Significance of Wharton’s jelly area in prediction of aberrant foetal growth


  • Sapna Amin Department of Obstetrics and Gynecology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Shripad Hebbar Department of Obstetrics and Gynecology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Deepika Pothakamuri Department of Obstetrics and Gynecology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Prashant Adiga Department of Obstetrics and Gynecology, KMC Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India



Macrosomia (LGA), Neonatal birth weight, Small for gestational age (SGA), Wharton’s Jelly Area


Background: Size of the baby at the time birth determines its outcome. Low birth weight babies have their own set of problems such as respiratory distress syndrome, hypoxic ischemic encephalopathy, metabolic derangements and high rates of admission to intensive care units. On the other hand too large babies may cause difficulty in vaginal births, higher incidence of birth trauma including the maternal genital injuries. Both conditions are associated with higher rates of operative delivery and hence it is important to investigate parameters which could identify these foetal growth abnormalities in the antenatal period only. The objective of the present investigation was to study the relationship between foetal umbilical cord Wharton’s Jelly Area and neonatal birth weight within two weeks of delivery

Methods: A prospective observational study was conducted at Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India over a period of two years. Two hundred and fifty women from 34 weeks gestational age who have delivered within two weeks of estimation of Wharton’s Jelly Area by ultrasound were analysed. Wharton’s Jelly Area was measured in pregnant woman after 34 weeks of gestation at the time of third trimester scan. Scans were repeated every two weeks till the woman delivered. Measurements were done in a free loop of the umbilical cord. Regression analysis was used to correlate Wharton’s jelly quantity with the birth weight obtained after birth of the neonate.

Results: There was a good correlation between Wharton’s Jelly Area and neonatal birth weight. The mean birth weight was 2247.2 gms in <than 10th centile group, 2945.1gms in 10th to 90th centile and 3552.1 gms in more than 90th centile group, demonstrating a consistent rise in mean birth weight with higher centile groups. Polynomial regression function showed good fit between Wharton’s jelly and birth weight (R² = 0.8842, p<0.001). When Wharton’s jelly area was less than 10th centile, 72% of neonates had small for gestational age (SGA).

Conclusions: There is a positive association between Wharton’s Jelly Area and neonatal birth weight. Birth weight of neonate showed steady increase with increasing Wharton’s Jelly Area.


Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements-a prospective study. Am J Obstet Gynaecol. 1985;151:333-7.

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.

American College of Obstetricians and Gynecologists (ACOG) Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013;121(5):1122-33.

Filiz AA, Rahime B, Keskin HL, Esra AK. Positive correlation between the quantity of Wharton's jelly in the umbilical cord and birth weight. Taiwan J Obstet Gynecol. 2011;50(1):33-6.

Di naro E, Ghezzi F, Raio L, Franchi M, D'addario V. Umbilical cord morphology and pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2001;96(2):150-7.

Barbieri C, Cecatti JG, Surita FG, Marussi EF, Costa JV. Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy. J Obstet Gynaecol. 2012;32(3):230-6.

Redline RW. Clinical and pathological umbilical cord abnormalities in fetal thrombotic vasculopathy. Hum Pathol. 2004;35(12):1494-8.

Raio L, Ghezzi F, Di Naro E, Franchi M, Maymon E, Mueller MD, Brühwiler H. Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth. Ultrasound Obstetr Gynecol. 1999;13(3):176-80.

Cromi A, Ghezzi F, Di naro E, Siesto G, Bergamini V, Raio L. Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol. 2007;30(6):861-6.

Ghezzi F, Raio L, Di naro E, Franchi M, Balestreri D, D'addario V. Nomogram of Wharton's jelly as depicted in the sonographic cross section of the umbilical cord. Ultrasound Obstet Gynecol. 2001;18(2):121-5.

Ferguson VL, Dodson RB. Bioengineering aspects of the umbilical cord. Eur J Obstet Gynecol Reprod Biol. 2009;144 Suppl 1:S108-13.

12. Takechi K, Kuwabane Y, Mizuna M. Ultrastructure and immunohistochemical studies of Wharton’s jelly umbilical cord cells. Placenta. 1993;14:235-45.

Labarrere C, Sebastiani M, Siminovich M, Torassa E, Althabe O. Absence of Wharton’s jelly around the umbilical arteries: an unusual cause of perinatal mortality. Placenta. 1985;6:555-9.

Scott JM, Wilkinson R. Further studies on the umbilical cord and its water content. J Clin Pathol 1978;31:944-8.

Gill P, Jarjoura D. Wharton’s jelly in the umbilical cord. A study of its quantitative variations and clinical correlates. J Reprod Med 1993; 38: 611-4.






Original Research Articles