DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183851

Antenatal sonographic assessment of cross sectional area of umbilical cord components and its reference value in normal pregnancy

Khizer Hussain Afroze, Lakshmiprabha Subash, Anand S. H.

Abstract


Background: Measuring the cross-sectional area of umbilical components in normal pregnant women helps in assessing the fetal abnormalities. Very few literatures were available on evaluation of reference values of cross sectional areas of umbilical cord components. The present study was conducted with the aim to determine the normal reference values of cross sectional areas of umbilical arteries, umbilical vein and Wharton’s jelly and to correlate them with the gestational age of the fetus.

Methods: A cross sectional study was conducted on 300 normal pregnant women at the Department of Radiodiagnosis, Sri Siddhartha Medical College, Tumakuru, Karnataka to assess the reference range of cross sectional areas of umbilical cord arteries, umbilical vein and Wharton’s jelly at different gestational age of the fetus to analyze their growth.

Results: A statistically significant correlation was observed between cross sectional areas of umbilical artery and vein and gestational age before and after 34 weeks (p=0.005 and 0.006 respectively) but no significant correlation was noticed with the cross-sectional area of Wharton’s jelly (p=0.088).

Conclusions: Cross sectional area measurements of umbilical cord components can be considered as important tools for estimation of fetal growth.


Keywords


Normal pregnancy, Ultrasonography, Umbilical cord components

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References


Wang HS, Hung SC, Peng ST, Huang CC, Wei HM, Guo YJ, et al. Mesenchymal stem cells in the Wharton's jelly of the human umbilical cord. Stem Cells. 2004;22:1330-7.

Qureshi F, Jacques SM. Marked segmental thinning of the umbilical cord vessels. Arch Pathol Lab Med. 1994;118:828-30.

Sun Y, Arbucku S, Hocking G, Billso V. Umbilical cord stricture and intrauterine fetal death. Pediatr Pathol Lab Med. 1995;5:723-32.

Togni FA, Araújo E, Vasques FA, Moron AF, Torloni MR, Nardozza LM. The cross-sectional area of umbilical cord components in normal pregnancy. Int J Gynecol Obstet. 2007;96(3):156-61.

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 Obstetrics Gynaecol. 2012;32(3):230-6.

Afroze KH, Prabha SL, Chandrakala V, Deepak M. Sonographic Estimation of Umbilical Cord Cross-section Area and its Reference Value in Normal Pregnancy. J Clin Diagn Res. 2017;11(8):4-6.

Weissman A, Jakobi P, Bronshtein M, Golstein I. Sonographic measurements of the umbilical cord and vessels during normal pregnancies. J Ultrasound Med. 1994;13:11-4.

Raio L, Ghezzi F, Di Naro E, Gomez R, Franchi M, Mazor M, et al. Sonographic measurement of the umbilical cord and fetal anthropometric parameters. Eur J Obstet Gynecol Reprod Biol. 1999;83:131-5.

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

Skulstad SM, Ulriksen M, Rasmussen S, Kiserud T. Effect of umbilical ring constriction on Wharton's jelly. Ultrasound Obstet Gynecol. 2006;28:692-8.

Fahmy M. Anatomy of the Umbilical Cord. In: Umbilicus and Umbilical Cord. Springer, Cham; 2018: 47-56.

Schöni‐Affolter F, Dubuis‐Grieder C, Strauch E. The umbilical cord. 2007. Available at: http://www.embryology.ch/anglais/fplacenta/cordon01.html.

Cochard LR. Netter's Atlas of Human Embryology. 1st ed. New Jersey: Icon Learning Systems; 2002.

Standring S, editor. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40 ed. Edinburgh: Churchill Livingstone Elsevier; 2008.

Blackburn ST. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective. 3rd ed. St. Louis: Sanders Elsevier; 2007.

Callen PW. Ultrasonography in Obstetrics and Gynecology. 4th ed. Philadelphia: WB Saunders Company; 2000.

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

Moshiri M, Zaidi SF, Robinson TJ, Bhargava P, Siebert JR, Dubinsky TJ, et al. Comprehensive Imaging Review of Abnormalities of the Umbilical Cord. RadioGraphics 2014;34:179-96.

Morgan BLG, Ross MG. Umbilical Cord Complications. emedicine.com. 2006.

Gossett DR, Lantz ME, Chisholm CA. Antenatal Diagnosis of Single Umbilical Artery: Is Fetal Echocardiography Warranted? Obstet Gynecol. 2002;100(5):903-8.

Cruikshank DW. Breech, Other Malpresentations, and Umbilical Cord Complications. In: Scott JR, et al, eds. Danforth's Obstetrics and Gynecology. 9th Edition. Philadelphia: Lippincott Williams and Wilkins; 2003: 381-395.

Oyelese Y, Smulian JC. Placenta Previa, Placenta Accreta, and Vasaprevia. Obstetrics Gynecol. 2006;107(4):927-41.

Kliman HJ. The Umbilical Cord. Available at: shttps://medicine.yale.edu/obgyn/kliman/placenta/research/Umbilical%20Cord%20EOR_163162_284_18220_v1.pdf.

Deka D, Dadhwal V, Roy KK, Malhotra N, Vaid A, Mittal S. Indications of 1342 fetal cord blood sampling procedures performed as an integral part of high risk pregnancy care. J Obstet Gynaecol India. 2012;62(1):20-4.

Wang Y, Zhao S. Vascular Biology of the Placenta. San Rafael (CA): Morgan & Claypool Life Sciences; 2010.

Predanic M. Sonographic assessment of the umbilical cord. Ultrasound Rev Obstet Gynecol. 2005;5:105-10.

Di Naro E, Ghezzi F, Raio L, Franchi M, D'Addario V, Lanzillotti G, et al. Umbilical vein blood flow in fetuses with normal and lean umbilical cord. Ultrasound Obstet Gynecol. 2001;17:224-8.

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.

Hanretty K. Obstetrics Illustrated. Edinburgh: Churchill Livingstone Elsevier; 2010.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 23rd ed. New York: McGraw Hill Medical; 2010.

Strong TH Jr, Elliot JP, Radin TG. Non-coiled umbilical blood vessels: a marker for the fetus at risk. Obstetrics and Gynecol. 1993;81:409-11.

Skulstad SM, Rasmussen S, Seglem S, Svanaes RH, Aareskjold HM, Kiserud T. Effect of umbilical venous constriction on placental development, cord length and perinatal outcome. Early Human Development. 2005;81:325-31.

Chakraborty SK, Yousuf A, Banu LA, Shamim KM. A gross and histomorphological study of the umbilical cord in gestational diabetes mellitus. Bangladesh J Anatomy. 2011;9(1):21-5.

Rostamzadeh S, Kalantari M, Shahriari M, Shakiba M. Sonographic measurement of the umbilical cord and its vessels and their relation with fetal anthropometric measurements. Iran J Radiol. 2015;12(3):e12230.