OJOG  Vol.3 No.9 A , November 2013
Periarterial stem villous edema is associated with hypercoiled umbilical cord and stem obliterative endarteritis
Abstract: To assess clinicopathologic correlations of a novel placental lesion featuring a distinct ring-like periarterial edema of stem villi (PASE). A retrospective case-control statistical comparison (Yates χ2 or analysis of variance) of 30 clinical and 41 placental features of 100 consecutive placentas with PASE and 100 gestational age-matched cases without PASE, extracted from 2403 placentas from high-risk pregnancies signed out by the author since year 2006. The PASE was seen in 4.2% of placentas, average gestational age 35.9 weeks (range, 24 - 42 weeks). Frequencies of stem obliterative endarteritis and hypercoiled umbilical cord (coiling index > 0.3) were 23% vs 5% (p = 0.005), and 20% vs 9% (p = 0.04) in the study group and comparative group, respectively. There were no statistically significant differences (p > 0.05) between the groups in clinical or other placental variables. The PASE may be linked to chronically abnormal blood flow in umbilical cord arteries and their stem branches and may be a histological placental sign of non-obliterative umbilical cord compromise.
Cite this paper: Stanek, J. (2013) Periarterial stem villous edema is associated with hypercoiled umbilical cord and stem obliterative endarteritis. Open Journal of Obstetrics and Gynecology, 3, 9-14. doi: 10.4236/ojog.2013.39A002.

[1]   Benirschke, K., Kaufmann, P. and Baergen, R.N. (2006) Pathology of the human placenta. Springer, New York.

[2]   Fox, H. and Sebire, N.J. (2007) Pathology of the placenta. Saunders, London.

[3]   Naeye, R.L. (1992) Disorders of the placenta, fetus, and neonate. Mosby, St. Louis, 174-179.

[4]   Boyd, T.K. and Redline, R.W. (2007) Pathology of the placenta. In: Gilbert-Barness, E., Ed., Potter’s Pathology of the Fetus, Infant and Child. Mosby, New York.

[5]   Stanek, J. (2012) Utility of diagnosing various histological patterns of diffuse chronic hypoxic placental injury. Pediatric and Developmental Pathology, 15, 13-23.

[6]   Coulter, J.B., Scott, J.M. and Jordan, M.M. (1975) Oedema of the umbilical cord and respiratory distress in the newborn. BJOG: An International Journal of Obstetrics & Gynaecology, 82, 453-459.

[7]   Cohen, M.C., Roper, E.C., Sebire, N.J., Stanek, J. and Anumba, D.O. (2005) Placental mesenchymal dysplasia associated with fetal aneuploidy. Prenatal Diagnosis, 25, 187-192. 10.1002/pd.1103

[8]   Stanek, J. and Biesiada, J. (2011) Gestational age correlation of clinical conditions and placental lesions. Placenta, 32, A1-A149.

[9]   Stanek, J. and Biesiada, J. (2012) Clustering of maternal/ fetal clinical conditions and outcomes and placental lesions. American Journal of Obstetrics & Gynecology, 206, 493.e1-8. 10.1016/j.ajog.2012.03.025

[10]   Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Gilstrap III, L.C. and Wenstrom, K.D. (2005) Williams obstetrics. 32nd Edition, McGraw-Hill, New York.

[11]   Strong Jr., T.H., Jarles, D.L., Vega, J.S. and Feldman, D.B. (1994) The umbilical coiling index. American Journal of Obstetrics & Gynecology, 170, 29-32.

[12]   Dix, L., Roth-Kleiner, M. and Osterheld, M.C. (2010) Placental vascular obstructive lesions: Risk factor for developing necrotizing enterocolitis. Pathology Research International, 2010, 1-7.

[13]   van der Veen, E., Walker, S. and Fox, H. (1982) Endarteritis obliterans of the fetal stem arteries of the human placenta: An electron microscopic study. Placenta, 3, 181-190. 10.1016/S0143-4004(82)80051-9

[14]   Stanek, J. (2011) Placental membrane and placental disc microscopic chorionic cysts share similar clinicopathologic correlations. Pediatric and Developmental Pathology, 14, 1-9. 10.2350/10-02-0795-OA.1

[15]   Stanek, J. (2009) Acute and chronic placental membrane hypoxic lesions. Virchows Archiv, 455, 315-322.

[16]   Stanek, J. and Drummond, Z. (2007) Occult placenta accreta: The missing link in the diagnosis of abnormal placentation. Pediatric and Developmental Pathology, 10, 266-262. 10.2350/06-10-0174.1

[17]   Hasagawa, J., Matsuoka, R., Ischizuka, K., et al. (2009) Atypical variable deceleration in the first stage of labor is a characteristic fetal heart-rate pattern for velamentous cord insertion and hypercoiled cord. Journal of Obstetrics and Gynaecology Research, 35, 35-39. 10.1111/j.1447-0756.2008.00863.x

[18]   Kashanian, M., Akbarian, A. and Kouhpayehzadeh, J. (2006) The umbilical coiling index and adverse perinatal outcome. International Journal of Gynecology & Obstetrics, 95, 8-13. 10.1016/j.ijgo.2006.05.029

[19]   de Laat, M.W.M., van der Meu, J.J.C., Visser, G.H.A., Franx, A. and Nikkels, P.G.J. (2007) Hypercoiling of the umbilical cord and placental maturation defect: Associated pathology? Pediatric and Developmental Pathology, 10, 293-299.

[20]   Nishio, J., Nakai, Y., Mine, M., Imanaka, M. and Ogita, S. (1999) Characteristics of blood flow in intrauterine growthrestricted fetuses with hypercoiled cord. Ultrasound in Obstetrics & Gynecology, 13, 171-175.

[21]   Rana, J., Ebert, G.A. and Kappy, K.A. (1995) Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstetrics & Gynecology, 85, 573-577.

[22]   Parast, M.M., Crum, C.P. and Boyd, T.K. (2008) Placental histologic criteria for umbilical blood flow restriction in unexpected stillbirth. Human Pathology, 39, 948-953. j.humpath.2007.10.032

[23]   Redline, R.W. (2004) Clinical and pathological umbilical; cord abnormalities in fetal thrombotic vasculopathy. Human Pathology, 35, 1494-1498.

[24]   Stanek, J. and Biesiada, J. (2012) Sensitivity and specificity of finding of multinucleate trophoblastic giant cells in decidua in placentas from high-risk pregnancies. Human Pathology, 43, 261-268.

[25]   Stanek, J. (2013) Hypoxic patterns of placental injury. A review. Archives of Pathology & Laboratory Medicine, 137, 706-720.