Yifat Wiener

Long-term outcomes of children with umbilical vein varix diagnosed prenatally

The current study aims were to assess the long‐term outcomes of children who were diagnosed with umbilical vein varix (UVV) prenatally.

Is there a correlation between time of delivery and newborn cord pH

Abstract Purpose: Since more senior and attending physicians work in labor wards during morning shifts, we expect a better delivery outcome during that time period. Materials and methods: A retrospective study was conducted between 1/2005 and 12/2014. Records of 56 428 singleton deliveries from a tertiary hospital in which cord blood pH was routinely measured at birth were analyzed. Time of birth was divided into shifts: 7 AM–3 PM (morning shift), 3 PM–11 PM (afternoon shift), and 11 PM–7 AM (night shift). Additional stratification compared weekdays and weekend deliveries. Results: 19 601, 18 429, and 18 398 neonates were born during morning, afternoon, and night shifts, respectively. There was no significant difference in maternal age, neonatal weight, or mean 5-min Apgar score among the three shift periods. Furthermore, there was no correlation between shift time of delivery and newborn acidosis with respect to cord pH less than 7 (0.1% in each time periods, p = 0.67). Despite the above, instrumental deliveries and cesarean sections were more common in the morning shift compared to the afternoon and night shift, respectively (p = 0.001 each). Conclusions: Although shift time of delivery was found to be related to mode of delivery it was not related to either 5-min Apgar score or newborn acidosis as reflected by cord pH.

The Triple Test Markers Profile Among Fetuses and Children Diagnosed With Umbilical Vein Varix

Umbilical vein varix (UVV) is defined as a focal enlargement of the umbilical vein and represents approximately 4% of fetal umbilical cord malformations. The reported neonatal outcome of fetuses with UVV varies widely due to its rarity, hence the small sample sizes of the case series in the literature. Earlier studies reported high fetal mortality, but more recent reports have demonstrated no association between UVV and intrauterine fetal death. A recent study has described a possible association between UVV diagnosed prenatally and child developmental delay. The present study of fetuses with UVV was done to evaluate and compare the levels of triple test serum biomarkers used for Down syndrome screening (human chorionic gonadotropin, α-fetoprotein, and unconjugated estriol) between a group of fetuses with uneventful obstetric outcome versus a subgroup of children with developmental delay.

Response to "long-term outcomes of children with umbilical vein varix diagnosed prenatally".

We thank Prefumo and Frusca for their interest in our recent publication: ‘Long-term outcomes of children with umbilical vein varix (UVV) diagnosed prenatally’ as well as their stimulating comments. Prefumo and Frusca noted that there was a high incidence of preterm deliveries (72% in the study group) in our study. Our department’s policy was to induce labor at 34–36weeks. This was based on the generally grave outcomes reported. However, in recent years, we changed our policy on the basis of reassuring literature and our own experience and postponed induction to 37–38week’s gestation. A telephone questionnaire, for both the entire study and the control group, based on the Ages and Stages Questionnaire was used only as a screening tool. A formal cognitive and an in-depth neurodevelopmental assessment were conducted by our pediatricians and developmental psychologist’s team. Detailed descriptions of the methods used for the cognitive assessments have been published elsewhere and wasmentioned in depth in our manuscript. Actually, of the ten children with UVV with abnormal screening results who were formally assessed, four (40%) were confirmed as having developmental delay. Only one child in the control group had formal assessment. This limitation was already mentioned in the manuscript. We agree that the family’s socioeconomic status could be a confounder in long-term neurodevelopment studies and theoretically could introduce same bias in our results. We agree with Prefumo and Frusca that not just the mere presence of a dilated umbilical vein, but some other mechanism such as circulatory disturbance and thrombi formation may cause brain damage, which eventually results in developmental delay. In our study, we did not aim to explore those hypotheses, and it is our hope that future research will illuminate this issue. In conclusion, this is a first study to point on a possible association between UVV diagnosed prenatally and child developmental delay. As originally stated in our manuscript, the clinical management and implications based on our findings are premature, and we did not recommend any action to be taken based on our findings. Larger prospective controlled studies are needed to confirm our results and to validate them.