Fetal arrhythmias: organometric parameters of the placenta and umbilical cord

Fetal arrhythmias (FA) are reported in the literature in 1% to 5% of all pregnancies, and about 10% of cases are potentially harmful to fetal life. It should be emphasised that both the diagnosis and treatment of FA are still relevant, unresolved and controversial.The objective: to determine the diagnostic and prognostic value and the relationship of the main morphometric parameters and abnormal macroscopic findings of the umbilical cord and placenta with the development of heart failure in the case of FA.Material and methods. 102 pregnant women were included in the study. The main group involved 72 pregnant women with fetal heart rhythm disturbances – FA, the control group – 30 somatically healthy patients with a physiological course of pregnancy and satisfactory intrauterine fetal condition. During the study, 4 cases of antenatal fetal death were excluded from the main group. Ultrasound examination of the fetal cardiac structure and recording of fetal cardiac activity were carried out. Postnatal macroscopic examination of the placenta and umbilical cord were studied: placental weight, its shape, thickness, presence of macroscopic involutional-dystrophic changes, umbilical cord length and diameter, number of vessels, tortuosity index, type of the placenta insertion, volume of Wharton’s jelly, presence of knots and entanglement of the umbilical cord.Results. Pregnancy in the group with FA was accompanied by a high percentage of complications (86.8%), in which the most important factors in terms of stratification of the risk of negative perinatal outcomes were the threat of pregnancy loss (26.5%), acute respiratory infections in the first half of pregnancy (30.9%), asymptomatic bacteriuria and vaginitis, autoimmune disorders (antiphospholipid syndrome, autoimmune thyroiditis), latent cytomegalovirus infection (27.9%), and gestational diabetes (22.1%). Pregnancies with FA were associated with an increased proportion of preterm births (20.6%), birth of a fetal low weight for a gestational age (29.4%), surgical delivery (32.4%), antenatal death (4.4%) and the need for intensive care (13.2%).Out of 68 live births, 55 children (88.9%) were born with an Apgar score of ≥ 7 points, 13 babies (19.1%) were born with an Apgar score of ≤ 6 points, 9 babies (13.2%) were transferred to the neonatal intensive care unit, and birth weight < 10th percentile was found in 20 cases (29.4%).The postnatal macroscopic examination of the placenta and umbilical cord demonstrated an increased rate of macroscopic umbilical cord abnormalities (37.5%), namely eccentric umbilical cord insertion (61.8%), marginal and velamentous umbilical cord insertion (22.1%), an increased frequency of short umbilical cord (47.1%), changes in the umbilical cord tortuosity index (hyper-tortuosity (42.6%) and hypotortuosity (33.8%)), and deficiency of Wharton’s jelly (27.9%). The assessment of the identified features of postnatal placental macromorphology revealed an increase in placental tissue weight, a decrease in average thickness and an increased rate of abnormal forms (60.3%).Conclusions. Macroscopic abnormalities of the placenta and umbilical cord were diagnosed postnatally in patients with FA, namely an increase in the weight of the placental tissue, a decrease in the average thickness and an increased rate of abnormal forms (60.3%), eccentric insertion of the umbilical cord (61.8%), marginal and velamentous umbilical cord insertion (22.1%), increase in the proportion of short umbilical cord (47.1%), changes in the umbilical cord tortuosity index (hyper-tortuosity up to 42.6% and hypotortuosity up to 33.8%), and deficiency of Wharton’s jelly (27.9%).