Definition/General
Introduction:
Umbilical cord compression is a common complication involving external pressure on the cord causing vascular compromise
It occurs in 10-15% of pregnancies
The condition can be intermittent or sustained
It results in fetal hypoxia and variable fetal heart rate patterns.
Origin:
Results from external pressure on umbilical cord
Oligohydramnios (most common cause)
Nuchal cord or cord around body parts
Uterine contractions compressing cord
Fetal parts compressing cord
Maternal positioning effects.
Classification:
Classified by duration: acute versus chronic compression
Severity: mild, moderate, severe
Cause: oligohydramnios, nuchal cord, entanglement
Pattern: intermittent versus continuous
Reversibility: reversible versus irreversible.
Epidemiology:
Incidence: 10-15% of all pregnancies
Higher frequency with oligohydramnios
More common in post-term pregnancies
Associated with intrauterine growth restriction
Increased risk with nuchal cord.
Clinical Features
Presentation:
Variable decelerations on fetal monitoring
Fetal distress patterns
Decreased fetal movements
Meconium-stained liquor
Abnormal fetal heart rate
Signs of fetal hypoxia.
Symptoms:
Fetal bradycardia during contractions
Variable fetal heart rate patterns
Cord compression signs on monitoring
Abnormal cardiotocography
Emergency delivery indication
Neonatal complications.
Risk Factors:
Oligohydramnios (most important)
Post-term pregnancy
Intrauterine growth restriction
Nuchal cord
Multiple pregnancy
Long umbilical cord
Maternal hypertension.
Screening:
Continuous fetal monitoring
Amniotic fluid volume assessment
Umbilical artery Doppler
Biophysical profile
Recognition of variable decelerations
Maternal position changes.
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Gross Description
Appearance:
Flattened cord segments at compression sites
Blanching or congestion patterns
Indentation marks from external pressure
May show edema distal to compression
Color changes indicating ischemia.
Characteristics:
Vessel compression with luminal narrowing
Surrounding tissue edema or fibrosis
Hemorrhage at compression sites
Thrombosis in severe cases
Normal cord segments between compressions.
Size Location:
Compression sites: variable locations
Nuchal cord around neck
Body entanglement patterns
Multiple compression sites possible
Cord length usually normal.
Multifocality:
Usually multiple sites affected
Severity varies between sites
May involve entire cord length
Associated with coiling abnormalities.
Microscopic Description
Histological Features:
Vessel compression with luminal narrowing
Endothelial damage at compression sites
Smooth muscle changes in vessel walls
Perivascular edema or fibrosis
Thrombosis in severe cases.
Cellular Characteristics:
Endothelial cell swelling and damage
Smooth muscle degeneration
Inflammatory cells around vessels
Fibroblast proliferation
Red blood cell extravasation.
Architectural Patterns:
Oval-shaped vessel compression
Loss of circular vessel architecture
Perivascular changes
Wharton's jelly compression
Focal tissue ischemia.
Grading Criteria:
Assessment of compression degree
Vessel luminal narrowing
Duration indicators (acute vs chronic)
Inflammatory response severity
Thrombosis presence.
Immunohistochemistry
Positive Markers:
CD31 highlights compressed endothelium
CD34 in vessel walls
Smooth muscle actin in vessel walls
Factor VIII in endothelium
Fibrin stains if thrombosis.
Negative Markers:
Cytokeratin negative in vessels
No specific negative markers required
Normal vascular immunophenotype maintained
Tissue-specific markers preserved.
Diagnostic Utility:
Documents vessel integrity
Assesses endothelial damage
Identifies thrombosis
Evaluates tissue viability
Research applications.
Molecular Subtypes:
No specific molecular classification
Hypoxia markers may be positive
Inflammatory mediators present
Stress response proteins elevated.
Molecular/Genetic
Genetic Mutations:
No specific genetic associations
Cord abnormalities may predispose
Connective tissue variants possible
Environmental rather than genetic
Mechanical etiology primary.
Molecular Markers:
Hypoxia-inducible factors upregulated
Inflammatory cytokines elevated
Stress response pathways activated
Apoptosis markers in severe cases
Vascular remodeling factors.
Prognostic Significance:
Severity and duration determine outcome
Intermittent compression better tolerated
Chronic compression worse prognosis
Associated with neurodevelopmental issues
Early recognition improves outcomes.
Therapeutic Targets:
Maternal position changes
Amnioinfusion for oligohydramnios
Delivery timing optimization
Continuous fetal monitoring
Emergency delivery if severe.
Differential Diagnosis
Similar Entities:
Cord prolapse
Cord thrombosis
Cord torsion
Uterine compression
Placental insufficiency.
Distinguishing Features:
Compression: external pressure effects
Compression: variable patterns
Prolapse: cord ahead of fetus
Thrombosis: intravascular clot
Torsion: twisting pattern
Insufficiency: placental pathology.
Diagnostic Challenges:
Cause identification
Severity assessment
Duration determination
Clinical correlation importance
Reversibility evaluation.
Rare Variants:
Massive cord compression
Compression with cord rupture
Chronic compression syndrome
Multiple site compression
Compression in twins.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Clinical Presentation
Clinical presentation: [variable decelerations/fetal distress] consistent with cord compression
Compression Sites
Compression sites: [location], [number] of sites, [pattern description]
Severity Assessment
Severity: [mild/moderate/severe] compression with [degree] of vessel narrowing
Vessel Examination
Vessels: [compressed/flattened/normal], [present/absent] thrombosis
Duration Indicators
Duration: [acute/chronic] based on [tissue changes/clinical history]
Underlying Cause
Cause: [oligohydramnios/nuchal cord/other], [identified/presumed] etiology
Microscopic Findings
Microscopy shows [degree] of vessel compression with [present/absent] ischemic changes
Final Diagnosis
Umbilical cord compression, [severity], [cause]