,andwal lt hi c kne s sofumbi l i c al ve s s e l swe r eme as ur e di ns ys t e mat i cr andom s ampl e sus i ng unbi as e ds t e r e ol ogy me t hods . An ANOVA t e s twasus e df ors t at i s t i c alanal ys i s .I nt hec hr oni chype r t e ns i veandpr e e c l ampt i cgr oups wi t hnor malDoppl e rFVW,t het hi c kne s soft heumbi l i c alc or dve s s e l sr e mai ne dne ar l yc ons t ant , whe r e asbot ht het ot alar e aandt hel ume nar e awe r er e duc e d.The s ec hange sc or r e l at ewi t ht he hi s t opat hol ogi c alfindi ngs ,s ugge s t i ngamai nl yvas oc ons t r i c t i vee e c t .Byc ont r as t ,anal ys i soft he pr e e c l ampt i cgr oupwi t hpat hol ogi cDoppl e rFVW s howe dac ompar abl er e duc t i onofal lpar ame t e r s oft heumbi l i c alc or d.Hi s t opat hol ogi c alfindi ngswe r er e l at e dt os mal l e r ,c ont r ac t e ds moot hmus c l e c e l l soft heve s s e lwal l ,whi c hi ss ugge s t i veofapr e domi nanthypopl as t i cme c hani s m.Asar e s ul tof r e duc e dut e r opl ac e nt alpe r f us i on,f e t alhypoxi aandi nt r aut e r i negr owt hr e t ar dat i onbe c omeunavoi dabl ei npr e e c l amps i a.Thehi s t opat hol ogi c alc hange si nt heumbi l i c alc or dbe t we e nt hec hr oni c hype r t e ns i veandpr e e c l ampt i cpat i e nt sde pe ndont heDoppl e rr e s ul t s .I nc onc l us i on,t heumbi l i c al ar t e r yDoppl e rFVW i ndi c e spr ovi degoodval ue sf orpr e di c t i ngi nt r aut e r i negr owt hr e t ar dat i oni n pr e e c l ampt i cpat i e nt s . Ke ywor ds :u mb i l i c a lc o r d ,mo r p h o me t r y ,h y p e r t e n s i v ei n d u c e dp r e g n a n c y
y p e r t e n s i v ed i s o r d e r si np r e g n a n c ya r er e s p o n s i b l ef o ras i g n i fi c a n ta mo u n to fma t e r n a la n d p e r i n a t a lmo r b i d i t ya n dmo r t a l i t y .Th ee t i o l o g yo ft h e s e d i s o r d e r si ss t i l lu n k n o wn .I tc o mp l i c a t e sa b o u t62 0
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o fa l lp r e g n a n c i e s .Pr e e c l a mp s i aa n de c l a mp s i ac o n s t i t u t e a b o u t7 0 o ft h e s ed i s o r d e r s ,wh e r e a sc h r o n i ch y p e r t e n s i o nr e p r e s e n t st h er e ma i n i n g3 0 o fh y p e r t e n s i v ed i s [ ] o r d e r si np r e g n a n c y1 ,2. Al t h o u g hp r e e c l a mp s i ai so n eo ft h ema j o rc a u s e so f ma t e r n a ld e a t h ,e s p e c i a l l yi nd e v e l o p i n gc o u n t r i e s ,p e r i n a t a lo u t c o me sa r ea l s on o tf a v o r a b l e .I n t r a u t e r i n e g r o wt hr e t a r d a t i o n ,p r e ma t u r ed e l i v e r y ,l o wb i r t hwe i g h t ,
1
Acta Medica Okayama, Vol. 56 [2002], Iss. 4, Art. 2
178 I nanetal .
f e t a ld e a t ha n dn e o n a t a ld e a t hd u et op r e ma t u r eb i r t ha r e c o mmo n c o mp l i c a t i o n s . Pr e d i c t i n g p r e e c l a mp s i ai s d ic u l ti ne a r l yp r e g n a n c y ,b u ts o mee p i d e mi o l o g i c a lr i s k f a c t o r sa r ek n o wn ,s u c ha sn u l l i p a r i t y ,p r e v i o u sp r e e c l a mp s i a ,f a mi l yh i s t o r y ,b l a c kr a c e ,o b e s i t y ,d i a b e t e s <1 me l l i t u s ,mu l t i f e t a lp r e g n a n c i e s ,a g eo fmo t h e r( 8 > [ ] a n d 3 5 ) ,a n dp r e v i o u sr e n a ld i s e a s e 3. Al t h o u g ht h ee t i o l o g yo fp r e e c l a mp s i ai ss t i l l u n k n o wn , t h ep l a c e n t ap l a y sac r u c i a lr o l ei nt h ed e v e l o p me n to ft h e [4 ].Pr d i s e a s e ,5 e e c l a mp s i ai sa s s o c i a t e dwi t hi n c r e a s e d v a s c u l a rr e s i s t a n c ea n dd e c r e a s e du t e r o p l a c e n t a l p e r f u s i o n . Ac c o r d i n gt ot h ed e g r e eo fd e c r e a s ei nu t e r o p l a c e n t a l p e r f u s i o n ,f e t a lh y p o x i aa n di n t r a u t e r i n eg r o wt hr e t a r d a [6 ].Ma t i o nc a nb e c o meu n a v o i d a b l e n ys t u d i e sh a v e d e mo n s t r a t e ds i g n i fi c a n td ie r e n c e si nt h emo r p h o l o g i c a l s t r u c t u r e so ft h ep l a c e n t aa n du mb i l i c a lc o r dv e s s e l s [7 b e t we e nn o r ma la n dp r e e c l a mp t i cp r e g n a n two me n ] 1 2.Mo s to ft h ewo me nwi t hp r e e c l a mp s i as h o wh i s t o l o g i c a la n db i o c h e mi c a le v i d e n c eo fp o o rp l a c e n t a t i o n a n di s c h e mi a .Br u c he ta l .r e p o r t e dt h a tg r o wt h r e t a r d e d f e t u s e swi t ho rwi t h o u tu mb i l i c a la r t e r yDo p p l e ra b n o r ma l i t i e sh a v eas ma l l e ru mb i l i c a lc o r dc r o s s s e c t i o n a la r e a [1 ].DiNa a td e l i v e r yt h a nd on o r ma lh e a l t h yf e t u s e s 0 r o f o u n dt h a tt h ed i a me t e r sa n da r e a so fu mb i l i c a lc o r d s c h a n g e dd u r i n gg e s t a t i o n ,a n dt h e s ed ie r e n c e sd e p e n d e d o nt h er e d u c t i o no fWh a r t o nj e l l yr a t h e rt h a nt h eu mb i l i c a l [1 ].J v e s s e l st h e ms e l v e s 1 u n e ke ta l .d e mo n s t r a t e dt h a t u mb i l i c a la r t e r i e swe r et h i c k e ri nt h ep r e e c l a mp t i cg r o u p t h a ni nu n c o mp l i c a t e dp r e g n a n c i e s . Th e s ed ie r e n c e s we r ee s p e c i a l l yo b s e r v e di nt h et u n i c ai n t i maa n dme d i a . Th e s ed ie r e n c e swe r ea c c e p t e da sar e s u l to ft h ea d a p t a t i o ns y s t e mo ft h eu mb i l i c a l c o r da r t e r i e su n d e rt h ea l t e r e d [1 ]. h o mo d y n a mi cc o n d i t i o n si np r e e c l a mp s i a 2 I twa so b s e r v e dt h a tu mb i l i c a la r t e r i a lv a s o c o n s t r i c t i o n wa si n d u c e db ya ne x c e s so fe i t h e re n d o t h e l i u mo r p l a t e l e t d e r i v e dt h r o mb o x a n eA2 ,a sd e s c r i b e di nI UGR [1 ].A h 3 i g h e rp r o d u c t i o no fe n d o t h e l i ni nI UGRwa s [1 ].Bu a l s od e s c r i b e d 4 tt h ed e g r e eo fd e f e c t i v ep l a c e n t a t i o na n dp l a c e n t a li s c h e mi ama yn o ta d j u s tt ot h es e v e r i t y o fp r e e c l a mp s i a .Th e r e f o r es o meo t h e rp r e e x i s t i n gf a c t o r s mu s ta l s ob ep r e s e n t .Th e s ea l t e r a t i o n si nt h ep l a c e n t a a n du mb i l i c a lc o r dv e s s e l sma yd e v e l o pa sar e s u l to fa d e c r e a s ei nav a s o d i l a t o rs u b s t a n c eo ra ni n c r e a s ei n [ v a s o c o n s t r i c t o r sd u et oap a t h o p h y s i o l o g i ce v e n t1 5 ] 1 8 . An a b n o r ma le n d o t h e l i a lh y p e r s t i mu l a t i o na n d d y s f u n c t i o nmi g h tb et h ema i ne v e n t ,a n dp r e e c l a mp s i a c a nb ea na c u t ef o r mo fs u c has i t u a t i o n .Bo t hp r e e c l a mp s i aa n dc h r o n i ch y p e r t e n s i o ni n c l u d es i mi l a rr i s kf a c t o r s
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Act aMed.Okay ama Vol .56,No.4
a n db i o c h e mi c a la l t e r a t i o n s .Al t h o u g ht h ep e r i n a t a lr i s k f o rwo me nwi t hc h r o n i ch y p e r t e n s i o ni sl e s st h a nf o r p r e e c l a mp t i cwo me n ,t h eh i s t o p a t h o l o g i c a ld ie r e n c e si n b o t hg r o u p sma yb ei mp o r t a n tf o rt h ed e v e l o p i n gf e t u s . Th ea i mo ft h i ss t u d ywa st oc o mp a r et h emo r p h o l o g i c a l c h a n g e si nt h eu mb i l i c a lc o r dv e s s e l si nn o r mo t e n s i v e p r e g n a n c i e s ,c h r o n i ch y p e r t e n s i v ep r e g n a n c i e sa n dp r e e c l a mp t i cp a t i e n t swi t ha n dwi t h o u tp a t h o l o g i cu mb i l i c a l a r t e r yDo p p l e ru l t r a s o u n ds t u d yr e s u l t s .
Mat e r i al sandMe t hods Th eEt h i c sCo mmi t t e eo ft h eRe s e a r c h Ce n t e ro fAe g e a nSo c i a lSe c u r i t yHo s p i t a la p p r o v e dt h e p r o t o c o l .St u d i e swe r ep e r f o r me do nt h eu mb i l i c a lc o r d s -4 o f1 3 5n e wb o r n s ,d e l i v e r e db e t we e n3 5 0we e k so f g e s t a t i o n .I na l lc a s e s ,1 0c ml o n gs e c t i o n so ft h e u mb i l i c a lc o r dwe r ec u t ,b e g i n n i n gf r o mt h e i rp l a c e n t a l e n d ,f o rmo r p h o me t r i cs t u d yo ft h eu mb i l i c a lc o r dv e s s e l s .Pa t i e n t swe r es e p a r a t e di n t o4g r o u p s .Th e r ewe r e ± SD) n os t a t i s t i c a l l ys i g n i fi c a n td ie r e n c e si nt h eme a n( a g eo ft h ewo me na mo n gt h eg r o u p s .Pa t i e n tc h a r a c t e r i s t i c sa r eg i v e ni nTa b l e1 .Fo ra l lp a t i e n t s ,a r t e r i a l u mb i l i c a lfl o wv e l o c i t ywa v e f o r ms( FVW)f r o m2 4ht o1 we e kb e f o r ed e l i v e r ywe r er e c o r d e dwi t hTo s h i b a2 5 0 p u l s e wa v e dDo p p l e rUSG,u s i n ga5MHza b d o mi n a l t r a n s d u c e r . No r ma lu mb i l i c a lDo p p l e ri n d i c e s we r e d e fi n e da sas y s t o l i c/d i a s t o l i cv a l u eb e t we e n5 a n d 9 5 wi t hr e s p e c tt og e s t a t i o n a la g e .Va l u e so u to ft h i s r a n g ewe r et a k e na sa b n o r ma l . Gr o u p1:Th ec o n t r o lma t e r i a lwa st a k e nf r o mn e w-3 b o r n sd e l i v e r e db yh e a l t h ymo t h e r s ,a g e d2 3 2 ,wi t h -1 n o r ma l b l o o dp r e s s u r e( s y s t o l i c1 0 0 3 5mmHg ,d i a s t o l i c = 6 08 5 )a n dh a v i n gn o r ma lu mb i l i c a lDo p p l e rFVW ( n 3 4 ) . Ex c l u s i o nc r i t e r i ai n c l u d e d mu l t i p l ep r e g n a n c i e s , e s s e n t i a lh y p e r t e n s i o n ,d i a b e t e s ,c h r o n i cr e n a ld i s e a s e , p l a t e l e td i s o r d e r s ,a n de p i l e p s y .Th eme a nb o d ywe i g h t o ft h en e wb o r n swa s3 , 2 6 1 . 7± 4 1 8 . 3g r a ms . Gr o u p2:I nt h i sg r o u p ,t h eu mb i l i c a lc o r d swe r e -3 t a k e nf r o mn e wb o r n sd e l i v e r e db ymo t h e r s ,a g e d2 4 3 , wi t he s s e n t i a lh y p e r t e n s i o nb e f o r et h e2 0t hwe e ko f p r e g n a n c ya n dh a v i n gn o r ma lu mb i l i c a lDo p p l e rFVW ( n= 3 1 ) .Th eme a nb o d ywe i g h to ft h e s en e wb o r n swa s ± 3 , 1 5 3 . 2 3 1 4 . 8g r a ms . Gr o u p3:I nt h i sg r o u p ,t h eu mb i l i c a lc o r d swe r e -3 t a k e nf r o mn e wb o r n sd e l i v e r e db ymo t h e r s ,a g e d2 2 2 , wi t hp r e e c l a mp s i a .Wo me nwe r ed i a g n o s e dwi t hp r e e c l a mp s i ai ft h e yh a db l o o da r t e r i a lp r e s s u r ea sf o l l o ws :
2
Inan et al.: Comparative morphological differences between umbilical
Augus t2002 Ta b l e1
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Cl i n i c a lc h a r a c t e r i s t i c so fn o r ma l ,c h r o n i ch y p e r t e n s i v ea n dp r e e c l a mp t i cp r e g n a n c i e s GROUP
Ag e / Pa r i t y( Nu l l i p a r mu l t i p a r ) Ge s t a t i o n a la g e( wk ) Si s t o l i cBl o o d Pr e s s u r e( mmHg ) Di a s t o l i cBl o o d Pr e s s u r e( mmHg ) Ed e ma / Sp o n t a n td e l i v e r y Ce s a r i a ns e c t i o n APGAR Fe t a lwe i g h t( g m)
GROUP1
GROUP2
GROUP3 A
GROUP3 B
Co n t r o l
Ch r o n i cHT wi t hn o r ma l Do p p l e rFVW
Pr e e c l a mp s i a wi t hn o r ma l Do p p l e rFVW
Pr e e c l a mp s i a wi t hp a t h o l o g i c a l Do p p l e rFVW
n= 3 4 2 7 . 7± 4 . 6 /1 2 1 3 # 3 9 . 0± 0 . 5
N= 3 1 2 8 . 3± 4 . 4 / 1 0 2 1 3 8 . 3± 1 . 0
n= 3 2 2 7 . 6± 5 . 3 / 2 3 9 3 7 . 3± 0 . 9
n= 3 8 2 5 . 5± 3 . 8 / 2 6 1 2 3 6 . 4± 1 . 1
# 1 0 7 . 0± 1 0 . 8
1 4 8 . 3± 1 1 . 8
1 4 9 . 8± 1 1 . 8
1 5 6 . 5± 1 2 . 7
# 6 9 . 4± 9 . 9
9 5 . 9± 6 . 1
1 0 1 . 0± 1 1 . 4
1 0 5 . 1± 1 0 . 7
#
0 . 9± 0 . 9
2 . 2± 0 . 4
2 . 2± 0 . 4
/ 1 6 1 5
/ 6 2 6
/3 7 1
1 . 0± 0 . 6 #
/ 2 5 9
#
8 . 3± 0 . 6 3 2 6 1 . 7± 4 1 8 . 3
8 . 0± 0 . 7 3 1 5 3 . 2± 3 1 4 . 8
7 . 4± 0 . 8 3 0 1 5 . 6± 4 2 6 . 6
6 . 8± 1 . 2 2 1 0 9 . 2± 5 8 9 . 9
#
,P< 0 . 0 5Gr o u p1v s .Gr o u p2 ,3 A,3 B; ,P< 0 . 0 5Gr o u p3 Av s .Gr o u p2; ,P< 0 . 0 5Gr o u p3 Bv s .Gr o u p3 A,2 .
s y s t o l i c> 1 4 0mmHg ,d i a s t o l i c> 9 0mmHgme a s u r e d o n2o rmo r eo c c a s i o n sa tl e a s t4ha p a r ta f t e rt h e2 0t h we e ko fg e s t a t i o n .Pr o t e i n u r i awa sc o n s i d e r e dp r e s e n t > wh e nt h e r ewa sau r i n ed i p s t i c kv a l u eo fa tl e a s t1+ ( /d 3 0mg l )o n2s e p a r a t eo c c a s i o n sa tl e a s t6ha p a r t . No n eo ft h ewo me nh a da nMg SO4o rb e t a me t h a s o n e i n j e c t i o nb e f o r et h eb l o o ds a mp l e swe r ed r a wn .Th i s g r o u pwa ss u b d i v i d e di n t o2g r o u p sa c c o r d i n gt oDo p p l e r FVW r e s u l t s . Gr o u p3 A:Wi t hn o r ma lu mb i l i c a la r t e r yDo p p l e r FVW ( n= 3 2 ) .Th eme a nb o d ywe i g h to ft h e s en e wb o r n swa s3 , 0 1 5 . 6± 4 2 6 . 6g r a ms . Gr o u p3 B( 4 ) :Wi t ha b n o r ma lu mb i l i c a la r t e r yDo p p l e rFVW ( n= 3 8 ) .Th eme a nb o d ywe i g h to ft h e s e n e wb o r n swa s2 , 1 0 9 . 2± 5 8 9 . 9g r a ms . Ea c hu mb i l i c a lc o r dwa si mme d i a t e l y c l a mp e da td e l i v e r y .I na l lc a s e s ,1 0c ml o n gs e c t i o n so f u mb i l i c a lc o r dwe r ec u t ,b e g i n n i n gf r o mt h e i rp l a c e n t a l e n d ,f o rmo r p h o me t r i cs t u d yo ft h eu mb i l i c a lc o r dv e s s e l s .Fi v eb l o c k so fc o r dc r o s s s e c t i o n swe r ec u t .A r o u t i n ep a r a np r o c e d u r ewa sd o n e .I nb r i e f ,t i s s u e s a mp l e swe r efi x e di n1 0 f o r ma l i ns o l u t i o n .Th e ywe r e d e h y d r a t e di nag r a d e de t h a n o ls e r i e s ,c l e a n e di nx y l e n e a n de mb e d d e di np a r an .Se c t i o n swe r ec u ta t5μm t h i c k n e s s ,d e p a r an i s e da n dh y d r a t e d .Se r i a ls e c t i o n so f t h eu mb i l i c a lc o r d swe r es t a i n e dwi t hh e ma t o x y l i na n d e o s i n( H. E) .Sy s t e ma t i cr a n d o ms a mp l e so fu mb i l i c a l
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×4 c o r ds e c t i o n swe r ei d e n t i fi e du n d e rami c r o s c o p e( 0 ) , a n du n b i a s e dmo r p h o me t r i cs t u d ywa sp e r f o r me du s i n ga n Ol y mp u smi c r o s c o p e .Th ev i e wf r o mt h emi c r o s c o p ewa s d i r e c t l yp r o j e c t e do n t ot h ec o mp u t e rs c r e e n .As y s t e ma t i c g r i do fc r o s s e swa sr a n d o ml yt h r o wno n t ot h ev i e we d o b j e c t .Th ei n t e r c r o s ss p a c i n gi nt h exa n dyd i r e c t i o ni s Δxa n dΔyu n i t s ,r e s p e c t i v e l y .Th i sme a n st h a te a c h /pu c r o s sh a sa na s s o c i a t e da r e ao fa n i t s.Th en u mb e r /pi o fc r o s s e st h a th i tt h eo b j e c tmu l t i p l i e db ya sa n [1 ] u n b i a s e de s t i ma t eo ft h eo b j e c t sa r e a 8 .Th ef o l l o wi n gp a r a me t e r swe r eme a s u r e df o re a c hu mb i l i c a lc o r d: t o t a l c o r da n dWh a r t o nj e l l ya r e a s ,t o t a lv e s s e l a n dl u me n a r e a s ,a n dwa l lt h i c k n e s s .Wa l l t h i c k n e s sme a s u r e me n t s e x p r e s st h ewh o l et h i c k n e s so ft h ev e s s e lwa l l ,f r o mt h e e n d o t h e l i u mt ot h eWh a r t o nj e l l y . Al lmo r p h o me t r i c me a s u r e me n t swe r ed o n ei nab l i n df a s h i o n ,wi t h o u t p r e e x i s t i n gk n o wl e d g eo ft h ec l i n i c a ld a t a . Al lr e s u l t sa r ee x p r e s s e d a sme a nv a l u e s± SEs .St a t i s t i c a la n a l y s i so fd a t aa n d SEswa sc a l c u l a t e df o re a c hp a r a me t e ra n de s t i ma t e di n e a c hg r o u p . Fo rc o mp u t a t i o n we u s e dt h e SPSS Ad v a n c e dSt a t i s t i c a lp a c k a g e .Th ed a t awa sa n a l y z e db y a n ANOVA t e s t ,a n dd ie r e n c e s we r ec o n s i d e r e d s i g n i fi c a n ti fP< 0 . 0 5 .
3
Acta Medica Okayama, Vol. 56 [2002], Iss. 4, Art. 2
180 I nanetal .
Act aMed.Okay ama Vol .56,No.4
Re s ul t s De mo g r a p h i ca n dc l i n i c a lfi n d i n g so ft h ec o n t r o l g r o u p ( Gr o u p1 ) ,c h r o n i ch y p e r t e n s i v e+ p r e g n a n c y( Gr o u p2 ) , p r e e c l a mp t i cwi t hn o r ma lDo p p l e r( Gr o u p3 A)a n dp r e e c l a mp t i cwi t ha b n o r ma lDo p p l e r( Gr o u p3 B)a r es u mma r i z e di nTa b l e1 .Ase x p e c t e df r o mt h ei n c l u s i o na n d ma t c h i n gc r i t e r i a ,t h ep a t i e n t sa g e swe r en o ts i g n i fi c a n t l y d ie r e n t ,b u to t h e rp a r a me t e r ss u c ha sb l o o dp r e s s u r e a n de d e mawe r es i g n i fi c a n t l ye l e v a t e d( P< 0 . 0 5 )i nt h e p r e e c l a mp t i cg r o u p .Th eme t h o do fd e l i v e r ywa su s u a l l y c e s a r e a ns e c t i o ni nGr o u p s3 Aa n d3 B.Wea l s os a wt h a t t h eg e s t a t i o n a la g ea n db i r t hwe i g h twe r es i g n i fi c a n t l y l o we ri nt h ep r e e c l a mp t i cg r o u p ,e s p e c i a l l yi nt h ep a t h o l o g i cDo p p l e rfl o wp a t t e r n s .Re l a t e dwi t ht h e s efi n d i n g s , APGARs c o r e si nGr o u p s2 ,3 Aa n d3 Bwe r ef o u n dt o b el o w.Th er e s u l t so ft h emo r p h o me t r i cp a r a me t e r so f u mb i l i c a lc o r d sa r eg i v e ni nTa b l e2 . Hi s t o l o g i c a le x a mi n a t i o no ft h eu mb i l i c a lc o r ds h o ws s e v e r a ld i s t i n c tl a y e r su n d e rt h el i g h tmi c r o s c o p ei nt h e c o n t r o lg r o u p( Fi g .1 A) .Ont h es u r f a c ei sawe l l d e fi n e d s i n g l el a y e ro fs q u a mo i da mn i o t i ce p i t h e l i u m.De e pi nt h e e p i t h e l i u mt h a tc o mp r i s e st h es u r f a c eo ft h ec o r di st h e s u b s t a n c ek n o wna sWh a r t o nsj e l l y .Emb e d d e dwi t h i n t h eWh a r t o nsj e l l ya r et h eu mb i l i c a lv e s s e l s .Th ev a s -
Ta b l e2
c u l a t u r eo ft h eu mb i l i c a lc o r di sc o mp o s e do f2a r t e r i e s a n das i n g l ev e i n .Th ea r t e r i e sp o s s e s sn oe l a s t i cl a mi n a a n dh a v ead o u b l e l a y e r e dmu s c u l a rwa l l( Fi g .1 B) .Ea c h o ft h e s emu s c u l a rl a y e r si sc o mp o s e do fan e t wo r ko f i n t e r l a c i n gs mo o t hmu s c l eb u n d l e s .Th ev e i nh a sa ni n n e r e l a s t i cl a mi n a( Fi g .1 C) .Th eu mb i l i c a lv e i n ,wh i c h g e n e r a l l yh a sal a r g e rd i a me t e r ,p o s s e s s e sat h i n n e r mu s c u l a rc o a tc o n s i s t i n go fas i n g l el a y e ro fc i r c u l a r s mo o t hmu s c l e .I nt h ec o n t r o lg r o u p ,t h eme a nc o r da r e a wa s6 3 . 5 8± 2 . 0 0 ,t h et o t a la r e ao ft h ev e i nwa s6 . 2 8± 0 . 4 4a n dt h ewa l lt h i c k n e s so ft h ev e i nwa s4 7 1 . 7 5± 3 3 . 2 7 .Th et h i c k n e s s e so ft h ea r t e r i e swe r es i mi l a rt o e a c ho t h e r .Th eme a nwa l lt h i c k n e s so ft h ea r t e r i e swa s 5 9 7 . 0 8± 1 8 . 0 2a n dt h e i rt o t a la r e awa s2 . 9 7± 0 . 1 8 . Wh e nt h eu mb i l i c a lc o r dv e s s e l si nGr o u p2( c h r o n i c h y p e r t e n s i v e+ p r e g n a n c y )we r ee x a mi n e du n d e rt h el i g h t mi c r o s c o p e ,t h eh i s t o l o g i c a la p p e a r a n c ea p p e a r e dt ob e c l o s et on o r ma l( Fi g .2 A) .Th ee n d o t h e l i u ma n dt h e s u b e n d o t h e l i u mo ft h eu mb i l i c a la r t e r y( Fi g .2 B)a n dv e i n ( Fi g .2 C)we r es e e nt ob ei nt h e i rn o r ma l s t a t e .Al t h o u g h af e wc o n t r a c t i o n si nt h en u c l e u sc o u l db es e e n ,t h e s mo o t hmu s c l ec e l l sg e n e r a l l yh a dt h ea p p e a r a n c eo fb e i n g n o r ma la n do fn o r ma ls i z e( Fi g .2 D) .Th ei n t e r c e l l u l a r g a p sh a da nu n n o t i c e a b l ewi d e n i n gb e t we e nt h e m.Th e mo r p h o me t r i ca n a l y s e so ft h i sg r o u ps h o we dt h a tt h et o t a l
Co r r e l a t i o nsc o r dp a r a me t e r s
UMBI LI CALCORD PARAMETERS
Umb i l i c a lc o r d To t a lc o r da r e a J e l l ya r e a To t a lv e s s e la r e a To t a ll u me na r e a Ve i n To t a la r e amm Lu me na r e amm Wa l lt h i c k n e s sμm Ar t e r y To t a la r e amm Lu me na r e amm Wa l lt h i c k n e s sμm
GROUP1
GROUP2
GROUP3 A
GROUP3 B
Co n t r o l
Ch r o n i cHT wi t hn o r ma l Do p p l e rFVW
Pr e e c l a mp s i a wi t hn o r ma l Do p p l e rFVW
Pr e e c l a mp s i a wi t hp a t h o l o g i c a l Do p p l e rFVW
n= 3 4
N= 3 1
n= 3 2
n= 3 8
# 6 3 . 5 8± 2 . 0 0 # 5 1 . 3 7± 1 . 7 9 # 8 . 4 4± 0 . 6 9 # 3 . 7 7± 0 . 1 3
5 4 . 0 9± 2 . 6 5 4 3 . 9 5± 2 . 4 3 7 . 0 1± 0 . 2 9 3 . 1 1± 0 . 2 8
4 8 . 9 9± 3 . 1 8 4 0 . 3 9± 3 . 0 9 6 . 0 7± 0 . 2 2 2 . 5 8± 0 . 1 0
4 1 . 8 4± 1 . 5 8 3 5 . 2 2± 1 . 7 7 5 . 0 1± 0 . 1 9 1 . 6 1± 0 . 1 1
# 6 . 2 8± 0 . 4 4 # 2 . 9 7± 0 . 2 9 4 7 1 . 7 5± 3 3 . 2 7
4 . 9 5± 0 . 0 9 2 . 4 7± 0 . 0 5 4 5 9 . 5 8± 1 1 . 5 8
3 . 6 1± 0 . 1 1 1 . 9 6± 0 . 2 1 4 3 7 . 7 5± 1 0 . 7 9
2 . 5 1± 0 . 2 2 1 . 1 0± 0 . 2 2 3 9 8 . 5 8± 1 1 . 5 4
# 2 . 9 7± 0 . 1 8 0 . 4 0± 0 . 0 5 5 9 7 . 0 8± 1 8 . 0 2
2 . 5 9± 0 . 1 4 0 . 3 2± 0 . 0 4 5 4 4 . 9 0± 1 7 . 4 0
2 . 4 9± 0 . 1 2 0 . 3 1± 0 . 0 5 5 4 7 . 5 8± 1 2 . 0 1
2 . 0 6± 0 . 0 6 0 . 2 5± 0 . 0 6 4 2 6 . 6 6± 1 9 . 2 2
#
,P< 0 . 0 5Gr o u p1v s .Gr o u p2 ,3 A,3 B; ,P< 0 . 0 5Gr o u p3 Av s .Gr o u p2; ,P< 0 . 0 5Gr o u p3 Bv s .Gr o u p2 ,3 A,1 .
http://escholarship.lib.okayama-u.ac.jp/amo/vol56/iss4/2
4
Inan et al.: Comparative morphological differences between umbilical
Augus t2002
Pr egnancy ,Hy per t ens i on,Umbi l i calCor d 181
Fi g.1 Ph o t o mi c r o g r a p h so fu mb i l i c a lc o r dt a k e nf r o man e wb o r nwi t han o r mo t e n s i v e ,h e a l t h ymo t h e r( Co n t r o lg r o u p ) .No r ma l a p p e a r a n c e o fu mb i l i c a lc o r da n dv e s s e l swe r es e e n .Ont h es u r f a c ei sawe l l d e fi n e ds i n g l el a y e ro fa mn i o t i ce p i t h e l i u m( a ) ,e mb e d d e dwi t h i nt h es u b s t a n c e o fWh a r t o nsj e l l y( w)a r et h eu mb i l i c a lv e s s e l s .Ge n e r a lv i e wo fu mb i l i c a lc o r da tama g n i f i c a t i o no f× 1 0( A) ;u mb i l i c a lc o r da r t e r y ,× 4 0 ( B) ;u mb i l i c a lv e i n( V) ,× 4 0( C) .H. E.
c o r da n dj e l l ya r e a ,a n dt h et o t a lv e s s e la r e awe r e s i g n i fi c a n t l yr e d u c e d( Fi g .2 A) .Th ewa l lt h i c k n e s so ft h e u mb i l i c a lv e s s e l swa sd e c r e a s e di nGr o u p2 ,b u tt h e d ie r e n c ewi t ht h ec o n t r o lg r o u pwa sn o ts t a t i s t i c a l l y s i g n i fi c a n t . I twa so b s e r v e dt h a ti np r e e c l a mp t i cp a t i e n t sh a v i n g n o r ma lDo p p l e rFVW ( Gr o u p3 A) ,awi d e n i n gu n d e rt h e e p i t h e l i u mo ft h ea r t e r ya n db e t we e nt h emu s c l el a y e r s wa sp r e s e n td u et ot h ee d e ma( Fi g .3 B) .Th ec o n t r a c t i o n o ft h emu s c l ec e l l so c c u r r e dwi t hawa v e l i k ea p p e a r a n c e o ft h en u c l e u s .Se p a r a t i o n sa p p e a r e db e t we e nt h emu s c l e c e l l sd u et ot h ei n c r e a s ei nfl u i db e t we e nt h ec e l l s ,wh i c h wa sa s s o c i a t e dwi t ht h ee d e ma .Th i se d e mai nr e l a t i o nt o t h ec o n n e c t i v et i s s u eb e t we e nt h el a y e r so fmu s c l ema d e i tmu c he a s i e rt od i s t i n g u i s hb e t we e nt h el a y e r s .Th ev e i n l u me nwa ss e e nt oh a v en a r r o we dd u et ot h ee d e mao nt h e v e i nwa l la n dt ot h ev a s o c o n s t r i c t i o n( Fi g .3 C,3 D) .
Produced by The Berkeley Electronic Press, 2002
Ma c r o s c o p i c a l l y ,t h ec o r dt h i c k n e s swa ss i g n i fi c a n t l y r e d u c e di nt h i sg r o u pi nc o mp a r i s o nwi t ht h ec o n t r o la n d h y p e r t e n s i v eg r o u p s .Wh e nGr o u p3 A wa sc o mp a r e d wi t hGr o u p2 ,as i g n i fi c a n tr e d u c t i o no ft h et o t a lv e s s e l a r e ao ft h ec o r dwa so b s e r v e d .I nc o n t r a s t ,n od ie r e n c e wa so b s e r v e di nt h ewa l lt h i c k n e s so ft h ev e s s e l s . Th eu mb i l i c a lc o r dv e s s e l s ,wh i c hwe r et a k e nf r o m p r e e c l a mp t i cp a t i e n t swh oh a da na b n o r ma lDo p p l e r ( Gr o u p3 B) ,s e e me dt ob emo r p h o l o g i c a l l yh y p o p l a s t i c ( Fi g .4 ) .Wh e ne x a mi n e du n d e ral i g h tmi c r o s c o p e ,t h e d i a me t e r so ft h ev e s s e l swe r es i g n i fi c a n t l yr e d u c e d( Fi g . 4 A) .Th emu s c l ea r e as e p a r a t e df r o mt h ec o n n e c t i v e t i s s u e s ,wh i c hl e di nt u r nt ot h es u b s t a n t i a ln a r r o wi n go f t h ed i a me t e ro ft h el u me n ,wh i c hwa se s p e c i a l l yn o t i c e a b l e i nt h ea r t e r i e s( Fi g .4 B) .Th i sn a r r o wi n go ft h el u me n r e s u l t e di nt h en a r r o wi n go ft h ev e i nd i a me t e r( Fi g .4 C) . Th emu s c l ec e l l swe r es e e nt ob eh y p o p l a s t i ca n ds ma l l e r
5
Acta Medica Okayama, Vol. 56 [2002], Iss. 4, Art. 2
182 I nanetal .
Act aMed.Okay ama Vol .56,No.4
Fi g.2 Ph o t o mi c r o g r a p h so fu mb i l i c a lc o r dt a k e nf r o mc h r o n i ch y p e r t e n s i v emo t h e r( Gr o u p2 ) .Th ee n d o t e la n ds u b e n d o t e ls e e me dt ol o o k c l o s et on o r ma l ,t h es mo o t hmu s c l ec e l l so nt h ev e s s e lwa l l swe r ea l s os e e nt ob eo nt h e i rn o r ma ls t a t e .Al t h o u g hi tc o u l db es e e nt h a ta f e wv a s o c o n t r i c t i o n sh a dap a t c h e ds t a t ei nt h en u c l e u s( a r r o w) .Ge n e r a lv i e wo fu mb i l i c a lc o r da tama g n i f i c a t i o no f× 1 0( A) ;u mb i l i c a lc o r d a r t e r y ,× 4 0( B) ;u mb i l i c a lv e i n( V) ,× 4 0( C) ;h i g h e rma g n i fi c a t i o no ft h ev e i nwa l l ,× 2 0 0( D) .H. E.
[7 -1 ] e dwi t hs ma l l e rp l a c e n t a sa n dt h i nu mb i l i c a l c o r d s 0 . I nt h i ss t u d y ,t h eh i s t o p a t h o l o g i c a la n dmo r p h o me t r i c d ie r e n c e sa s s o c i a t e dwi t hp r e g n a n c y i n d u c e dh y p e r t e n s i o n( p r e e c l a mp s i a )a n dc h r o n i ch y p e r t e n s i o nwe r eo b s e r v e d .Ab n o r ma lu mb i l i c a lc o r da r t e r i a lDo p p l e rFVW wa s a s s o c i a t e dwi t ht h er e d u c e du mb i l i c a lc o r dd i a me t e r .I t wa sa l s oa s s o c i a t e dwi t hb o t hr e d u c e dt o t a l c o r da r e a sa n d r e d u c e dWh a r t o nj e l l ya r e a s . Ch r o n i ch y p e r t e n s i o ni sc h a r a c t e r i z e db ya ni n c r e a s e d v a s c u l a rr e s i s t a n c ea n dmo d i fi c a t i o n si nt h eme c h a n i c a l [2 ].Ve p r o p e r t i e so fb l o o dv e s s e l s 0 s s e l sc o n t r a c tv i aa v a r i e t yo fp h a r ma c o l o g i c a la g e n t si n c l u d i n gs e r o t o n i n , p o t a s s i u mc h l o r i d e ,b r a d y k i n i n ,a n g i o t e n s i n e ,o x y t o s i n Di s c us s i on [2 ].Th a n do t h e r s 1 ,2 2 e s ep r o p e r t i e sh a v en o tb e e n Th eu mb i l i c a l c o r da p p e a r st op l a ya ni mp o r t a n tr o l ei n f u l l yi n v e s t i g a t e di np r e g n a n c y i n d u c e dh y p e r t e n s i o n .Bu t i n t e r a c t i o n sb e t we e nt h emo t h e ra n df e t u sd u r i n gp r e g - l i k ec h r o n i ch y p e r t e n s i o ni np r e e c l a mp s i a ,t h ei n h i b i t i o n n a n c y .Pr e g n a n c i e swi t hg r o wt hr e t a r d a t i o na r ea s s o c i a t - o fp r o s t a c y c l i n es y n t h e s i s ,h y p e r s e n s i t i v i t yt ov a s o c o n t h a nt h e i rn o r ma ls i z e( Fi g .4 D) .Th ec o n t r a c t e ds mo o t h mu s c l ec e l l swe r es e e nt oh a v es e p a r a t e dt h e i rl i n k sf r o m e a c ho t h e ri ns o mep a r t s .Th ee n d o t h e l i u ma n ds u b e n d o t h e l i u mo ft h ev e s s e l sa n dt h ei n n e rl a y e r so fmu s c l e we r eo b s e r v e dt oh a v ec o mp l e t e l yj o i n e de a c ho t h e r .Wi t h t h i so b s e r v a t i o n ,h y p o p l a s yc o u l db ec l e a r l yd e t e c t e d .I n t h i sg r o u p ,i twa so b s e r v e dt h a ta l lp a r a me t e r so ft h e u mb i l i c a lc o r dwe r es i g n i fi c a n t l yr e d u c e di nc o mp a r i s o nt o t h en o r ma la n dh y p e r t e n s i v eg r o u p s .As i g n i fi c a n tc o r r e l a t i o nwa sa l s oo b s e r v e db e t we e nt h et h i c k n e s so fav e s s e l wa l la n dt h ep a t h o l o g i cDo p p l e rv a l u e s .
http://escholarship.lib.okayama-u.ac.jp/amo/vol56/iss4/2
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Inan et al.: Comparative morphological differences between umbilical
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Fi g.3 Ph o t o mi c r o g r a p h so fu mb i l i c a lc o r dt a k e nf r o mp r e e c l a mp t i cmo t h e rh a v i n gn o r ma lDo p p l e rFVW( Gr o u p3 A) .Awi d e n i n gu n d e rt h e e p i t h e l i u mb e t we e nt h emu s c l el a y e r sa n dt h ec o n t r a c t i o no ft h emu s c l ec e l l swa ss e e nwi t hawa v e dl i k ea p p e a r a n c eo ft h en u c l e u s . Se p a r a t i o n sa p p e a r e di nb e t we e nt h emu s c l ec e l l sa n di nb e t we e nt h el a y e r so fmu s c l e( a r r o w) .Th ev e i nl u me nwa ss e e nt oh a v en a r r o we d . Ge n e r a lv i e wo fu mb i l i c a lc o r da tama g n i f i c a t i o no f× 1 0( A) ;u mb i l i c a lc o r da r t e r y ,× 4 0( B) ;u mb i l i c a lv e i n( V) ,× 4 0( C) ;h i g h e r ma g n i fi c a t i o no ft h ev e i nwa l l ,× 2 0 0( D) .H. E.
[2 ]. v s t r i c t o r sa n de n d o t h e l i a lc e l ld e a t hwe r eo b s e r v e d 3 e s s e lwi l ld i mi n i s h ,a g a i nt ok e e pt r a n s mu r a lp r e s s u r e Do b r i nr e p o r t e dt h a tb l o o dv e s s e l se x h i b i t e dc h a r a c t e r - c o n s t a n t . Ro ma n o wi c ze ta l .d e mo n s t r a t e dt h a tt h e [2 ].Th i s t i cc h a n g e sd u r i n gf e t a ld e v e l o p me n t 4 ewi d e n - i n s o l u b l ee l a s t i nc o n t e n td e c r e a s e di nt h eu mb i l i c a lc o r d i n go ft h eme d i a ,a ni n c r e a s e dn u mb e ra n dat h i c k e n i n go f v e i n so fn e wb o r n sd e l i v e r e db ymo t h e r swi t hp r e e c l a mp s i a ] e l a s t i cl a me l l a ,d e c r e a s e dc e l l u l a r i t ya n da u g me n t e dc o l - [2 6 .Re c o n s t r u c t i n gt h eu mb i l i c a lc o r dv e i nwa l lma y l a g e nc o n t e n tc h a r a c t e r i z et h emo r p h o l o g i cd e v e l o p me n t d i s t u r bf e t a lb l o o dfl o wa n dae c tt h ev a s c u l a rs y s t e mi n [ ] d u r i n gt h i sp e r i o d .I twa sr e p o r t e dt h a tt h eu mb i l i c a l a d u l t h o o d2 7. [2 ] p e r f u s i o nd e c r e a s e di np r e e c l a mp s i a 5 .Th ev e s s e l Ou rmo r p h o me t r i cr e s u l t swe r ei na g r e e me n twi t ht h e wa l l sc o u l dr e a c twi t ht h ea l t e r a t i o n s ,b u tt h e i rc o mp o s i - r e s u l t so fp r e v i o u ss t u d i e si nt h ec o n t r o la n dp r e e c l a mp t i c [1 ].Ou t i o nt oma i n t a i nt h e i rt r a n s mu r a lp r e s s u r ea ta no p t i ma l g r o u p s 0 2 3 rr e s u l t ss h o wt h a twh e nGr o u p s2 l e v e lwo u l dh a v et ob es u s t a i n e d .I nas i t u a t i o no fi n - a n d3 A we r ec o mp a r e d ,t h et h i c k n e s so ft h eu mb i l i c a l c r e a s e dp l a c e n t a lr e s i s t a n c e ,a ni n c r e a s ei ni n t r a l u me n c o r dv e s s e l sr e ma i n e dn e a r l yc o n s t a n t ,wh e r e a sb o t ht o t a l p r e s s u r ei nt h eu mb i l i c a la r t e r ywi l lt e n dt oi n c r e a s e a r e a sa n dl u me na r e a swe r er e d u c e dwi t hr e s p e c tt ot h e c o mp l i a n c ei no r d e rt ok e e pt r a n s mu r a lp r e s s u r er e l a t i v e l y c o n t r o lg r o u p .Th e s ec h a n g e sc o r r e l a t ewi t ho u rh i s c o n s t a n t .Co n v e r s e l y ,t h ei n t r a u t e r i n el u me np r e s s u r ei n t o p a t h o l o g i c a lfi n d i n g s ,wh i c hi n c l u d e dawi d e n i n gu n d e r t h eu mb i l i c a lv e i nwi l ld e c r e a s e ,a n dt h ec o mp l i a n c eo ft h e t h ee p i t h e l i u m,t h ec o n t r a c t i o no ft h emu s c l ec e l l s ,a n d
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184 I nanetal .
Act aMed.Okay ama Vol .56,No.4
Fi g.4 Ph o t o mi c r o g r a p h so fu mb i l i c a lc o r dt a k e nf r o mp r e e c l a mp t i cmo t h e rh a v i n ga b n o r ma lFVW( Gr o u p3 B) .Th emu s c l ea r e awa ss e e n t oh a v es e p a r a t e df r o mt h ec o n n e c t i v et i s s u e s .Th emu s c l ec e l l swe r es e e nt ob eh y p o p l a s t i ca n ds ma l l e rt h a nt h e i rn o r ma ls i z e .Th e r ewa s as i g n i fi c a n td e c r e a s ei nt h el u me na r e ai nt h i sg r o u p ,c o mp a r e dt ot h en o r ma l a n dc h r o n i ch y p e r t e n s i v eg r o u p .Ge n e r a l v i e wo fu mb i l i c a l c o r d a tama g n i f i c a t i o no f× 1 0( A) ;u mb i l i c a lc o r da r t e r y ,× 4 0( B) ;u mb i l i c a lv e i n( V) ,× 4 0( C) ;h i g h e rma g n i fi c a t i o no ft h ev e i nwa l l ,× 2 0 0 ( D) .H. E.
s e p a r a t i o n sb e t we e nt h emu s c l ec e l l sa s s o c i a t e dwi t ht h e ma t r i xc o mp o n e n t swe r et h ema i nr e s u l t so ft h er e d u c t i o n [ ] e d e ma .Th e s efi n d i n g ss u g g e s tama i n l yv a s o c o n s t r i c t i v e o ft h ed i a me t e ro ft h eu mb i l i c a l c o r d1 1 ,2 62 7.Th e s e ee c t .By c o n t r a s t , ac o mp a r i s o no fGr o u p3 Bt o c h a n g e smi g h tb er e s p o n s i b l ef o rt h eg r o wt hf a c t o r s , Gr o u p s2a n d1s h o we dac o mp a r a b l er e d u c t i o no fa l l wh i c hmo d i f ymy o fi b r o b l a s tp r o l i f e r a t i o ng e n ee x p r e s s i o n , p a r a me t e r so ft h ev e s s e l s .I nGr o u p3 B,o u rh i s t o p a t h - p r o t e i nb i o s y n t h e s i sa n d/o ro t h e rp r o c e s s e s . o l o g i c a lfi n d i n g sa r er e l a t e dt ot h en a r r o wi n gl u me no ft h e Re c e n ts t u d i e sh a v es u g g e s t e dt h a tDo p p l e rwa v e f o r m v e s s e l sa n dt h ec o n t r a c t e ds mo o t hmu s c l ec e l l st h a twe r e i n d i c e sf r o mt h eu mb i l i c a la r t e r y ,f e t a la o r t aa n df e t a l s ma l l e rt h a nt h e i rn o r ma ls i z e .Th e s efi n d i n g sa r es u g g e s - mi d d l ec e r e b r a la r t e r i e sa r eu s e f u li ni d e n t i f y i n gI UGR t i v eo fap r e d o mi n a n th y p o p l a s t i cme c h a n i s m.Th e s e2 a n dd e t e r mi n i n gt h er i s ko fs u b s e q u e n tp e r i n a t a l mo r b i d i t y ]. An a me c h a n i s ms ,v a s o c o n s t r i c t i o na n dah y p o p l a s t i cee c t , [2 8 ,2 9 b n o r ma lu mb i l i c a la r t e r y Do p p l e r [1 ]. wa ma yb ed ie r e n te v e n t so rma yf o l l o we a c ho t h e r 0 v e f o r mi sas t r o n gp r e d i c t o ro fa d v e r s ep e r i n a t a l Th efi r s tr e s p o n s et oh y p o x e mi ai sv a s o c o n s t r i c t i o no ft h e o u t c o mei np a t i e n t swi t hp r e e c l a mp s i a .A c o r r e l a t i o n v e s s e l s .I fh y p o x e mi ac o n t i n u e s ,i tma yc a u s emo r - b e t we e nt h eu mb i l i c a la r t e r yDo p p l e ri n d i c e sa n da d v e r s e [2 p h o l o g i c a lc h a n g e ss u c ha sh y p o p l a s i a . p e r i n a t a lo u t c o mewa sf o u n di np r e v i o u ss t u d i e s 4 , ] Ch a n g e so ft h ec o mp o s i t i o no fWh a r t o nj e l l ys u c ha s 2 9 .Th eu mb i l i c a la r t e r yDo p p l e ri n d i c e sa r er e l a t e dt o t h eg l y c o s a mi n o g l y c a n s ,wa t e rc o n t e n t ,a n de x t r a c e l l u l a r p l a c e n t a lv a s c u l a rr e s i s t a n c e . Th e s ee a r l i e rs t u d i e s
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Inan et al.: Comparative morphological differences between umbilical
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s h o we dt h eu s eo fu mb i l i c a la r t e r yDo p p l e rwa v e f o r m i n d i c e si nt h ep r e d i c t i o no fa b n o r ma ln e o n a t a lmo r p h o me t r y . Do p p l e ru l t r a s o n o g r a p h yo ft h eu mb i l i c a l a r t e r i e si si n c r e a s i n gi ni mp o r t a n c ei nt h ea n t e n a t a l d i a g n o s i so ff e t a lwe l lb e i n g .Th eu mb i l i c a lv a s c u l a ra r c h i t e c t u r e i si n t e r e s t i n gn o to n l yf r o mamo r p h o l o g i cp o i n to fv i e w b u ta l s oa sab a s i sf o rf u n c t i o n a li n t e r p r e t a t i o n .I ti s s u g g e s t e dt h a twa v e f o r msr e fl e c tp l a c e n t a li mp e d a n c et o b l o o dfl o w,a n dt h a tc h a n g e so ffl o wp a t t e r n sma yb e c a u s e db yh i s t o mo r p h o l o g i ca l t e r a t i o n so ft h ef e t o p l a c e n t a l v e s s e lt r e e .Ab n o r ma lDo p p l e rs y s t o l i c/d i a s t o l i cr a t i o s mi g h tr e fl e c tap a t h o l o g i cf e t a lc i r c u l a t i o nr e s u l t i n gi n i n t r a u t e r i n eg r o wt hr e t a r d a t i o n ,wh e r e a sn o r ma lv a l u e s r e fl e c tan o r ma lf e t o p l a c e n t a lc i r c u l a t i o na s s o c i a t e dwi t h [3 -3 ]. s ma l lf e t a ls i z e 0 4 I nc o n c l u s i o n ,t h eu mb i l i c a la r t e r yDo p p l e rFVW i n d i c e sp r o v i d eg o o dv a l u e sf o rp r e d i c t i n gi n t r a u t e r i n e g r o wt hr e t a r d a t i o ni np r e e c l a mp t i cp a t i e n t s .Wea l s o o b s e r v e dt h a tt h eu mb i l i c a lv e s s e l swa l lt h i c k n e s s e swe r e r e d u c e di nt h eg r o u po fp r e e c l a mp t i cp a t i e n t swi t hp a t h o l o g i c a lDo p p l e r .I ti sn o tc l e a rwh e t h e rt h emo r p h o l o g i c a l c h a n g e sd i s t u r bt h efl o wi nt h ev e s s e l so ri far e d u c t i o no f t h efl o wc a u s e st h emo r p h o l o g i c a lc h a n g e s .I fap r o g r e s s i v ei n c r e a s ei nb l o o dfl o wwa sak e yf a c t o rc o n t r i b u t i n g t ot h ee mb r y o n i cd e v e l o p me n to ft h ev a s c u l a rt r e e ,a n i n i t i a lu mb i l i c a lv a s o c o n s t r i c t i o ni nr e s p o n s et oah y p o x i c s t r e s sp r o d u c e dar e d u c t i o ni nt h eu mb i l i c a lb l o o dfl o w a n di nt u r nl e dt oal e s s -d e v e l o p e da r t e r i a lt r e ewi t ha n e x p e c t e di n c r e a s ei nt o t a lp l a c e n t a lv a s c u l a rr e s i s t a n c e [1 ].Ch 0 r o n i ch y p e r t e n s i o na n dp r e e c l a mp s i ama ys h a r e s i mi l a rp a t h o p h y s i o l o g i ce v e n t s . Fu r t h e rs t u d i e sa r e n e c e s s a r yt oe l u c i d a t et h ee x a c tme c h a n i s ms .
8 .
9 .
1 0 .
1 1 .
1 2 .
1 3 .
1 4 . 1 5 .
1 6 .
1 7 .
1 8 . 1 9 .
2 0 .
Re f e r e nc e s 2 1 . 1 .Z u s p a n FB:Ne wc o n c e p t si nt h eu n d e r s t a n d i n go fh y p e r t e n s i v e d i s e a s e sd u r i n gp r e g n a n c y .Ano v e r v i e w.Cl i nPe r i n a t o l( 1 9 9 1 ) , 6 5 3 6 5 9 . 2 . Es k e n a z iB,Fe n s t e rLa n dSi d n e yS:Amu l t i v a r i a t ea n a l y s i so fr i s k -2 f a c t o r sf o rp r e e c l a mp s i a .J AMA( 1 9 9 1 ) ,2 3 7 4 1 . 3 . Mi t t e n d o r fR,La i nKY,Wi l l i a msMAa n dWa l k e rCK:Ur i n a r yt r a c t i n f e c t i o n sa n do t h e rr i s kf a c t o r sf o rp r e e c l a mp s i a .JRe p r o dMe d -4 ( 1 9 9 6 ) ,4 9 1 9 6 . 4 . Pi e r i n gWF,Ga r a n c i sJ G,Be c k e rCG,Be r e sJ Aa n dLe ma n nJJ r : Pr e e c l a mp s i ar e l a t e dt oaf u n c t i o n i n ge x t r a u t e r i n ep l a c e n t a:Re p o r to f -3 ac a s ea n d2 5 y e a rf o l l o wu p:Am JKi d n e yDi s( 1 9 9 3 ) ,3 1 0 1 3 . 5 . Fr i e d ma nSA,Ta y l o rRNa n dRo b e r t sJ M:Pa t h o p h y s i o l o g yo fp r e -6 e c l a mp s i a .Cl i nPe r i n a t o l( 1 9 9 1 ) ,6 6 1 8 2 . 6 . Ro b e r t sJ Ma n dRe d ma nCW:Pr e e c l a mp s i a:Mo r et h a np r e g n a n c y i n d u c e dh y p e r t e n s i o n .La n c e t( 1 9 9 3 ) ,1 4 4 7 1 4 5 1 . 7 . La sHe r a sJ , Ba s k e r v i l l eJ C, Ha r d i n g PG a n d Ha u s tMD:Mo r -
Produced by The Berkeley Electronic Press, 2002
2 2 .
2 3 .
2 4 . 2 5 .
p h o me t r i cs t u d i e so ff e t a lp l a c e n t a ls t e ma r t e r i e si nh y p e r t e n s i v e d i s o r d e r s( t o x a e mi a)o fp r e g n a n c y .Pl a c e n t a( 1 9 8 5 ) ,2 1 7 2 2 7 . Ka u f ma n nP,Lu c k h a r d tMa n dLe i s e rR:Th r e e d i me n s i o n a lp r e s e n t a t i o no ft h ef e t a lv e s s e ls y s t e mi nt h eh u ma np l a c e n t a .Re s( 1 9 8 8 ), -1 1 1 3 3 7 . J o h n s t o n e FD, Ug a i l y Th u l e s i u sL, Th u l e s i u sO a n d Na s r a tAN: Umb i l i c a la r t e r yr e a c t i v i t ya n du l t r a s t r u c t u r a lc h a n g e si np r e g n a n c y i n d u c e dh y p e r t e n s i o na n do t h e rc o mp l i c a t e dp r e g n a n c i e s .Cl i nPh y s i o l -5 ( 1 9 8 7 ) ,4 9 3 0 2 . Br u c hJ F,Si b o n yO,Be n a l iK,Ch a l l i e rJ C,Bl o tPa n dNe s s ma n nC: Co mp u t e r i z e d mi c r o s c o p e mo r p h o me t r yo fu mb i l i c a lv e s s e l sf r o m p r e g n a n c i e swi t hi n t r a u t e r i n eg r o wt hr e t a r d a t i o na n da b n o r ma lu mb i l i -1 c a la r t e r yDo p p l e r .Hu m Pa t h o l( 1 9 9 7 ) ,1 1 3 9 1 4 5 . DiNa r oE,Gh e z z iF,Ra i oL,Fr a n c h iMa n dDAd d a r i oV:Umb i l i c a l c o r dmo r p h o l o g ya n dp r e g n a n c yo u t c o me .Eu rJOb s t e tGy n e c o l -1 Re p r o dBi o l( 2 0 0 1 ) ,1 5 0 5 7 . J u n e kT,Ba u m O,La u t e rH,Ve t t e rK,Ma t e j e v i cDa n dGr a fR: Pr e e c l a mp s i aa s s o c i a t e da l t e r a t i o n so ft h ee l a s t i cfi b r es y s t e mi n -3 u mb i l i c a lc o r dv e s s e l s .An a tEmb r y o l( 2 0 0 0 ) ,2 9 1 0 3 . Te mp l e t o nAG,Ki n g d o mJ C,Wh i t t l eMJa n dMcGr a t hJ C:Co n t r a c t i l e r e s p o n s e so ft h eh u ma nu mb i l i c a la r t e r yf r o mp r e g n a n c i e sc o mp l i c a t e d -5 b yi n t r a u t e r i n eg r o wt hr e t a r d a t i o n .Pl a c e n t a( 1 9 9 3 ) ,5 6 3 7 0 . Ha r t i k a i n e n So r r iA,Vu o l t e e n a h oO,Le p p a l u o t oJa n dRu s k o a h oH: En d o t h e l i ni nu mb i l i c a la r t e r yv a s o s p a s m.La n c e t( 1 9 9 1 ) ,6 1 9 . Ho wa r dRB,Ho s o k a waTa n dMa g u i r eMH:Hy p o x i a i n d u c e df e t o p l a c e n t a lv a s o c o n s t r i c t i o ni np e r f u s e dh u ma np l a c e n t a l c o t y l e d o n s .Am -1 JOb s t e tGy n e c o l( 1 9 8 7 ) ,1 2 6 1 2 6 6 . St u a r tMJ ,Cl a r kDA,Su n d e r j iSG,Al l e nJ B,Ya mb oT,El r a dHa n d Sl o t tJ H:De c r e a s ep r o s t a c y c l i n ep r o d u c t i o n:A c h a r a c t e r i s t i co f c h r o n i cp l a c e n t a li n s uc i e n c ys y n d r o me s .La n c e t( 1 9 8 1 ) ,1 1 2 6 1 1 2 8 . Bo d e l s s o nG,Ma r s a lKa n dSt j e r n q u i s tM:Re d u c e dc o n t r a c t i l eee c t o fe n d o t h e l i n 1a n dn o r a d r e n a l i ni nh u ma nu mb i l i c a la r t e r yf r o m p r e g n a n c i e swi t ha b n o r ma lu mb i l i c a la r t e r yfl o wv e l o c i t ywa v e f o r ms . -2 Ea r l yHu m De v( 1 9 9 5 ) ,1 5 8 . Ro b e r t sJ M:En d o t h e l i a ld y s f u n c t i o ni np r e e c l a mp s i a .Se mi nRe p r o d -1 En d o c r i n o l( 1 9 9 8 ) ,5 5 . Ho wa r dCVa n dRe e dMG:Un b i a s e dSt e r e o l o g y .Th r e e Di me n t i o n a l Me a s u r e me n ti nMi c r o s c o p y .1 s tEd ,BI OSSc i e n t i fi cPu b l i s h e r sLt d , Ox f o r d ,UK( 1 9 9 8 )p p2 8 3 7 . Me e k i n sJ W,Pi j n e n b o r gR,Ha n s s e n sM,Mc Fa d y e nI Ra n dv a nAs s h e A:As t u d yo fp l a c e n t a lb e ds p i r a la r t e r i e sa n dt r o p h o b l a s ti n v a s i o ni n n o r ma la n ds e v e r ep r e e c l a mp t i cp r e g n a n c i e s .BrJOb s t e tGy n a e c o l ( 1 9 9 4 ) ,6 6 9 6 7 4 . Na s i e l lJ ,Ni s e l lH,Bl a n c kA,Lu n e lNO a n dFa x e nM:Pl a c e n t a l e x p r e s s i o no fe n d o t h e l i a lc o n s t i t u t i v en i t r i co x i d es y n t h a s emRNAi n p r e g n a n c yc o mp l i c a t e db yp r e e c l a mp s i a .Ac t aOb s t e tGy n e c o lSc a n d -4 ( 1 9 9 8 ) ,4 9 2 9 6 . Kh o n gTY,DeWo l fF,Ro b e r t s o nWB a n dBr o s e n sI :I n a d e q u a t e ma t e r n a lv a s c u l a rr e s p o n s et op l a c e n t a t i o ni np r e g n a n c i e sc o mp l i c a t e d b yp r e e c l a mp s i aa n db ys ma l l f o r g e s t a t i o n a la g ei n f a n t s .BrJOb s t e t -1 Gy n a e c o l( 1 9 8 6 ) ,1 0 4 9 0 5 9 . Be r t r a n dC,Du p e r r o nL a n dSt Lo u i sJ :Umb i l i c a la n dp l a c e n t a l v e s s e l s :Mo d i fi c a t i o n so ft h e i rme c h a n i c a lp r o p e r t i e si np r e e c l a mp s i a . -1 Am JOb s t e tGy n e c o l( 1 9 9 3 ) ,1 5 3 7 5 4 6 . Do b r i nPB:Me c h a n i c a lp r o p e r t i e so fa r t e r i s e s .Ph y s i o lRe v( 1 9 7 8 ) , -4 3 9 7 6 0 . Bi a g i o t t iR,Sg a mb a t iE a n dBr i z z iE:Pl a c e n t a lmo r p h o me t r yi n p r e g n a n c i e sc o mp l i c a t e db yi n t r a u t e r i n eg r o wt hr e t a r d a t i o n wi t h a b s e n to rr e v e r s e de n dd i a s t o l i cfl o wi nt h eu mb i l i c a l a r t e r y .I t a l JAn a t Emb r y o l( 1 9 9 9 ) ,2 0 1 2 0 7 .
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Acta Medica Okayama, Vol. 56 [2002], Iss. 4, Art. 2
186 I nanetal . 2 6 . Ro ma n o wi c zLa n dSo b o l e ws k iK:Ex t r a c e l l u l a rma t r i xc o mp o n e n t so f t h ewa l lo fu mb i l i c a lc o r dv e i na n dt h e i ra l t e r a t i o n si np r e e c l a mp s i a . -1 JPe r i n a tMe d( 2 0 0 0 ) ,1 4 0 4 6 . 2 7 . Ro ma n o wi c zL,Ba n k o ws k iE,So b o l e ws k iKa n dJ a wo r s k iS:Ac t i v i t i e s o fs o meg l y c o s a mi n o g l y c a n d e g r a d i n ge n z y me si nWh a r t o nsj e l l ya n d t h e i ra l t e r a t i o ni nEPHg e s t o s i s( Pr e e c l a mp s i a ) .Bi o lNe o n a t e( 1 9 9 9 ) -1 ,1 4 4 5 2 . 2 8 . Mi t r aSC,Se s h a nSVa n dRi a c h iLE:Pl a c e n t a lv e s s e lmo r p h o me t r yi n g r o wt hr e t a r d a t i o na n di n c r e a s e dr e s i s t a n c eo ft h eu mb i l i c a la r t e r y -2 Do p p l e rfl o w.JMa t e r nFe t a lMe d( 2 0 0 0 ) ,2 8 2 8 6 . 2 9 . Yo o n BH, Le e CM a n d Ki m SW:An a b n o r ma lu mb i l i c a la r t e r y wa v e f o r m:As t r o n ga n di n d e p e n d e n tp r e d i c t o ro fa d v e r s ep e r i n a t a l o u t c o mei np a t i e n t swi t hp r e e c l a mp s i a .Am JOb s t e tGy n e c o l( 1 9 9 4 ) -7 ,7 1 3 2 1 . 3 0 . Ba r t h aJ L,Co mi n o De l g a d oR,Go n z a l e z Me n aC,Lo p e zIa n dAr r a b a l J :Umb i l i c a lb l o o dfl o wa n dn e o n a t a lmo r p h o me t r y :Amu l t i v a r i a t e a n a l y s i s .Eu rJOb s t e tGy n e c o lRe p r o dBi o l( 1 9 9 8 ) ,2 7 3 3 . 3 1 . At k i n s o nMW,Ma h e rJ E,Owe nJ ,Ha u t hJ C,Go l d e n b e r gRLa n d
http://escholarship.lib.okayama-u.ac.jp/amo/vol56/iss4/2
Act aMed.Okay ama Vol .56,No.4 Co p p e rRL:Th ep r e d i c t i v ev a l u eo fu mb i l i c a l a r t e r yDo p p l e rs t u d i e sf o r p r e e c l a mp s i ao rf e t a lg r o wt hr e t a r d a t i o ni nap r e e c l a mp s i ap r e v e n t i o n t r i a l .Ob s t e tGy n e c o l( 1 9 9 4 ) ,6 0 9 6 1 2 . 3 2 . Be r k o wi t zGS,Ch i t k a r aU,Ro s e n b e r gJ ,Co g s we l lC,Wa l k e rB, La h ma nEA,Me h a l e kKEa n dBe r k o wi t zRL:So n o g r a p h i ce s t i ma t i o n o ff e t a lwe i g h ta n dDo p p l e ra n a l y s i so fu mb i l i c a la r t e r yv e l o c i me t r yi n t h ep r e d i c t i o no fi n t r a u t e r i n eg r o wt hr e t a r d a t i o n:Ap r o s p e c t i v es t u d y . -1 Am JOb s t e tg y n e c o l( 1 9 8 8 ) ,1 1 4 9 1 5 3 . 3 3 . Ch a n gTC,Ro b s o nSC,Sp e n c e rJ Aa n dGa l l i v a nS:I d e n t i fi c a t i o no f f e t a lg r o wt hr e t a r d a t i o n:Co mp a r i s o no fDo p p l e rwa v e f o r mi n d i c e sa n d s e r i a lu l t r a s o u n dme a s u r e me n t so fa b d o mi n a lc i r c u mf e r e n c ea n df e t a l -2 we i g h t .Ob s t e tGy n e c o l( 1 9 9 3 ) ,2 3 0 3 6 . 3 4 . Mc Co wa nLM,Ha r d i n gJ Ea n dSt e wa r tAW:Umb i l i c a la r t e r yDo p p l e r s t u d i e si ns ma l lf o rg e s t a t i o n a la g eb a b i e sr e fl e c td i s e a s es e v e r i t y . -9 BJ OG( 2 0 0 0 ) ,9 1 6 2 5 .
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