The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks
Main Article Content
Abstract
Umbilical cord pathology accounts for 20–25% of stillbirths worldwide. Recent publications suggest that stillbirths could be prevented by routine 18 – 20-week ultrasound evaluations that include the full anatomy of the umbilical cord from the placenta to the fetal umbilicus. This manuscript reviews our current understanding of this field and includes suggestions for the future.
Keywords:
Umbilical Cord, Ultrasound, Stillbirth, Umbilical Cord Pathologies, Nuchal Cord, True Knot, Torsion, Fetal Acidosis, Hypercoiling, Umbilical Cord Entanglement
Article Details
How to Cite
COLLINS, Jason H.
The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks.
Medical Research Archives, [S.l.], v. 9, n. 10, oct. 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2565>. Date accessed: 19 apr. 2024.
doi: https://doi.org/10.18103/mra.v9i10.2565.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Krzyżanowski A, Kwiatek M, Gęca T, Stupak A, Kwaśniewska A. Modern ultrasonography of the umbilical cord: prenatal diagnosis of umbilical cord abnormalities and assessment of fetal wellbeing. Med Sci Monit. 2019; 25:3170–3180. doi: 10.12659/MSM.913762.
4. 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; 34:179–196. doi:10.1148/rg.341125127.
5. Benirschke K. Obstetrically important lesions of the umbilical cord. J Reprod Med. 1994; Apr 39(4):262–272.
6. Parast MM, Crum CP, Boyd TK. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum Pathol. 2008; 39(6):948–953. doi:10.1016/j.humpath.2007.10.032.
7. Baergen, RN. Cord abnormalities, structural lesions, and cord “accidents”. Semin Diag Pathol. 2007; 24:23–32. doi: 10.1053/j.semdp.2007.02.004.
8. Vrabie SC, Novac L, Manolea MM, Dijmarescu LA, Novac M, Siminel MA. Abnormalities of the umbilical cord. In: Tudorache S, Ed. Congenital anomalies - from the embryo to the neonate. 2016. doi: 10.5772/intechopen.72666.
9. Dodds M, Windrim R, Kingdom J. Complex umbilical cord entanglement. J Matern Fetal Neonatal Med. 2012; 25(9):1827–1829. doi:10.3109/14767058.2011.644361.
10. Sherer DM, Dalloul M, Ward K, Nakagawa J, Joseph I, Grube S, Abulafia O.
Letters to the Editor. Coexisting true umbilical cord knot and nuchal cord: possible cumulative increased risk of adverse perinatal outcome. Ultrasound Obstet Gynecol. 2017; 50:404–405. https://doi.org/10.1002/uog.17389.
11. Sherer DM, Roach C, Soyemi S, Dalloul M. Current perspectives of prenatal sonographic diagnosis and clinical management challenges of complex umbilical cord entanglement. Int J Womens Health. 2021; 13;247–256. doi: 10.2147/IJWH.S285860.
12. Collins JH. Two cases of multiple umbilical cord abnormalities resulting in stillbirth: prenatal observation with ultrasonography and fetal heart rates. Am J Obstet Gynecol. Jan 1993; 168:125–128. doi: 10.1016/s0002-9378(12)90899-6.
13. Shweta S, Vaiphei K. Intestinal atresia: histopathologist view. Int Surg J. 2021; 8:226–231. doi: 10.18203/2349-2902.isj20205885.
14. Ravishankar S. Fetal Vascular lesions. 2020. http://docplayer.net/208140224-Fetal-vascular-lesions.html.
15. Aronowitz D, Dolgin S, Bornstein E, Little-Richardson A, Bajaj J, Williamson A, et al. Perinatal hemorrhage from ulceration of the umbilical cord: a potentially catastrophic association with duodenal and jejunal obstruction. J Ped Surg. 2018; 53(9) 1669–1674.
doi: 10.1016/j.jpedsurg.2017.11.045.
16. Singh AK. Abnormal fetal movement and nuchal cord in fetal distress – a determinant of poor neonatal outcome. J Med Sci Clin Res. 2021; 9(7):1. doi: 10.18535/jmscr/v9i7.11.
17. Rosner-Tenerowicz A, Florjanski J, Paslawski W, Piatek A, Zimmer M. Cystic dilatation of umbilical cord associated with patent urachus. J Pol Gyn Soc. 2021; 8. doi: 10.5603/GP.a2021.0156.
18. Chandran AR, Agrawal S, Hobson SR, Windrim RC, Parks T, Kingdom JC. Stillbirth following normal ultrasound findings and maternal placenta growth factor levels. J Obst Gyn Canada. 2021; August doi: 10.1016/j.jogc.2021.07.019.
19. Svelato A, Vergatti MC, Rinaldo D, Sergiampietri C, De Luca C, Ragusa A. Cord entanglement in a monochorionic-monoamniotic twin pregnancy: a case report Int J Gyn Obst. 2021; 154 (3):570–571. doi: 10.1002/ijgo.13780.
20. Metz TD, Berry RS, Fretts RC, Reddy UM, Turrentine MA. ACOG obstetrical care consensus. Number 10 March 2020. Ukr J Perinatol Peds 2021; 2(86):75. doi: 10.1016/j.ajog.2020.01.017.
21. Meganathan HS, Rajeshwaran R, Bhuvana S. MRI findings in a fetus with a tight cord around the neck. Neurol India. 2017; Sept 65(5):1130–1131. doi: 10.4103/neuroindia.NI_671_16.
22. Bord A, Yagel S, Valsky DV. Overburdened and undernourished. Am J Obst Gyn. 2007; Sept 197:324.e1–324.e2. doi: 10.1016/j.ajog.2007.07.011.
23. Schreiber H, Daykan Y, Arbib N, Markovitch O, Berkovitz A, Biron‑Shental T. Adverse pregnancy outcomes and multiple nuchal cord loops. Arch Gyn Obst. 2019; 300:279–283. doi: 10.1007/s00404-019-05178-w.
24. Sherer DM, Dalloul M, Sabir S, London V, Haughton M, Abulafia O. Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth. Ultrasound Obstet Gynecol. 2017; Mar 49(3):409–410. doi: 10.1002/uog.15940.
25. Cho F-N, Liu C-B, Li J-Y, Carey JR, Liou W-S. Absent fetal movement and brain sparing effect associated with multiple tight nuchal cords. Taiwan J Obst Gyn. 2013; 52: 457–459. doi: 10.1016/j.tjog.2013.06.009.
26. Zbeidy R, Souki FG. One long umbilical cord, four nuchal cord loops and a true knot. BMJ Case Rep. 2017;1–2. doi:10.1136/bcr-2017-223241.
27. Wilson B. Sonography of the placenta and umbilical cord. Radiol Technol. 2008; Mar/Apr 79(4): 333–345S.
28. Guzikowski W, Kowalczyk D, Więcek J. Diagnosis of true umbilical cord knot. Arch Med Sci. 2014; 10(1):91–95. doi: 10.5114/aoms.2013.33068.
29. Mawupe MM, Sudre AM. Six fetal deaths during delivery because of repeated cervical circular (nuchal cord). Seventh pregnancy. Proof of work. Caesarean. Child living with (circulars). In: Chosson MJ, President. 402-General Gynecology and Obstetrics Society in France. 1960 May 7.
30. Linde LE, Rasmussen S, Kessler J, Ebbing C. Extreme umbilical cord lengths, cord knot and entanglement: risk factors and risk of adverse outcomes, a population-based study. PLoS One. 2018; 13(83):e0194814. doi: 10.1371/journal.pone.0194814.
31. Weiner E, Fainstein N, Schreiber L, et al. The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol. 2015; 35:919–923. doi: 10.1038/jp.2015.
32. Bakotic BW, Boyd T, Poppiti R, Pflueger S. Recurrent umbilical cord torsion leading to fetal death in 3 subsequent pregnancies. A case report and review of the literature. Arch Pathol Lab Med. 2000; 124:1352–1355. doi: 10.5858/2000-124-1352-RUCTLT.
33. Khatiwada P, Alsabri M, Wiredu S, et al. Spontaneous umbilical cord hematoma. Cureus 2021; 13(2):e13048. doi: 10.7759/cureus.13048.
34. Rabetsimamanga LZA, Rabarikoto HF, Rekoronirina EB, Andrianampanalinarivo HR. Spontaneous umbilical cord hematoma causing stillbirth: a case report. Madagascar Int J Reprod Contracept Obstet Gynecol. 2018; 7:2031–2033. doi: 10.18203/2320-1770.ijrcog20181474.
35. Zhu Y, Beejadhursing R, Liu Y. Ten cases of umbilical cord thrombosis in the third trimester. Arch Gyn Obst. 2021; 304(1):59–64. doi: 10.1007/s00404-020-05910-x.
36. Wang X, Liu Z, Chen S, Wang Y, Lin S. Clinical characteristics and perinatal outcomes of eight cases of umbilical cord vascular rupture. J Int Med Res. 2020; 48(6):1–9. doi: 10.1177/0300060520919249.
37. Heifetz SA. Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Fetal Ped Pathol. 1988; 8(1):37–54. doi: 10.3109/15513818809022278.
38. Alhousseini A, Jaiman S, Hernandez-Andrade E, Zeineddine S, Qureshi F, Jacques SM. Umbilical artery thrombosis with associated acute and severe fetal growth restriction and transient severe protein S deficiency: report of a case with prenatal ultrasound diagnosis allowing for timely intervention and good outcome. Case Rep Obst Gyn. 2018; 2018:6324362. doi: 10.1155/2018/6324362.
39. Isotton AL, Salazar CC, Peralta CFA, Abdalla JML, Vettorazzi J. In vitro fertilization and vasa previa. A report of two cases. Rev Bras Ginecol Obstet. 2019; 41:348–351. doi: 10.1055/s-0039-1683354.
40. Jauniaux E, Melcer Y, Maymon R. Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review. Am J Obst Gyn. 2017; 216(6):568-575. doi: 10.1016/j.ajog.2017.01.029.
41. Frasch MG, Mansano RZ, Gagnon R, et al. Measures of acidosis with repetitive umbilical cord occlusions leading to fetal asphyxia in the near-term ovine fetus. Am J Obstet Gynecol. 2009; 200:200.e1–200.e7. doi: 10.1016/j.ajog.2008.10.022.
42. Bennet L, Westgate JA, Liu Y-C, Wassink G, Gunn AJ. Fetal acidosis and hypotension during repeated umbilical cord occlusions are associated with enhanced chemoreflex responses in near-term fetal sheep. Appl Physiol. 2005; 99:1477–1482. doi: 10.1152/japplphysiol.00431.2005.
43. Heifetz SA. Pathology of the umbilical cord. In: Lewis SH, Perrin E. Pathology of the Placenta. 2nd edition. New York, N.Y.: Churchill Livingstone; 1999. pp.1007–1136.
44. Collins JH, Collins CL. Chapter 26. The human umbilical cord. In: Kingdom J, Jauniaux E, O’Brien S. The Placenta: Basic Science and Clinical Practice. London: RCOG Press. 2000. pp. 319–329.
45. Collins JH: Umbilical cord accidents: human studies. Semin Perinatol. 2002;
26(1):79–82. doi: 10.1053/sper.2002.29860.
46. Collins J. Silent Risk: issues about the human umbilical cord. Bloomington, Indiana: Xlibris; 2014.
47. Chan JS, Baergen RN. Gross umbilical cord complications are associated with placental lesions of circulatory stasis and fetal hypoxia. Pediatr Dev Pathol. 2012; 15:487–434. doi:10.2350/12-06-1211-OA.1.
2. Hammad IA, Blue NR, Allshouse AA, Silver RM, Gibbins KJ, Page JM, et al. Umbilical cord abnormalities and stillbirth. Obstet Gynecol. 2020; 135(3):644–652. doi: 10.1097/ AOG.0000000000003676.
3. Krzyżanowski A, Kwiatek M, Gęca T, Stupak A, Kwaśniewska A. Modern ultrasonography of the umbilical cord: prenatal diagnosis of umbilical cord abnormalities and assessment of fetal wellbeing. Med Sci Monit. 2019; 25:3170–3180. doi: 10.12659/MSM.913762.
4. 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; 34:179–196. doi:10.1148/rg.341125127.
5. Benirschke K. Obstetrically important lesions of the umbilical cord. J Reprod Med. 1994; Apr 39(4):262–272.
6. Parast MM, Crum CP, Boyd TK. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum Pathol. 2008; 39(6):948–953. doi:10.1016/j.humpath.2007.10.032.
7. Baergen, RN. Cord abnormalities, structural lesions, and cord “accidents”. Semin Diag Pathol. 2007; 24:23–32. doi: 10.1053/j.semdp.2007.02.004.
8. Vrabie SC, Novac L, Manolea MM, Dijmarescu LA, Novac M, Siminel MA. Abnormalities of the umbilical cord. In: Tudorache S, Ed. Congenital anomalies - from the embryo to the neonate. 2016. doi: 10.5772/intechopen.72666.
9. Dodds M, Windrim R, Kingdom J. Complex umbilical cord entanglement. J Matern Fetal Neonatal Med. 2012; 25(9):1827–1829. doi:10.3109/14767058.2011.644361.
10. Sherer DM, Dalloul M, Ward K, Nakagawa J, Joseph I, Grube S, Abulafia O.
Letters to the Editor. Coexisting true umbilical cord knot and nuchal cord: possible cumulative increased risk of adverse perinatal outcome. Ultrasound Obstet Gynecol. 2017; 50:404–405. https://doi.org/10.1002/uog.17389.
11. Sherer DM, Roach C, Soyemi S, Dalloul M. Current perspectives of prenatal sonographic diagnosis and clinical management challenges of complex umbilical cord entanglement. Int J Womens Health. 2021; 13;247–256. doi: 10.2147/IJWH.S285860.
12. Collins JH. Two cases of multiple umbilical cord abnormalities resulting in stillbirth: prenatal observation with ultrasonography and fetal heart rates. Am J Obstet Gynecol. Jan 1993; 168:125–128. doi: 10.1016/s0002-9378(12)90899-6.
13. Shweta S, Vaiphei K. Intestinal atresia: histopathologist view. Int Surg J. 2021; 8:226–231. doi: 10.18203/2349-2902.isj20205885.
14. Ravishankar S. Fetal Vascular lesions. 2020. http://docplayer.net/208140224-Fetal-vascular-lesions.html.
15. Aronowitz D, Dolgin S, Bornstein E, Little-Richardson A, Bajaj J, Williamson A, et al. Perinatal hemorrhage from ulceration of the umbilical cord: a potentially catastrophic association with duodenal and jejunal obstruction. J Ped Surg. 2018; 53(9) 1669–1674.
doi: 10.1016/j.jpedsurg.2017.11.045.
16. Singh AK. Abnormal fetal movement and nuchal cord in fetal distress – a determinant of poor neonatal outcome. J Med Sci Clin Res. 2021; 9(7):1. doi: 10.18535/jmscr/v9i7.11.
17. Rosner-Tenerowicz A, Florjanski J, Paslawski W, Piatek A, Zimmer M. Cystic dilatation of umbilical cord associated with patent urachus. J Pol Gyn Soc. 2021; 8. doi: 10.5603/GP.a2021.0156.
18. Chandran AR, Agrawal S, Hobson SR, Windrim RC, Parks T, Kingdom JC. Stillbirth following normal ultrasound findings and maternal placenta growth factor levels. J Obst Gyn Canada. 2021; August doi: 10.1016/j.jogc.2021.07.019.
19. Svelato A, Vergatti MC, Rinaldo D, Sergiampietri C, De Luca C, Ragusa A. Cord entanglement in a monochorionic-monoamniotic twin pregnancy: a case report Int J Gyn Obst. 2021; 154 (3):570–571. doi: 10.1002/ijgo.13780.
20. Metz TD, Berry RS, Fretts RC, Reddy UM, Turrentine MA. ACOG obstetrical care consensus. Number 10 March 2020. Ukr J Perinatol Peds 2021; 2(86):75. doi: 10.1016/j.ajog.2020.01.017.
21. Meganathan HS, Rajeshwaran R, Bhuvana S. MRI findings in a fetus with a tight cord around the neck. Neurol India. 2017; Sept 65(5):1130–1131. doi: 10.4103/neuroindia.NI_671_16.
22. Bord A, Yagel S, Valsky DV. Overburdened and undernourished. Am J Obst Gyn. 2007; Sept 197:324.e1–324.e2. doi: 10.1016/j.ajog.2007.07.011.
23. Schreiber H, Daykan Y, Arbib N, Markovitch O, Berkovitz A, Biron‑Shental T. Adverse pregnancy outcomes and multiple nuchal cord loops. Arch Gyn Obst. 2019; 300:279–283. doi: 10.1007/s00404-019-05178-w.
24. Sherer DM, Dalloul M, Sabir S, London V, Haughton M, Abulafia O. Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth. Ultrasound Obstet Gynecol. 2017; Mar 49(3):409–410. doi: 10.1002/uog.15940.
25. Cho F-N, Liu C-B, Li J-Y, Carey JR, Liou W-S. Absent fetal movement and brain sparing effect associated with multiple tight nuchal cords. Taiwan J Obst Gyn. 2013; 52: 457–459. doi: 10.1016/j.tjog.2013.06.009.
26. Zbeidy R, Souki FG. One long umbilical cord, four nuchal cord loops and a true knot. BMJ Case Rep. 2017;1–2. doi:10.1136/bcr-2017-223241.
27. Wilson B. Sonography of the placenta and umbilical cord. Radiol Technol. 2008; Mar/Apr 79(4): 333–345S.
28. Guzikowski W, Kowalczyk D, Więcek J. Diagnosis of true umbilical cord knot. Arch Med Sci. 2014; 10(1):91–95. doi: 10.5114/aoms.2013.33068.
29. Mawupe MM, Sudre AM. Six fetal deaths during delivery because of repeated cervical circular (nuchal cord). Seventh pregnancy. Proof of work. Caesarean. Child living with (circulars). In: Chosson MJ, President. 402-General Gynecology and Obstetrics Society in France. 1960 May 7.
30. Linde LE, Rasmussen S, Kessler J, Ebbing C. Extreme umbilical cord lengths, cord knot and entanglement: risk factors and risk of adverse outcomes, a population-based study. PLoS One. 2018; 13(83):e0194814. doi: 10.1371/journal.pone.0194814.
31. Weiner E, Fainstein N, Schreiber L, et al. The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol. 2015; 35:919–923. doi: 10.1038/jp.2015.
32. Bakotic BW, Boyd T, Poppiti R, Pflueger S. Recurrent umbilical cord torsion leading to fetal death in 3 subsequent pregnancies. A case report and review of the literature. Arch Pathol Lab Med. 2000; 124:1352–1355. doi: 10.5858/2000-124-1352-RUCTLT.
33. Khatiwada P, Alsabri M, Wiredu S, et al. Spontaneous umbilical cord hematoma. Cureus 2021; 13(2):e13048. doi: 10.7759/cureus.13048.
34. Rabetsimamanga LZA, Rabarikoto HF, Rekoronirina EB, Andrianampanalinarivo HR. Spontaneous umbilical cord hematoma causing stillbirth: a case report. Madagascar Int J Reprod Contracept Obstet Gynecol. 2018; 7:2031–2033. doi: 10.18203/2320-1770.ijrcog20181474.
35. Zhu Y, Beejadhursing R, Liu Y. Ten cases of umbilical cord thrombosis in the third trimester. Arch Gyn Obst. 2021; 304(1):59–64. doi: 10.1007/s00404-020-05910-x.
36. Wang X, Liu Z, Chen S, Wang Y, Lin S. Clinical characteristics and perinatal outcomes of eight cases of umbilical cord vascular rupture. J Int Med Res. 2020; 48(6):1–9. doi: 10.1177/0300060520919249.
37. Heifetz SA. Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Fetal Ped Pathol. 1988; 8(1):37–54. doi: 10.3109/15513818809022278.
38. Alhousseini A, Jaiman S, Hernandez-Andrade E, Zeineddine S, Qureshi F, Jacques SM. Umbilical artery thrombosis with associated acute and severe fetal growth restriction and transient severe protein S deficiency: report of a case with prenatal ultrasound diagnosis allowing for timely intervention and good outcome. Case Rep Obst Gyn. 2018; 2018:6324362. doi: 10.1155/2018/6324362.
39. Isotton AL, Salazar CC, Peralta CFA, Abdalla JML, Vettorazzi J. In vitro fertilization and vasa previa. A report of two cases. Rev Bras Ginecol Obstet. 2019; 41:348–351. doi: 10.1055/s-0039-1683354.
40. Jauniaux E, Melcer Y, Maymon R. Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review. Am J Obst Gyn. 2017; 216(6):568-575. doi: 10.1016/j.ajog.2017.01.029.
41. Frasch MG, Mansano RZ, Gagnon R, et al. Measures of acidosis with repetitive umbilical cord occlusions leading to fetal asphyxia in the near-term ovine fetus. Am J Obstet Gynecol. 2009; 200:200.e1–200.e7. doi: 10.1016/j.ajog.2008.10.022.
42. Bennet L, Westgate JA, Liu Y-C, Wassink G, Gunn AJ. Fetal acidosis and hypotension during repeated umbilical cord occlusions are associated with enhanced chemoreflex responses in near-term fetal sheep. Appl Physiol. 2005; 99:1477–1482. doi: 10.1152/japplphysiol.00431.2005.
43. Heifetz SA. Pathology of the umbilical cord. In: Lewis SH, Perrin E. Pathology of the Placenta. 2nd edition. New York, N.Y.: Churchill Livingstone; 1999. pp.1007–1136.
44. Collins JH, Collins CL. Chapter 26. The human umbilical cord. In: Kingdom J, Jauniaux E, O’Brien S. The Placenta: Basic Science and Clinical Practice. London: RCOG Press. 2000. pp. 319–329.
45. Collins JH: Umbilical cord accidents: human studies. Semin Perinatol. 2002;
26(1):79–82. doi: 10.1053/sper.2002.29860.
46. Collins J. Silent Risk: issues about the human umbilical cord. Bloomington, Indiana: Xlibris; 2014.
47. Chan JS, Baergen RN. Gross umbilical cord complications are associated with placental lesions of circulatory stasis and fetal hypoxia. Pediatr Dev Pathol. 2012; 15:487–434. doi:10.2350/12-06-1211-OA.1.