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.