Umbilical Cord

Question 1

Vessels in cord

Answer 1

2 arteries:
1. Right umbilical artery
2. Left umbilical artery

1 vein: Left umbilical vein

Question 2

Remnant of umbilical artery and vein in adults

Answer 2

UA: Medial umbilical artery
UV: Ligamentum teres

Question 3

Length of cord

Answer 3

40-70 cm
Long cord: >70 cm
Short cord: <32 cm

Question 4

Connective tissue of cord

Answer 4

Wharton’s jelly

Question 5

Folds of cord are known as

Answer 5

Folds of Hobokon

Question 6

Inflammation of cord and Fetal surface of placenta is known as

Answer 6

Funisitis

Question 7

Types of Fetal membranes

Answer 7

1. Chorion (Outermost)
2. Amnion (Innermost)
3. Yolk sac
4. Allantois

Question 8

Formation of chorion

Answer 8

From chorion laevae/ cytotrophoblast/trophoblast
By D8 after fertilisation

Question 9

Formation of amnion

Answer 9

From Fetal ectoderm
By D10 after fertilisation

Question 10

Tensile strength of membranes is due to

Answer 10

Amnion

Question 11

1st site for hematopoiesis in fetus

Answer 11

Yolk sac
Forms primitive Hb like Portland Hb, Gower Hb

Question 12

Source of alpha fetoprotein in membranes

Answer 12

Yolk sac
Also produced in:
1. Fetal liver
2. Fetal GIT

Question 13

What is Allantois?

Answer 13

Diverticulum that connects hind gut to connecting stalk

Question 14

Fetal membranes are rich in

Answer 14

PGE 2

Question 15

Normal cord insertion

Answer 15

Center on Fetal side of placenta

Question 16

What is Battledore placenta?

Answer 16

When cord is attached to margins of placenta
Cord attached within 2 cm of placental edge

Question 17

Complications of Battledore placenta

Answer 17

1. Cord avulsion
2. Retained placenta
3. PPH
4. Vasa previa

Question 18

Velamentous insertion of cord

Answer 18

Cord ends before attaching to placenta, instead diversified blood vessels without Wharton’s jelly are attached to margins of placenta and Fetal membranes

Question 19

Risks of velamentous insertion

Answer 19

1. Compression of blood vessel
2. Kinking of blood vessels
   Both lead to reduced blood supply to fetus:
   >Fetal distress
   >IUGR
   >Oligohydramnios
3. Vasa previa

Question 20

What is vasa previa?

Answer 20

Condition where Fetal vessels are present over membranes covering int os

Question 21

Types of vasa previa

Answer 21

Type 1: Asso with velamentous insertion
Type 2: Asso with succenturiate lobe
Type 3: Asso with placenta previa

Question 22

IOC of vasa previa

Answer 22

TVS with Doppler

Question 23

Management of vasa previa

Answer 23

Plan C section between 34-37 weeks
Antenatal steroids given before 34 weeks

Question 24

Test to differentiate between vasa previa and placenta previa

Answer 24

Singer’s alkali denaturation test/Apt test

Question 25

Principle of Apt test

Answer 25

HbF resistant to acid and alkali HbA sensitive to acid and alkali

Question 26

Results of Apt test

Answer 26

Add 1% NaOH, Color changes to brown: Hemolysis occurred, HbA present (Placenta previa) Color changes no: No hemolysis, HbF present (Vasa previa)

Question 27

Most common anomaly of cord

Answer 27

Single umbilical artery (SUA)

Question 28

Types of SUA

Answer 28

Type 1: Single artery of Allantoic origin+Left umbilical vein Type 2: Single artery of vitelline origin from sup mesenteric artery

Question 29

SUA most commonly asso with

Answer 29

Congenital anomalies of fetus M/C renal>CVS

Question 30

Most common aneuploidy in SUA

Answer 30

Trisomy M/C trisomy: Trisomy 18

Question 31

SUA common in

Answer 31

1. Twin pregnancies 2. Inc maternal age 3. Diabetes 4. HTN 5. Seizure

Question 32

What is cord prolapse?

Answer 32

During labour, post rupture of membranes, if cord comes out first, then it is cord prolapse

Question 33

What is overt cord prolapse?

Answer 33

Cord slips ahead of Fetal presenting part and prolapses into cervix, vagina and beyond

Question 34

Problem with overt CP

Answer 34

Cord exposed to ext environment which leads to vasoconstriction

Question 35

What is occult CP?

Answer 35

Cord slips alongside but not ahead of presenting part

Question 36

Problem with occult CP

Answer 36

Cord compression

Question 37

What is cord/funic presentation?

Answer 37

Cord present ahead of presenting part but is above int os

Question 38

What is compound presentation?

Answer 38

Cord and presenting part of fetus alongside each other and above int os

Question 39

Where does cord prolapse happen?

Answer 39

Disengagement of presenting part during obstetric procedure

Question 40

Risk factors of cord prolapse

Answer 40

1. Malpresentation 2. Preterm delivery 3. Polyhydramnios 4. Twin pregnancies 5. Multiparity