Umbilical cord abnormalities

Abstract

Objective: Stillbirths and neonatal outcome after delivery has been associated with umbilical cord findings. Cord abnormalities may put the baby in higher risk of certain diseases or low birth weight. The etiology of the umbilical cord abnormalities are not clear diagnosis. Although the fetal mortality associated with umbilical cord abnormalities is very high, identification of the fetus at risk has remained a difficult problem. The aim of this academic work is to study the human umbilical cord (UC) congenital abnormalities including length, diameter, coiling pattern, and placental insertion site in full term Sudanese neonates. Materials and Methods: One thousand and twenty UC of full-term birth neonates of both sexes, single and twin, of normal vaginal delivery in 2013, were studied in the Department of Obstetrics and Gynecology, Omdurman Maternity Hospital. UC length was entirely measured in centimeters using flexible plastic meter and the diameter was measured by Vernier caliper. The number of UC coils, coils pattern, insertion site, knots, cysts, and the blood vessels were fully studied. Results: The average UC length was about 58 cm, with minimal difference between male to female, single to twin birth. In majority of the cases, true knots occur without any clinical significance, whereas the tight knot may impede the circulation and may lead to low birth or intrauterine death. Thin cord places fetus at risk during pregnancy and may result in restricted growth, low birth weight, and neonates which are small for gestational age. This appears to be a consequence of reduction in the area of Wharton's jelly or small cord diameter. Very helical designs may predispose the fetus to certain blood flow changes, and very straight designs may be susceptible to compression. In both these types of coils, the degree of coils vary depending on cord length, diameter, fetal gender, and number of pregnancy. Hypercoiled coils may predispose the fetus to certain blood flow changes and hypocoiled cords may lead to the fetus being susceptible to compression; however in both cases, the blood flow and fetal weight may be affected. These factors were considered regarding possible interactions and correlation to pregnancy and perinatal outcome. Conclusion: Average length of UC in Sudanese neonates about 55 cm, being long in males and single birth, and there is no big difference in the cord length measurement before and after birth, comparing the two methods (ultrasound and manual measurements). 20cm of the cord length is suitable for fetus to be delivered vaginally. Average UC diameter in Sudanese neonates about 1.5 cm, big in males and single birth, Maximum UC coils about 45 coils, more in males and single birth, eccentric insertion is more common than central or marginal false knots of the are also more common than true knots. Most of the cord true knots located near to the fetal end of the umbilical cord, and they were commonly coiled to the left side (anticlockwise direction) incidence of a SUA in Sudanese neonate about 1% more common in males