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Comprehensive Application of Prenatal Diagnostic Ultrasound in Studying Umbilical Cord Abnormalities

Explore the various abnormalities of the umbilical cord detected through prenatal diagnostic ultrasound. Learn about vessel number, cord coiling, morphological and structural variations, and associated conditions like single umbilical artery and cord cysts. Gain insights into umbilical cord aneurysms, vasa previa, nuchal cord, and cord coiling indices, and understand the potential implications for fetal health and pregnancy outcomes.

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Comprehensive Application of Prenatal Diagnostic Ultrasound in Studying Umbilical Cord Abnormalities

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  1. Prenatal Diagnostic Ultrasound in Application of Umbilical Cord 台北榮總婦產部 陳志堯 洪正修主任指導 2006年中華醫用超音波年會

  2. 媽媽的慈繩愛索

  3. What Ultrasound Can Do?

  4. In Diagnosis • Vessel Number: Normal cord has 3 vessels encased in Wharton jelly. (2A1V) • Arteries flanking the bladder. • Cord Coiled: Arteries coil around vein. • Connections: Abdominal wall & central placenta. (vesa previa, velamentous insertion)

  5. Cord Length (50~60 cm) • Short cord • Akinesia sequence • Trisomy 21 • Body stalk anomalies • Long cord • Hyperactivity • Increased likelihood of true cord knot

  6. Morphological Abnormalities

  7. Single Umbilical Artery • 3% in 1st trimester, 1~2% 2nd tri., 0.63% newborn. • 70% absent LT UA, 30% RT • Size is larger than 3 vessel cord UA • Less coiled • 15% develop IUGR • Non-isolated SUA: 50% aneuploidy (T18 & 13) • D/D • Fused UAs. • Umbilical vessel thrombosis • Excessive Wharton jelly

  8. Umbilical Cord Cyst (UCC) • Para-axial (60%), axial (40%), mid-UC (39%) • 2% in 1st trimester, 2nd~3rd trimester: aneuploidy (T18 & T13) • Single UCC (75%): good prognosis • Multiple UCC (25%): 2/3 aneuploidy & anomalies. • D/D • Normal yolk sac • UC aneurysm • Resolving UC hematoma (rare) • UC supernumerary vessels (very rare, conjoined twins)

  9. Umbilical Cord Aneurysm (UCA) • UV varix (UV > 9mm) • May associated with persistent Rt umbilical vein • Between abdominal insertion site and inferior liver • May be large • UA aneurysm • May have A-V fistula to UV • Associated with multiple anomalies (T18) • Near placental origin • More rare than UV varix; wall may be calcified

  10. Umbilical Cord Aneurysm (UCA) • Careful research for other anomalies • UV varix may be first manifestation of  vein pressure • Monitor impending hydrops • Monitor for anemia • Use color Doppler for checking • D/D • Normal fluid-filled structures • Abdominal cysts (choledochal cyst, meconium pseudocyst, ovarian cyst, urachal cyst) • UC cysts

  11. Meconium pseudocyst

  12. Vasa Previa • Submembranous fetal vessels cross cervical os • Doppler shows fixed fetal vessels overlying cx os • From succenturiate lobe: most common etiology • Best imagine tool: TVS + color Doppler + PW • D/D • Marginal sinus previa • Cord presentation • Uterine vessel near cervix

  13. Vasa Previa • Pathology: 1 in 3500 deliveries • 60~80% fetal mortality if diagnosis missed. • C/S before onset of labor

  14. Nuchal Cord • One or more complete loops of UC around fetal neck. • Males>females; 29% at 42wks • Single loop 10.6%, double 2.5% • Diagnosis best by: Doppler US and 3D ultrasound • Recommendations~ • Look for vascular compromise (S/D ratio) • Fetal growth and movement, amniotic fluid • D/D • Cord adjacent to neck • Cystic hygroma

  15. Special Topic Cord Index

  16. OBGYN 2006

  17. Under coiling is associates with (umbilical coiling index below the 10th percentile) • fetal death • spontaneous preterm delivery • trisomies • low Apgar score at 5 minutes • velamentous cord insertion • single umbilical artery

  18. There was an inverse relationship between the umbilical coiling index and the birth weight percentile. • Over coiling (umbilical coiling index above the 90th percentile) • asphyxia • umbilical arterial pH < 7.05 • small for gestational age infants • trisomies • single umbilical artery

  19. Under-coiling may give way to kinking and compression, whereas over-coiling may give way to occlusion in cases with cord entanglement. • Early second-trimester low umbilical coiling index predicts small-for-gestational-age fetuses.(J Ultrasound Med 20:1183–1188, 2001)

  20. It appears that umbilical cord coiling modulates noticeably blood flow through the umbilical cord.We speculate that more prominent umbilicalcoiling (higher antenatal UCI values) has a protective effect on blood flow in terms of decreased arterial resistance and higher blood flow velocities, as well as increased venous blood flow.

  21. Abnormal Cord Doppler & Clinical Significance

  22. 叫我第一名

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