13 umblical cord imaging dr ahmed esawy
single umblical artery
two vessels cords
four vessels cords
Two veins & two arteries
One vein & 3 arteries
One vein, two arteries and a duct
five and more vessels cords
Cords with unequal numbers of vessels at
the fetal and placental ends
Velamentous insertion of the cord
vasa previa
Ductus venosus agenesis
Replaced umbilical artery to the superior mesenteric
artery
Coronary sinus drainage to the umbilical portion of
the left portal vein
Persistent right umbilical vein
Arteriovenous fistula
Hypoplastic umbilical artery
Umbilical artery stenosis
Thrombosis
Segmental thinning of umbilical cord vessels
Umbilical cord constriction
Nuchal cord loops
Type A - nuchal loop that encircles the neck in a freely sliding pattern
Type B - nuchal loop that encircles the neck in a locked pattern
Other locations are also frequent, such as the abdomen or the lower limbs.
Multiple cord loops are also a frequent event. This is a rare case of quintuple
nuchal cord entanglement.
Some cords seem entangled but they are not, and they are called
draped around the neck.
Cord-to-cord entanglement in twin gestations
Umbilical vein varix
Abnormal cord coiling
Non-coiled cords and poorly coiled cords
Hyper-coiled cords
Abnormal cord length.
Short cords (Defined as total length of 40 cm or less
)
Long cords (defined as total length over 70 cm)
Abnormal cord width
7. • Cord daimeter cross section (outer to outer)
• Short cord less than 40 cm
• long cord more than 70 cm
• Vessel diameter inner to inner up to 4 mm
Dr/AHMED ESAWY
8. I. Abnormal number of vessels
single umblical artery
two vessels cords
four vessels cords
Two veins & two arteries
One vein & 3 arteries
One vein, two arteries and a duct
five and more vessels cords
Cords with unequal numbers of vessels at
the fetal and placental ends
Dr/AHMED ESAWY
9. II-Abnormal course or connection of vessels
Velamentous insertion of the cord
vasa previa
Ductus venosus agenesis
Replaced umbilical artery to the superior mesenteric
artery
Coronary sinus drainage to the umbilical portion of
the left portal vein
Persistent right umbilical vein
Arteriovenous fistula Dr/AHMED ESAWY
10. III-Abnormal structure or configuration of vessels
Hypoplastic umbilical artery
Umbilical artery stenosis
Thrombosis
Segmental thinning of umbilical cord vessels
Umbilical cord constriction
Nuchal cord loops
Type A - nuchal loop that encircles the neck in a freely sliding pattern
Type B - nuchal loop that encircles the neck in a locked pattern
Other locations are also frequent, such as the abdomen or the lower limbs.
Multiple cord loops are also a frequent event. This is a rare case of quintuple
nuchal cord entanglement.
Some cords seem entangled but they are not, and they are called
draped around the neck.
Dr/AHMED ESAWY
11. III-Abnormal structure or configuration of vessels
Cord-to-cord entanglement in twin gestations
Umbilical vein varix
Abnormal cord coiling
Non-coiled cords and poorly coiled cords
Hyper-coiled cords
Abnormal cord length.
Short cords (
Defined as total length of 40 cm or less
)
Long cords (defined as total length over 70 cm)
Abnormal cord width
Dr/AHMED ESAWY
12. UC Position
Normally:
• anterior to the fetal abdominal wall and adjacent to the
limbs.
Malposition
• Nucal: around fetal neck
• Around limbs
• Between the fetal presentation part and the lower
uterine segment (funic presentation). more common
with malpresentations such as breech or transverse lie.
• Prolapse
Dr/AHMED ESAWY
18. Single Umbilical Artery
= 2 Vessel Cord
• In isolation, not significant risk of aneuploidy
• Associated with other anomalies 20-50% of cases
• UA anastomosis may normally occur at placental end –
• avoid diagnosing 2V cord there
• Useful view: 2 UAs at the level of the bladder
Dr/AHMED ESAWY
19. shows all the reported structural anomalies
associated with single umbilical artery
Dr/AHMED ESAWY
34. Artifacts
Occasionally the incidence of the ultrasound
beam gives exquisite view of the vessels walls
and gives the impression of extra vessels.
Dr/AHMED ESAWY
46. Ductus venosus agenesis
Although absence of the ductus arteriosus is very rare
absence of the venosus is occasionally seen. The return of
the umbilical flow is via various vicarious ways
• a suprahepatic connection to the inferior vena cava or
• rarely to the right atrium directly
• an infrahepatic connection to the inferior vena cava
• cutaneous anastomosis with formation of a caput medusa
• left or right iliac connection.
Dr/AHMED ESAWY
59. 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
Dr/AHMED ESAWY
62. Umbilical Vein Varix
• Normal Umbilical Vein
• 3mm at 15wks 8mm at term
• Varix usually incidental finding
• In isolation, prognosis is good
• If large:
• follow-up is suggested
• look for intraluminal thrombus formation
Dr/AHMED ESAWY
73. Under coiling is associates
fetal death
spontaneous preterm delivery
Operative delivery for fetal distress.
Meconium staining.
trisomies
low Apgar score at 5 minutes
velamentous cord insertion
single umbilical artery
Repetitive intrapartum fetal heart rate decelerations.
Aneuploidy .
IUGR
Dr/AHMED ESAWY
74. • Under-coiling may give way to kinking and
compression
• 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.
Dr/AHMED ESAWY
81. Cord Length (50~70 cm)
• Short cord
– Akinesia sequence
– Trisomy 21
– Body stalk anomalies
• Long cord
– Hyperactivity
– Increased likelihood of true cord knot
Dr/AHMED ESAWY
82. Short cords
• Defined as total length of 40 cm or less, short
umbilical cords are uncommon.
Dr/AHMED ESAWY
83. • Fetal Akinesia Deformation Sequence (FADS) or Pena-
Shokeir Sequence,
• Spinal muscular atrophy (SMA)
• Body-stalk anomaly (also known as short cord umbilical
cord syndrome).
• Lateral meningocele syndrome (also known as "familial
osteosclerosis).
• Neu-Laxova syndromeDr/AHMED ESAWY
Short cords
84. Long cords
• Long umbilical cords, defined as total length over
70 cm, have been significantly associated with:
Maternal factors:
• Systemic diseases.
• Delivery complications.
• Increased maternal age.
Fetal factors:
• Non-reassuring fetal status during labor.
• Respiratory distress.
Dr/AHMED ESAWY
86. Abnormal cord width
Thin ("lean") cords
Defined as the cross-sectional area of the cord,
measured in a plane adjacent to the insertion into
the fetal abdomen, below the 10th centile for
gestational age. Lean cords have been associated
with
Dr/AHMED ESAWY
88. Cysts and pseudocysts
•
Umbilical cord cysts
• Pseudocysts are localized edema of Wharton"s
jelly or liquefaction of hematomas or thrombus
within the cord.
Dr/AHMED ESAWY
90. Patent urachus
It has been associated to structural anomalies are:
Anterior abdominal wall defects,
Bladder exstrophy and
Other lesions of the cord :hemangioma, varix, true knot, allantoic or
omphalomesenteric cysts.
Dr/AHMED ESAWY
97. Nuchal cord loops
Type A - nuchal loop that encircles the neck in a freely sliding
pattern
Type B - nuchal loop that encircles the neck in a locked pattern
Dr/AHMED ESAWY
98. Nuchal Cord
• One or more complete loops of UC around fetal neck.
• 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
Dr/AHMED ESAWY
99. Pathogenesis of Nuchal Cords
• Unclear.
• fetal movements .
• Excessive fetal movement and long umbilical cords .
Dr/AHMED ESAWY
100. Incidence of Nuchal Cords
• Ranges between 15.8% and 30%.
• Nuchal cords may reduce spontaneously.
Dr/AHMED ESAWY
101. Perinatal Outcome
• Fetal bradycardia and variable decelerations
• Umbilical artery acidemia
• Metabolic acidemia was infrequent
Dr/AHMED ESAWY
102. Perinatal Outcome
multiple nuchal cords were more likely to have
– Meconium-stained amniotic fluid
– Intrapartum fetal heart rate changes
– Operative vaginal delivery
– Low 1 minute Apgar scores
– Mild umbilical artery acidosis at birth
Dr/AHMED ESAWY
104. Ultrasonography of nuchal cords
• Requires a high-degree of suspicion.
• fixed point.
• high-resolution ultrasound with the “divot” sign representing
circular indentations of the fetal nuchal.
• D.D :
posterior cystic masses, folds of skin or amniotic fluid pockets,
with the “divot” sign.
Dr/AHMED ESAWY
105. Ultrasonography of Nuchal Cords
• color Doppler imaging.
• Both sagittal and axial
• .
• Doppler flow velocimetry may be applied to confirm
diagnosis.
• 3D ultrasound may improve prenatal diagnosis.
Dr/AHMED ESAWY
129. Persistent RT Umbilical Vein
• May replace the L UV,
or coexist with L UV
• Lateral to GB
• Curves towards ST
• Mixed accounts of prognosis
• Look for anatomic abnormalities
• In isolation, prognosis good
Dr/AHMED ESAWY
131. • References
• 1 Fox H. Pathology of the Placenta. London: W.B. Saunders 1978, pp.426-57.
2 Blazer S, Sujov P, Escholi Z, Itai BH, Bronshtein M. Single umbilical artery--right or left? does it matter? Prenat
Diagn 1997 Jan;17(1):5-8.
3 Benirschke K, BourneGL. The incidence and prognostic implication of congenital absence of one umbilical artery.
Am J Obstet Gynecol 1960; 79: 251-3.
4 Heifetz SA. Single Umbilical Artery. A statistical analyses of 237 autopsy cases and review of the kiterature.
Perspect Pediatr Pathol 1984; 8: 345-78.
5 Lilja M. Infants with single umbilical artery studied in a national registry: general epidemiological characteristics.
Paediatr Perinat Epidemiol 1991; 5: 27-36.
6 Saller DN Jr, Keen CL, Sun CC, Schwartz S. The association of single umbilical artery with cytogenetically
abnormal pregnancies.
7 Clausen I. Umbilical cord anomalies and antenatal fetal demise. Obstet Gynecol Surv.1989; 44: 841-5.
8 Chow JS, Benson CB, Doubilet PM. Frequency and nature of structural anomalies in fetuses with single umbilical
arteries. J Ultrasound Med 1998 Dec;17(12):765-8.
9 Thumala MR, Raju TN, Langemberg P. Isolated single artery anomaly and the risk of congenital malformations: a
metaanalysis. J Pediatr Surg 1998; 33: 580-5.
10 Weissman A, Drugan A. Sonographic findings of the umbilical cord: implications for the risk of fetal
chromosomal anomalies. Ultrasound Obstet Gynecol 2001 Jun;17(6):536-41.
11 Pavlopoulos PM, Konstantinidou AE, Agapitos E, Christodoulou CN, Davaris P. Association of single umbilical
artery with congenital malformations of vascular etiology. Pediatr Dev Pathol 1998 Nov-Dec;1(6):487-93.
12 Scalercio F, Ferraro M, Mastrantonio P, Scalercio A. Single umbilical artery (SUA) and congenital eye
abnormalities. 2 case reports. Minerva Pediatr 1998 Apr;50(4):141-4.
13 Meizner I, Sherizly I, Mashiach R, Shalev J, Kedron D, Ben-Rafael Z. Prenatal sonographic diagnosis of
laryngeal atresia in association with single umbilical artery. J Clin Ultrasound 2000 Oct;28(8):435-8.
Dr/AHMED ESAWY
132. • 14 Petrikovsky B, Schneider E. Prenatal diagnosis and clinical significance of hypoplastic umbilical artery. Prenat Diagn 1996; 16: 93-4.
15 Khong TY, George K. Chromosomal abnormalities associated with a single umbilical artery. Prenat Diagn 1992; 12: 965-8.
16 Rinehart BK, Terrone DA, Taylor CW, Isler CM, Larmon JE, Roberts WE. Single umbilical artery is associated with an increased incidence of
structural and chromosomal anomalies and growth restriction. Am J Perinatol 2000;17(5):229-32.
17 Jeanty P. fetal and funicular vascular anomalies: Identification with prenatal ultrasound. Radiology 1989; 173:367-70.
18 Rosenak D, Meizner I. Prenatal sonographic diagnoses of a single and double umbilical artery in the same fetus. J Ultrasound Med 1994; 13: 995-
6.
19 Painter D, Russell P. Four-vessel umbilical cord associated with multiple congenital anomalies. Obstet Gynecol 1977 Oct;50(4):505-7
20 Chiappa E, Viora E, Botta G, Abbruzzese PA, Ciriotti G, Campogrande M Arteriovenous fistulas of the placenta in a singleton fetus with large
atrial septal defect and anomalous connection of the umbilical veins. Ultrasound Obstet Gynecol 1998 Aug;12(2):132-5
21 Schimmel MS, Eidelman AI Supernumerary umbilical vein resulting in a four-vessel umbilical cord. Am J Perinatol 1998 May;15(5):299-301
22 Rodriguez MA Four-vessel umbilical cord without congenital abnormalities. South Med J 1984 Apr;77(4):539
23 Meyer WW, Lind J, Moinian M An accessory fourth vessel of the umbilical cord. A preliminary study. Am J Obstet Gynecol. 1969 Dec
1;105(7):1063-8
24 Fraser RB, Liston RM, Thompson DL, Wright JR Jr Monoamniotic twins delivered liveborn with a forked umbilical cord. Pediatr Pathol Lab Med
1997 Jul-Aug;17(4):639-44
25 Benirschke K, Kaufmann P: Pathology of the human placenta. New York: Springer-Verlag, 1990 pp. 200-4.
26 Bjoro K: Vascular anomalies of the umbilical cord. II. Perinatal and pediatric implications. Early Hum Dev 8:279-87, 1983.
27 2. Robinson LK, Jones KL, Benirschke K: The nature of structural defects associated with velamentous and marginal insertion of the umbilical
cord. Am J Obstet Gynecol 146:191-93, 1983.
28 Oyelese Y, Spong C, Fernandez MA, McLaren RA. Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa. J Matern
Fetal Med 2000 Nov-Dec;9(6):370-2.
29 Oyelese KO, Turner M, Lees C, Campbell S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv 1999 Feb;54(2):138-45.
30 Hata K, Hata T, Fujiwaki R, Ariyuki Y, Manabe A, Kitao M. An accurate antenatal diagnosis of vasa previa with transvaginal color Doppler
ultrasonography. Am J Obstet Gynecol 1994 Jul;171(1):265-7.
31 Catanzarite V, Maida C, Thomas W, Mendoza A, Stanco L, Piacquadio KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings
and obstetric outcome in ten cases.Ultrasound Obstet Gynecol. 2001 Aug;18(2):96-9.
32 Lee W, Lee VL, Kirk JS, Sloan CT, Smith RS, Comstock CH. Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome. Obstet
Gynecol 2000 Apr;95(4):572-6.
33 Lee W, Kirk JS, Comstock CH, Romero R. Vasa previa: prenatal detection by three-dimensional ultrasonography. Ultrasound Obstet Gynecol
2000 Sep;16(4):384-7.
Dr/AHMED ESAWY
133. • 34 Shin HS, Cho KJ, Suh YL, Chi JG Congenital absence of ductus arteriosus--an autopsy case. J Korean Med Sci 1988 Mar;3(1):41-3
35 Moore L, Toi A, Chitayat D Abnormalities of the intra-abdominal fetal umbilical vein: reports of four cases and a review of the
literature. Ultrasound Obstet Gynecol 1996 Jan;7(1):21-5
36 Avni EF, Ghysels M, Donner C, Damis E In utero diagnosis of congenital absence of the ductus venosus. J Clin Ultrasound 1997
Oct;25(8):456-8
37 Yoshinaga K, Kodama K Persistence of the hepatic segment of the left inferior vena cava in man and its relation to the ductus
venosus development. Acta Anat (Basel) 1997;160(2):132-8
38 Cohen SB, Lipitz S, Mashiach S, Hegesh J, Achiron R In utero ultrasonographic diagnosis of an aberrant umbilical vein associated
with fetal hepatic hyperechogenicity. Prenat Diagn 1997 Oct;17(10):978-82
39 Shryock EH. Janzen J, Barnard MC Report of a newborn human presenting sympus dipus, anomalous umbilical vein, tansposition of
the viscera and other anomalies. Anat Rec 82:347, 1942
40 Monie IW: Umbilical vein entering the right atrium: Comments on a previously reported human case. Teratology 4:461, 1971
41 Theander G, Karlsson S. Persistent right umbilical vein. Acta Radiol Diagn (Stockh). 1978;19(1B):268-74.
42 Jouk PS, Champetier J. Abnormal direct entry of the umbilical vein into the right atrium: antenatal
detection, embryologic aspects. Surg Radiol Anat. 1991;13(1):59-62.
43 Greiss HB, McGahan JP. Umbilical vein entering the right atrium: significance of in utero diagnosis. J Ultrasound Med. 1992
Mar;11(3):111-3.
44 Tordjeman N, Ville Y, Fermont L, Guis F, Doumerc S, Frydman R. Anomalies of umbilical vein in the fetus. A case report and
review of the literature. J Gynecol Obstet Biol Reprod (Paris). 1996;25(5):495-9.
45 Shih JC, Shyu MK, Hsieh MH, Yang JH, Huang SF, Lin GJ, Hsieh FJ. Agenesis of the ductus venosus in a case of monochorionic
twins which mimics twin-twin transfusion syndrome. Prenat Diagn. 1996 Mar;16(3):243-6.
46 Fliegel CP, Nars PW. Aberrant umbilical vein. Pediatr Radiol. 1984;14(1):55-6.
47 Currarino G, Stannard MW, Kolni H. Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the
liver. Pediatr Radiol. 1991;21(4):265-6.
48 Gembruch U, Baschat AA, Caliebe A, Gortner L Prenatal diagnosis of ductus venosus agenesis: a report of two cases and review of
the literature. Ultrasound Obstet Gynecol 1998 Mar;11(3):185-9
49 Strouse PJ, Di Pietro MA, Barr M Jr Pitfall: anomalous umbilical vein and absent ductus venosus in association with right congenital
diaphragmatic hernia. Pediatr Radiol 1997 Aug;27(8):651-3
50 Kurimoto S, Kitamura T, Ueki T, Moriyama N, Tajima A Obstruction of the lower ureter caused by an aberrant vessel. Br J Urol
1997 Aug;80(2):355-6
Dr/AHMED ESAWY
134. • 51 Cayol V, Braig S, Noto S, Jannet D, Bouillie J, Marpeau L, Milliez J Agenesia of the canal of Arantius. A case report. J Gynecol
Obstet Biol Reprod (Paris) 1997;26(4):430-4
52 Siven M, Ley D, Hagerstrand I, Svenningsen N Agenesis of the ductus venosus and its correlation to hydrops fetalis and the fetal
hepatic circulation: case reports and review of the literature. Pediatr Pathol Lab Med 1995 Jan-Feb;15(1):39-50
53 Jorgensen C, Andolf E Four cases of absent ductus venosus: three in combination with severe hydrops fetalis. Fetal Diagn Ther 1994
Nov-Dec;9(6):395-7
54 Leonidas JC, Fellows RA Congenital absence of the ductus venosus: with direct connection between the umbilical vein and the distal
inferior vena cava. Am J Roentgenol 1976 Apr;126(4):892-5
55 Laverdiere JT, Laor T, Benacerraf B Congenital absence of the portal vein: case report and MR demonstration. Pediatr Radiol
1995;25(1):52-3
56 Gembruch U, Baschat AA, Caliebe A, Gortner L Prenatal diagnosis of ductus venosus agenesis: a report of two cases and review of
the literature. Ultrasound Obstet Gynecol 1998 Mar;11(3):185-9
57 Kang YK, Suh YL, Kim CW, Chi JG Fetus in fetu: a case with complete umbilical cord and fetal sac. Pediatr Pathol 1994 May-
Jun;14(3):411-9
58 Sepulveda W, Romero R, Pryde PG, Wolfe HM, Addis JR, Cotton DB. Prenatal diagnosis of sirenomelus with color Doppler
ultrasonography. Am J Obstet Gynecol 1994 May;170(5 Pt 1):1377-9
59 Stevenson RE, Jones KL, Phelan MC, Jones MC, Barr M Jr, Clericuzio C, Harley RA, Benirschke K Vascular steal: the pathogenetic
mechanism producing sirenomelia and associated defects of the viscera and soft tissues. Pediatrics 1986 Sep;78(3):451-7
60 Ebner I, Dohr G Contribution to the significance of persisting embryonic vessels in the adult organism. Anat Anz 1986;162(2):73-8
61 Miyoshi S, Ikeda M, Kido T, Matsuda Y, Fukada R, Nakajima K, Izukura T Abnormal persistence of the right vitelline vein. J
Pediatr Surg 1984 Apr;19(2):204-5
62 Canavese F, Bardini T Intestinal occlusion caused by remnants of the vitelline artery. Pediatr Med Chir 1983 Jul-Aug;5(4):231-2
63 Waldschmidt J Intra-abdominal ligament remnants of the vitelline duct and vessels. Monatsschr Kinderheilkd 1983 Apr;131(4):222-7
64 Raahave D, Bjerre-Jepsen K A vascular band to Meckel"s diverticulum. Ann Chir Gynaecol 1983;72(5):287-8
65 Reichenbach F Chronic duodenal obstruction caused by a persistent vitelline artery. Zentralbl Chir 1982;107(20):1314-6
66 Jankowski A Persistent vitelline artery as cause of ileus in a 12-year-old boy. Wiad Lek 1977 Sep 15;30(18):1465-7
67 Kleinhaus S, Cohen MI, Boley SJ Vitelline artery and vein remnants as a cause of intestinal obstruction. J Pediatr Surg 1974
Jun;9(3):295-9
68 Myers NA, Rubin S Intestinal abstruction due to a persistent vitelline artery. Aust N Z J Surg 1973 Sep;43(2):161-2
69 Prust FW, Abouatme J Vitelline artery causing small bowel obstruction in an adult. Surgery 1969 Apr;65(4):716-20
70 Kokubo T, Okada Y, Itai Y, Iio M Coronary vein flowing into the umbilical portion of the left portal vein: angiographic appearance.
Radiat Med 1990 Jul-Aug;8(4):123-4
71 Jeanty P. Persistent right umbilical vein: an ominous prenatal finding? Radiology. 1990 Dec;177(3):735-8.
72 Blazer S, Zimmer EZ, Bronshtein M Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant. Obstet
Gynecol 2000 Mar;95(3):433-6 Dr/AHMED ESAWY
135. • 73 Miannay E, Dif D, Vaast P, Devisme L, Dufour P, Puech F Persistent right umbilical vein discovered by ultrasonography: prognostic value. Apropos
of 2 cases. J Gynecol Obstet Biol Reprod (Paris) 1999 Oct;28(6):563-5
74 Wolman I, Gull I, Fait G, Amster R, Kupferminc MJ, Lessing JB, Jaffa AJ. Persistent right umbilical vein: incidence and significance.Ultrasound
Obstet Gynecol 2002 Jun;19(6):562-4.
75 Bell AD, Gerlis LM, Variend S. Persistent right umbilical vein--case report and review of literature. Int J Cardiol. 1986 Feb;10(2):
76 De Catte L, Osmanagaoglu K, De Schrijver I Persistent right umbilical vein in trisomy 18: sonographic observation. J Ultrasound Med 1998
Dec;17(12):775-9
77 Ami MB, Perlitz Y, Matilsky M Prenatal sonographic diagnosis of persistent right umbilical vein with varix. J Clin Ultrasound 1999 Jun;27(5):273-5
78 Lai WW Prenatal diagnosis of abnormal persistence of the right or left umbilical vein: report of 4 cases and literature review. J Am Soc Echocardiogr
1998 Sep;11(9):905-9
79 Kirsch CF, Feldstein VA, Goldstein RB, Filly RA. Persistent intrahepatic right umbilical vein: a prenatal sonographic series without significant
anomalies. J Ultrasound Med. 1996 May;15(5):371-4.
80 Blazer S, Zimmer EZ, Bronshtein M. Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant. Obstet Gynecol 2000
Mar;95(3):433-6.
81 Shen O, Tadmor OP, Yagel S. Prenatal diagnosis of persistent right umbilical vein. Ultrasound Obstet Gynecol 1996 Jul;8(1):31-3.
82 Ami MB, Perlitz Y, Matilsky M. Prenatal sonographic diagnosis of persistent right umbilical vein with varix. J Clin Ultrasound 1999 Jun;27(5):273-5.
83 Hager J, Gschnitzer F, Hammerer I, Gassner I. Congenital epigastric-umbilical arteriovenous fistula. Contribution on a rare clinical picture.
Langenbecks Arch Chir 1982;357(4):269-73.
84 Dolkart LA, Reimers FT, Kuonen CA Discordant umbilical arteries: ultrasonographic and Doppler analysis. Obstet Gynecol 1992 Jan;79(1):59-63
85 Petrikovsky B, Schneider E Prenatal diagnosis and clinical significance of hypoplastic umbilical artery. Prenat Diagn 1996 Oct;16(10):938-40
86 Raio L, Ghezzi F, Di Naro E, Gomez R, Saile G, Bruhwiler H The clinical significance of antenatal detection of discordant umbilical arteries. Obstet
Gynecol 1998 Jan;91(1):86-91
87 Meir K, Yagel S, Amsalem H, Ariel I. Single umbilical artery stenosis associated with intrauterine fetal death post-transfusion. Prenat Diagn 2002
Mar;22(3):186-8.
88 Smith JF Jr, Warner KD, Bergmann M, Pushchak MJ. Umbilical artery regression: a rare complication of intravascular fetal transfusion. Obstet
Gynecol 1999 May;93(5 Pt 2):828-9.
89 Malee MP, Carr S, Rubin LP, Johal J, Feit L Prenatal ultrasound diagnosis of abdominal aortic aneurysm with fibrotic occlusion in aortic branch
vessels. Prenat Diagn 1997 May;17(5):479-82
90 Wolf HK, MacDonald J, Bradford WB, Lanman JT Jr Acardius anceps with evidence of intrauterine vascular occlusion: report of a case and
discussion of the pathogenesis. Pediatr Pathol 1991 Jan-Feb;11(1):143-52
91 Cook V, Weeks J, Brown J, Bendon R Umbilical artery occlusion and fetoplacental thromboembolism. Obstet Gynecol 1995 May;85(5 Pt 2):870-2
92 Baxi LV, Daftary A, Loucopoulos A Single fetal demise in a twin gestation: umbilical vein thrombosis. Gynecol Obstet Invest 1998;46(4):266-7
Dr/AHMED ESAWY
136. • 94 Fritz MA, Christopher CR. Umbilical vein thrombosis and maternal diabetes mellitus. J Reprod Med 1981 Jun;26(6):320-4.
95 Qureshi F, Jacques SM Marked segmental thinning of the umbilical cord vessels. Arch Pathol Lab Med 1994 Aug;118(8):826-30
96 Hallak M, Pryde PG, Qureshi F, Johnson MP, Jacques SM, Evans MI. Constriction of the umbilical cord leading to fetal death. A report of three cases. J Reprod
Med 1994 Jul;39(7):561-5.
97 Kanayama MD, Gaffey TA, Ogburn PL Jr. Constriction of the umbilical cord by an amniotic band, with fetal compromise illustrated by reverse diastolic flow in
the umbilical artery. A case report. J Reprod Med 1995 Jan;40(1):71-3.
98 Boughizane S, Zhioua F, Jedoui A, Kattech R, Gargoubi N, Srasra M, Ben Romdhane K, Meriah S. Swallowing of an amniotic string by a fetus at term. J
Gynecol Obstet Biol Reprod (Paris) 1993;22(4):409-10.
99 Heifetz SA. Strangulation of the umbilical cord by amniotic bands: report of 6 cases and literature review. Pediatr Pathol 1984;2(3):285-304.
100 Reles A, Friedmann W, Vogel M, Dudenhausen JW. Intrauterine fetal death after strangulation of the umbilical cord by amniotic bands. Geburtshilfe
Frauenheilkd 1991 Dec;51(12):1006-8.
101 Sherer DM, Anyaegbunam A. Prenatal ultrasonographic morphologic assessment of the umbilical cord: a review. Part I. Obstet Gynecol Surv 1997
Aug;52(8):506-14.
102 Heyl W, Rath W. Intrapartum therapy-resistant fetal bradycardia--color Doppler sonographic diagnosis of umbilical cord compression due to fetal grasping. Z
Geburtshilfe Neonatol 1996 Jan-Feb;200(1):30-2.
103 Ertan AK, Schmidt W. Umbilical cord entanglement and color-coded Doppler ultrasound. Geburtshilfe Frauenheilkd 1994 Apr;54(4):196-203.
104 Larson JD, Rayburn WF, Harlan VL. Nuchal cord entanglement and gestational age . Am J Perinatol 1997; 14(9): 555-557.
105 Adinma JI. Effect of cord entanglement on pregnancy outcome. Int J Gynaecol Obstet 1990 May;32(1):15-8.
106 Lipitz S, Seidman DS, Gale R, Stevenson DK, Alcalay M, Menczer J, Barkai G. Is fetal growth affected by cord entanglement? J Perinatol 1993 Sep-
Oct;13(5):385-8.
107 Giacomello F. Ultrasound determination of nuchal cord breech presentation. Am J Obstet Gynecol 1988; 159: 531-2.
108 Corridan M, Kendall ED, Begg JD. Cord entanglement causing premature placental separation and amniotic fluid embolism. Case report. Br J Obstet Gynaecol
1980 Nov;87(11):935-40.
109 Muth H, Engelbrecht R. Acute occlusion of the arterial blood supply of the right arm in a newborn following entanglement of the umbilical cord. Geburtshilfe
Frauenheilkd 1976 Dec;36(12):1099-101.
110 Shahabi S, Donner C, Wallond J, Schlikker I, Avni EF, Rodesch F. Monoamniotic twin cord entanglement. A case report with color flow Doppler
Ultrasonography for antenatal diagnosis. J Reprod Med 1997 Nov;42(11):740-2.
111 Westover T, Guzman ER, Shen-Schwarz S. Prenatal diagnosis of an unusual nuchal cord complication in monoamniotic twins. Obstet Gynecol 1994 Oct;84(4
Pt 2):689-91.
112 Prefumo F, Thilaganathan B, Tekay A. Antenatal diagnosis of fetal intra-abdominal umbilical vein dilatation.Ultrasound Obstet Gynecol 2001 Jan;17(1):82-5
113 Zalel Y, Lehavi O, Heifetz S, Aizenstein O, Dolitzki M, Lipitz S, Achiron R. Varix of the fetal intra-abdominal umbilical vein: prenatal sonographic diagnosis
and suggested in utero management. Ultrasound Obstet Gynecol 2000 Oct;16(5):476-8.
114 Batton DG, Amanullah A, Comstock C. Fetal schistocytic hemolytic anemia and umbilical vein varix. J Pediatr Hematol Oncol 2000 May-Jun;22(3):259-61.
115 Sepulveda W, Mackenna A, Sanchez J, Corral E, Carstens E. Fetal prognosis in varix of the intrafetal umbilical vein. J Ultrasound Med 1998 Mar;17(3):171-5.
116 Schrocksnadel H, Holbock E, Mitterschiffthaler G, Totsch M, Dapunt O. Thrombotic occlusion of an umbilical vein varix causing fetal death. Arch Gynecol
Obstet 1991;248(4):213-5.
117 Strong TH Jr, Jarles DL, Vega JS, Feldman DB. Am J Obstet Gynecol. The umbilical coiling index. 1995 Feb;172(2 Pt 1):718-20.
118 Ezimokhai M, Rizk DE, Thomas L. Abnormal vascular coiling of the umbilical cord in gestational diabetes mellitus. Arch Physiol Biochem 2001
Jul;109(3):209-14.
119 Ezimokhai M, Rizk DE, Thomas L. Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol 2000;17(8):441-5.
Dr/AHMED ESAWY
137. • 120 Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes.
Pediatr Dev Pathol 2000 Sep-Oct;3(5):462-71.
121 Strong TH Jr, Elliott JP, Radin TG. Non-coiled umbilical blood vessels: a new marker for the fetus at risk. Obstet Gynecol 1993
Mar;81(3):409-11.
122 Degani S, Leibovich Z, Shapiro I, Gonen R, Ohel G. Early second-trimester low umbilical coiling index predicts small-for-
gestational-age fetuses. J Ultrasound Med 2001 Nov;20(11):1183-8.
123 Herman A, Zabow P, Segal M, Ron-el R, Bukovsky Y, Caspi E. Extremely large number of twists of the umbilical cord causing
torsion and intrauterine fetal death. Int J Gynaecol Obstet 1991 Jun;35(2):165-7.
124 Strong TH Jr, Manriquez-Gilpin MP, Gilpin BG. Umbilical vascular coiling and nuchal entanglement. J Matern Fetal Med 1996
Nov-Dec;5(6):359-61.
125 Sornes T. Short umbilical cord as a cause of fetal distress. Acta Obstet Gynecol Scand 1989;68(7):609-11.
126 Miller ME, Higginbottom M, Smith DW. Short umbilical cord: its origin and relevance. Pediatrics 1981 May;67(5):618-21.
127 Ho NC. Monozygotic twins with fetal akinesia: the importance of clinicopathological work-up in predicting risks of recurrence.
Neuropediatrics 2000 Oct;31(5):252-6.
128 Hall JG. Analysis of Pena Shokeir phenotype. Am J Med Genet 1986 Sep;25(1):99-117.
129 Gonzalez De Dios J, Martinez Frias ML, Arroyo Carrera I, Fondevilla Sauci J, Sanchis Calvo A, Hernandez Ramon F, Martinez
Guardia N, Garcia Gonzalez MM. Role of signs of fetal hypokinesia in the diagnosis of spinal muscular atrophy of neonatal onset. An
Esp Pediatr 2002 Mar;56(3):233-40.
130 Daskalakis GJ, Nicolaides KH. Monozygotic twins discordant for body stalk anomaly. Ultrasound Obstet Gynecol 2002
Jul;20(1):79-81.
131 Negishi H, Yaegashi M, Kato EH, Yamada H, Okuyama K, Fujimoto S. Prenatal diagnosis of limb-body wall complex. J Reprod
Med 1998 Aug;43(8):659-64.
132 Gripp KW, Scott CI Jr, Hughes HE, Wallerstein R, Nicholson L, States L, Bason LD, Kaplan P, Zderic SA, Duhaime AC, Miller F,
Magnusson MR, Zackai EH. Lateral meningocele syndrome: three new patients and review of the literature. Am J Med Genet 1997 Jun
13;70(3):229-39
133 Philip et al. Familial osteosclerosis. J Pediatr 1977 90:49-54.
134 King JA, Gardner V, Chen H, Blackburn W. Neu-Laxova syndrome: pathological evaluation of a fetus and review of the
literature.Pediatr Pathol Lab Med 1995 Jan-Feb;15(1):57-79.
135 Baergen RN, Malicki D, Behling C, Benirschke K. Morbidity, mortality, and placental pathology in excessively long umbilical
cords: retrospective study. Pediatr Dev Pathol 2001 Mar-Apr;4(2):144-53.
136 Raio L, Ghezzi F, Di Naro E, Franchi M, Maymon E, Mueller MD, Bruhwiler 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 Obstet Gynecol. 1999 Mar;13(3):157-60.
137 Di Naro E, Ghezzi F, Raio L, Franchi M, D"Addario V, Lanzillotti G, Schneider H. Umbilical vein blood flow in fetuses with
normal and lean umbilical cord. Ultrasound Obstet Gynecol 2001 Mar;17(3):224-8.
Dr/AHMED ESAWY
138. • 138 Yamanaka M, Ohyama M, Koresawa M, Kawataki M, Ohsaki I, Tanaka Y. Umbilical cord ulceration and intestinal atresia. Eur J Obstet Gynecol Reprod Biol
1996 Dec 27;70(2):209-12.
139 Skibo LK, Lyons EA, Levi CS. First-trimester umbilical cord cysts. Radiology 1992; 182:719-22.
140 Ross JA, Jurcovic D, Zosmer N, Jauniaux E, Hacket E, Nicolaides KH. Umbilical cord cysts early in pregnancy. Obstet Gynecol 1997; 89:442-5.
141 Sepulveda W, Leible S, Ulloa A, Ivankovic M, Schnapp C. Clinical significance of first trimester umbilical cord cysts. J Ultrasound Med 1999; 18: 95-9.
142 Jauniaux E, Donner C, Thomas C, Francotte J, Rodesch F, Avni FE. Umbilical cord pseudocyst in trisomy18. Prenat Diagn 1988; 8:557-63.
143 Ramirez P, Haberman S, Baxi L. Significance of prenatal diagnosis of umbilical cord cyst in a afetus with trisomy 18. Am J Obstet Gynecol 1995; 173: 955-7.
144 Sepulveda W, Gutierrez J, Sanchez J, Be C, Schnapp C. Pseudocyst of the umbilical cord: prenatal sonographic appearance and clinical significance. Obstet
Gynecol 1999; 93: 377-81.
145 Zelante L, Dallapiccola B. Umbilical cord pseudocyst in trisomy 13. Prenat Diagn 1989; 9:448-9.
146 4. Tsuchida Y, Ishida M. Osmolar relationship between enlarged umbilical cord and patent urachus. J Pediatr Surg 4:465- 67, 1969.
147 6. Rich RH, Hardy BE, Filler RM. Surgery for anomalies of the urachus. J Pediatr Surg 18:370-372, 1983.
148 Seoud M, Aboul-Hosn L, Nassar A, Khalil A, Usta I. Spontaneous umbilical cord hematoma: a rare cause of acute fetal distress. Am J Perinatol 2001;18(2):99-
10.
149 Csecsei K, Kovacs T. Spontaneous haematoma of the umbilical cord with a single umbilical artery. Eur J Obstet Gynecol Reprod Biol 1996 Feb;64(2):231-3
150 Berg C, Geipel A, Germer U, Gloeckner-Hofmann K, Gembruch U. Prenatal diagnosis of umbilical cord aneurysm in a fetus with trisomy 18. Ultrasound
Obstet Gynecol 2001 Jan;17(1):79-81.
151 Siddiqi TA, Bendon R, Schultz DM, Miodovnik M. Umbilical artery aneurysm: prenatal diagnosis and management. Obstet Gynecol 1992 Sep;80(3 Pt 2):530-
3.
152 Mishriki YY, Vanyshelbaum Y, Epstein H, Blanc W. Hemangioma of the umbilical cord. Pediatr Pathol 1987;7(1):43-9.
153 Kamitomo M, Sueyoshi K, Matsukita S, Matsuda Y, Hatae M, Ikenoue T. Hemangioma of the umbilical cord: stenotic change of the umbilical vessels. Fetal
Diagn Ther 1999 Nov-Dec;14(6):328-31.
154 Armes JE, Billson VR. Umbilical cord hemangioma associated with polyhydramnios, congenital abnormalities and perinatal death in a twin pregnancy.
Pathology 1994 Apr;26(2):218-20.
155 Miller KA, Gauderer MW. Hemangioma of the umbilical cord mimicking an omphalocele. J Pediatr Surg 1997 Jun;32(6):810-2.
156 Dombrowski MP, Budev H, Wolfe HM, Sokol RJ, Perrin E. Fetal hemorrhage from umbilical cord hemangioma. Obstet Gynecol 1987 Sep;70(3 Pt 2):439-42.
157 Kreczy A, Alge A, Menardi G, Gassner I, Gschwendtner A, Mikuz G. Teratoma of the umbilical cord. Case report with review of the literature. Arch Pathol
Lab Med 1994 Sep;118(9):934-7.
158 Wagner H, Baretton G, Wisser J, Babic R, Lohrs U. Teratoma of the umbilical cord. Case report with literature review. Pathologe 1993 Dec;14(6):395-8.
159 Fortune DW, Ostor AG. Angiomyxomas of the umbilical cord. Obstet Gynecol 1980 Mar;55(3):375-8.
160 Guschmann M, Janda J, Wenzelides K, Vogel M. Intestinal polyp of the umbilical cord. Zentralbl Gynakol 2002 Feb;124(2):132-4.
161 Iwasaki I, Yu TJ, Itahashi K, Nito A, Yamaguchi H, Onoki J. Isolated well-formed intestinal tissue in the umbilical cord. A variant of cyst of
omphalomesenteric duct. Acta Pathol Jpn 1986 Apr;36(4):565-9.
162 Preminger A, Udassin R, Pappo O, Arad I. Ectopic liver tissue within the umbilical cord. J Pediatr Surg 2001 Jul;36(7):1085-6.
163 Airas U, Heinonen S. Clinical significance of true umbilical knots: a population-based analysis. Am J Perinatol 2002 Apr;19(3):127-32.
164 Jones I. A truly knotted cord. Aust N Z J Obstet Gynaecol 1998 Feb;38(1):98-9.
165 Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, Mazor M. Risk factors associated with true knots of the umbilical cord. Eur J
Obstet Gynecol Reprod Biol 2001 Sep;98(1):36-9.
166 Maher JT, Conti JA. A comparison of umbilical cord blood gas values between newborns with and without true knots. Obstet Gynecol 1996 Nov;88(5):863-6.
167 Gembruch U, Baschat AA. True knot of the umbilical cord: transient constrictive effect to umbilical venous blood flow demonstrated by Doppler sonography.
Ultrasound Obstet Gynecol 1996 Jul;8(1):53-6. Dr/AHMED ESAWY