ABNORMAL UMBLICAL CORD Flashcards
Umbilical cord length in the first trimester
Is same length as CRL
Normal cord length
40 -60cm
Short umbilical cord length
< 35cm in length
Absence of cord twisting indirect sign of
Decreased feral movement
Obstetric problems seen with short umbilical cord
Preterm delivery
Decrease heart rate during delivery
Meconium staining
If - cord completed atretic
Fetus attached directly to placenta at umbilicus emphalocele is always present
Long umblicalcord
> 80cm
Long umblical cord associated with
Nuchal cord
True cord knots
Card compression
Cord presentation
Prolapse of cord
Umbilical cord stricture or torsion
Due to excessive feral motion
Variations in card diameter attributed to
Defuse accumulation of Wharton’s jelly
Umbilical cord masses
-cystic mass
Omphalocele
Gastroschisis
Umbilical herniation
Teratoma of umbilical cord
Aneurysm
Varix of cord
Hematoma
True knot of the cord
Angioma
Thrombosis
Omphalocele
Failure of - intestines to return to abdomen
Single loop of bowel or most of intestine
Covered by epithelium of cord
Gastroschisis
A right paralumbical defect involving all layers of abdominal wall
Castroshisis measurement
2-4 Cm
Castroshisis
Small bowelalway eviscerates through defect خارج میشود
Loops of bowel never covered by membrane
What blood factor is elevated in Gastroshisis
And why
AFP is elevated BCS gastroshisis directly exposed to AF
Umbilical herniation
When intestine return a normally in abdominal cavity
Prenatally or postnatally
Through inadequately
Closed umbilicus
At the cord insertion level using color Doppler
The umbilical arteries entering the abdomen in a normal location that excludes
Diagnosis of emphalocele
Omphalamesentric cyst
Cystic lesion of cord caused by persistence and dilation of segment of emphalo mesentric duct
Lined by epithelium of gastrointestinal
Cord cyst affect females over males
Closer to feral Cord insertion
Omphalamesentric cyst
Associated with the condition of Meckels diverticulum
Omphalomesentric cyst
Hemangioma of the cord
From transepitherial cells of vessels of umbilical cord
Surrounded by edema and myxomatous degeneration of Whartons jelly حاوی موکویید
Sites of origin of hemangioma of the cord
Main vessels of umbilical cord
Involve more than one vessel
What abnormality of the umbilical cord may develop nonimmune hydros
Hemangioma of the cord
Hematoma of the cord
If blood clot new, mass is hyperechnic
If old, hype ethnicand separated
47% to 52% with feral mortality
Thrombosis of the umbilical vessels
Occlusion of one or more cord vessels
Thrombosis of the umbilical vessels primarily occurs in
Umbrical vein
Thrombosis of the umbilical vessels incidence higher in
Infants of diabetic mother
Thrombosis of the umbilical vessels secondary to
Torsion
Knotting
Looping
Compression
Hematoma
Thrombosis of the umbilical vessels
Look for
Aneurysmal dilation of cord
Presense of feral hydros
Umbilical cord knots divided
True knots
False knots
Cord knots increase
Incidence of congenital anomalies
Cord knots associated with
Long cords
Polyhydramnios
IUGR
Mono-amniotic twins
Decreased velocity in the blood flow
False knots of the cord
Blood vessels are longer than cord
Often folded on themselves und produce modulations on surface of cord
False knots of the cord
Most common cord entanglement in fetus
Nuchal cord
Umbilical cord insertion Abnormalities
Marginal insertion
Circumvallate placenta
Velamentous
Succenturiate lobe
Battledore or marginal insertion of the cord complications
When cord inserted near internal os
Labor may cause cord to prolapse
Become compressed during contractions
Membranous or velamentous cord insertion Iî risk of
Thrombosis
Cord rupture during delivery
Vasa previa
Vasa previa and prolapse of The cord is high risk when
Fetus in transverse or breech presentation
Vasa previa and prolapse of The cord meaning
Presence of umbrical cord vessels crossing internal OS
Vasa previa and prolapse of The cord reason for high mortality rate
Ranging from 60 to 70%
Caused from rupture of vessels and fetal
Exsanguination
Single umbilical Artery more frequent
Miscarriage
Autopsy series
Single umbilical artery associated anomalies affected other organs such as
Musculoskeletal
Genitourinary
Cardiovascular
Gastrointestinal
Central nervous
Single umbilical artery complications and risks
Congenital anomalies
Increase incidence of IUGR
Prenatal mortality
Incidence of chrome sal abnormality
Trisomy 18,13,21
Turner’s syndrome
Triploidy
Varix of the umbilical vein
Aneurysm and Varix
Focal dilation umbilical cord vessels
Artery and vein
Focal dilation of the umbilical vein always
Intraabdeminal
Extrahepatic
Regression of right umbilical vein happens in
By 6 weeks
Umbilical vein enters refi portal vein directly
Sonographic diagnosis of persistent right umblical vein is
Umbilical vein curves towards the stomach
Fetal GB is medially to the umbilical vein
Btw the stomach and
The umbilical vein
single umbilical artery
This finding is associated with:
C
This finding is associated with:
a. fetal demise
b. premature labor
c. multifetal gestations
d. maternal diabetes mellitus
- Which of the following is the most common placental location for deposits of fibrin to collect?
- Which of the following is the most common placental location for deposits of fibrin to collect?
a. basal plate
***b. subchorionic
c. within a placental lake
d. within the retroplacental complex
•Cystic mass
•Cystic mass
› cord usually omphalomesel
allantoic in origin
Generally small (<2 cm)
•Near fetal end of cord
Resolve by second trimester
Cysts that persist beyond first trimester us associated with other fetal anomalies and aneuploidy
Angioma of the cord
(well-circumscribed echogenic
Angioma of the cord
(well-circumscribed echogenic mass that may cause cardiac failure and hydrops; alpha-fetoprotein level is increased; associated with a cyst caused by transudation of fluid from a hemangioma)
Thrombosis of cord
secondary to compression or kinking, focal cord mass, true cord knots, velamentous cord insertion, cord entanglement in monoamniotic twins (commonly seen with fetal demise)
Omphalomesenteric Cyst
Omphalomesenteric Cyst
• Is closer to fetal cord insertion
• Varies in size (up to 6 cm)
• Affects females over males with ratio of 5:3
• May be associated with the condition of Mecke diverticulum
Hemangioma of the Cord
•Sites of origin are main vessels of umbilical cord;
may involve more than one vessel.
Rare
• When found near placental end of cord, size varies from small to large (up to 15 cm).
• Fetus may develop nonimmune hydrops.
Membranous or Velamentous Insertion of
• Associated with:
• Higher risk of low birth weight
Small for gestational age
Preterm delivery
Low Apgar scores
Abnormal intrapartum fetal HR pattern
Cord Presentation and Prolapse
Conditions predisposing to cord presentation and prolapse are as follo
Abnormal fetal presentation
•
•
Nonengagement of fetus because of prematurity
Long umbilical cord
• Abnormal bony pelvic inlet
• Leiomyomas
Polyhydramnios v
Vasa previa
Velamentous insertion of cord
Marginal insertion of cord in low-lying placenta
• Incompetent cervix with PROM
