The umbilical cord as a potential culprit in cases of perinatal asphyxia. A case–control study

OBJECTIVE: To characterize the pathological features of placentas from neonates with perinatal asphyxia and to compare them with those from neonates without asphyxia. METHODS: An observational case-control study was conducted, including a group of patients diagnosed with perinatal asphyxia and a comparison group without this condition. SETTING: A high-complexity neonatal unit. PARTICIPANTS: 83 neonates were included: 28 with perinatal asphyxia and 55 without asphyxia, all of whom had placental examination available. RESULTS: Umbilical cord abnormalities were significantly associated with perinatal asphyxia, particularly cervical entanglements-both tight and loose, and increased cord diameter; also, when comparing the presence of at least one anatomical abnormality of the umbilical cord. Among maternal complications, gestational diabetes showed a significant association; among fetal complications, major malformations and non-reassuring fetal status were significantly associated. CONCLUSION: Intrauterine factors are closely associated with perinatal asphyxia. We highlight the role of placental pathology-particularly anatomical alterations of the umbilical cord-in elucidating its underlying mechanisms. The evidence generated may contribute to enhancing early detection and informing the development of preventive strategies.