Cargando…

The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome

True umbilical knot (TUK), although not a commonly encountered pathology, hasan important psychological burden on the mother and obstetrician. It has an extremely low prenatal ultrasound diagnosis rate, despite its adverse perinatal outcomes when unknown. We conducted a retrospective observational a...

Descripción completa

Detalles Bibliográficos
Autores principales: Bohiltea, Roxana Elena, Varlas, Valentin-Nicolae, Dima, Vlad, Iordache, Ana-Maria, Salmen, Teodor, Mihai, Bianca-Margareta, Bohiltea, Alexia Teodora, Vladareanu, Emilia Maria, Ducu, Ioniță, Grigoriu, Corina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836486/
https://www.ncbi.nlm.nih.gov/pubmed/35160268
http://dx.doi.org/10.3390/jcm11030818
_version_ 1784649691459223552
author Bohiltea, Roxana Elena
Varlas, Valentin-Nicolae
Dima, Vlad
Iordache, Ana-Maria
Salmen, Teodor
Mihai, Bianca-Margareta
Bohiltea, Alexia Teodora
Vladareanu, Emilia Maria
Ducu, Ioniță
Grigoriu, Corina
author_facet Bohiltea, Roxana Elena
Varlas, Valentin-Nicolae
Dima, Vlad
Iordache, Ana-Maria
Salmen, Teodor
Mihai, Bianca-Margareta
Bohiltea, Alexia Teodora
Vladareanu, Emilia Maria
Ducu, Ioniță
Grigoriu, Corina
author_sort Bohiltea, Roxana Elena
collection PubMed
description True umbilical knot (TUK), although not a commonly encountered pathology, hasan important psychological burden on the mother and obstetrician. It has an extremely low prenatal ultrasound diagnosis rate, despite its adverse perinatal outcomes when unknown. We conducted a retrospective observational analytical study on a 7-year period (2015–2021), including all pregnancies overseen by a single fetal-maternal medicine specialist for monitoring and delivery. We analyzed the prenatal detection rate and correlations between prenatal diagnosis of TUK and pregnancy outcome in terms of associated maternal and fetal factors, time and mode of delivery, fetal weight at birth, maternal level of stress, and iatrogenic prematurity. We compared our results with an electronic search of the literature to study the relationship between TUK and prematurity. We prenatally diagnosed 16 TUKs, and there were two false positives and two undiagnosed knots. All of those women had birth at term. The main finding of the review was a small number of studies that included enough cases for analysis. The prematurity rate due to TUK is 14.2%, significantly increased compared to the general population. An umbilical artery flow velocimetry notch in twin pregnancies complicated by TUK was an important ultrasonographic finding. We consider intrauterine fetal death exceptional, and the main adverse neonatal outcome is due to iatrogenic prematurity caused by maternal anxiety of knowing the prenatal diagnosis and mode of delivery. The elective method for diagnosis should be the second-trimester ultrasound scan using three-dimensional (3D) reconstruction and cesarean delivery for a good neonatal outcome. Pregnant women should be counseled to understand the implications of iatrogenic prematurity, especially respiratory distress syndrome, to ensure these infants are delivered at term.
format Online
Article
Text
id pubmed-8836486
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-88364862022-02-12 The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome Bohiltea, Roxana Elena Varlas, Valentin-Nicolae Dima, Vlad Iordache, Ana-Maria Salmen, Teodor Mihai, Bianca-Margareta Bohiltea, Alexia Teodora Vladareanu, Emilia Maria Ducu, Ioniță Grigoriu, Corina J Clin Med Article True umbilical knot (TUK), although not a commonly encountered pathology, hasan important psychological burden on the mother and obstetrician. It has an extremely low prenatal ultrasound diagnosis rate, despite its adverse perinatal outcomes when unknown. We conducted a retrospective observational analytical study on a 7-year period (2015–2021), including all pregnancies overseen by a single fetal-maternal medicine specialist for monitoring and delivery. We analyzed the prenatal detection rate and correlations between prenatal diagnosis of TUK and pregnancy outcome in terms of associated maternal and fetal factors, time and mode of delivery, fetal weight at birth, maternal level of stress, and iatrogenic prematurity. We compared our results with an electronic search of the literature to study the relationship between TUK and prematurity. We prenatally diagnosed 16 TUKs, and there were two false positives and two undiagnosed knots. All of those women had birth at term. The main finding of the review was a small number of studies that included enough cases for analysis. The prematurity rate due to TUK is 14.2%, significantly increased compared to the general population. An umbilical artery flow velocimetry notch in twin pregnancies complicated by TUK was an important ultrasonographic finding. We consider intrauterine fetal death exceptional, and the main adverse neonatal outcome is due to iatrogenic prematurity caused by maternal anxiety of knowing the prenatal diagnosis and mode of delivery. The elective method for diagnosis should be the second-trimester ultrasound scan using three-dimensional (3D) reconstruction and cesarean delivery for a good neonatal outcome. Pregnant women should be counseled to understand the implications of iatrogenic prematurity, especially respiratory distress syndrome, to ensure these infants are delivered at term. MDPI 2022-02-03 /pmc/articles/PMC8836486/ /pubmed/35160268 http://dx.doi.org/10.3390/jcm11030818 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bohiltea, Roxana Elena
Varlas, Valentin-Nicolae
Dima, Vlad
Iordache, Ana-Maria
Salmen, Teodor
Mihai, Bianca-Margareta
Bohiltea, Alexia Teodora
Vladareanu, Emilia Maria
Ducu, Ioniță
Grigoriu, Corina
The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title_full The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title_fullStr The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title_full_unstemmed The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title_short The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome
title_sort strategy against iatrogenic prematurity due to true umbilical knot: from prenatal diagnosis challenges to the favorable fetal outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836486/
https://www.ncbi.nlm.nih.gov/pubmed/35160268
http://dx.doi.org/10.3390/jcm11030818
work_keys_str_mv AT bohiltearoxanaelena thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT varlasvalentinnicolae thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT dimavlad thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT iordacheanamaria thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT salmenteodor thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT mihaibiancamargareta thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT bohilteaalexiateodora thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT vladareanuemiliamaria thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT ducuionita thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT grigoriucorina thestrategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT bohiltearoxanaelena strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT varlasvalentinnicolae strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT dimavlad strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT iordacheanamaria strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT salmenteodor strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT mihaibiancamargareta strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT bohilteaalexiateodora strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT vladareanuemiliamaria strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT ducuionita strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome
AT grigoriucorina strategyagainstiatrogenicprematurityduetotrueumbilicalknotfromprenataldiagnosischallengestothefavorablefetaloutcome