P15.01: Umbilical cord anomalies: detection and expectations

Abstract

Fetal ultrasonographic screening has to include assessment of the umbilical cord for possible abnormalitiesthat can be: hypercoiled cord and nuchal cord, abnormal length and thickness of the cord, anomalies of the placental insertion site, vascular abnormalities and primary tumors of the cord. These conditions may be associated with fetal anomalies, chromosomal anomalies and intrauterine growth restriction. In our study we describe and analyze the ultrasound diagnosis and management of major umbilical cord abnormalities, considering the current knowledge on physiologic and pathologic aspects of each of them. A retrospective study was conducted in Universitary Emargency Hospital Bucharest over a 3-year period. We found 18 cases of single umbilical arteries, 6 cases of velamentous cord insertion, 3 of them associated with placental adherence abnormalities, partial placenta previa and one with vasa previa, 16 cases of more than 2 loops nuchal cord, 7 cases of true knot cord with 2 ultrasound undiagnosed cases, 5 true cord cysts and 3 cases of fetal intra-abdominal umbilical vein dilatation. A pregnancy with umbilical cord anomalies is more likely to be complicated with polyhydramnios, preterm delivery under 34 weeks, low birthweight, Caesarean delivery for fetal distress, perinatal death, admission to NICU and placental abnormalities compared with a pregnancy with a normal umbilical cord. We sustain that prenatal detection of umbilical cord abnormalities will decrease the number of emergent Caesarean sections and intrauterine fetal death. Safe fetal delivery, fetal echocardiography and karyotype analysis should be offered depending on risk associated to each umbilical cord abnormality. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities, whereas 3D/4D Doppler US of the fetal umbilical cord and abdominal vasculature allows a high accurate diagnosis of vascular abnormalities.