The Umbilical Cord and Its Abnormalities

Asheber Gaym M.D.

January 2009
 Outline

• Describe the normal anatomy of the umbilical

cord
• Discuss abnormalities of the umbilical cord
• Discuss possible consequences of
abnormalities of the umbilical cord

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 Normal anatomy of the Umbilical Cord (Funis)

• The umbilical cord contains the two umbilical arteries and the
larger single umbilical vein encased in the Wharton’s Jelly- a
jelatineaous substance protecting the vessels from pressure and
injury
• The Wharton’s Jelly is circumferentially encased by an extension of
the fetal membranes
• The umbilical cord is normally inserted into the center of the
dorsum of the placental surface
• The normal dimensions of the umbilical cord are:
– Length – 30cms- 100 cms ( Average 50cms)
– Diameter -variable
• Nuchal cord incidence- 25% (multiple Nuchal cord loops are rarer)

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 Abnormalities of the Umbilical Cord

Abnormality Consequences

Short cord - < 30 cms ( Shortest so far Abruption; fetal distress during labor;
found is 2cms) detachment during delivery … etc

Long cord - > 100 cms ( Longest so far is 2 Cord entanglement; Nuchal cords; Cord
meters ) prolapse; True cord knots; Fetal asphyxia
True Knots – very rare Can lead to asphyxia during labor or
sometimes earlier
False Knots No significance in causing fetal pathology

Single umbilical artery 30% of fetuses with single umbilical artery

Velamentous insertion of the cord- cord
inserted away from the placenta on the
membranes and long vessels traversing
the membranes to reach placenta
have associated congenital anomalies
Sometimes leads to a large vessel crossing
over the cervix to reach the placenta-
such vessels ( Vasa previa) can rupture
during membrane rupture causing severe
fetal bleeding and asphyxia

Battledore insertion – cord insertion at Can lead to difficulties at placental

the margin of the placenta delivery
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