Ultrasonography of umbilical cord

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  • U/S of umbilical cord Aboubakr Elnashar
  • Structure and function -Umbilical cord is covered by amnion and contains a single umbilical vein, and two umbilical arteries supported in Wharton jelly. -Amnion covers the umbilical cord except near the fetal insertion, where an epithelial covering is substituted. -The arteries wind around the umbilical vein in a spiral fashion and, because the vessels are longer the cord itself, there are a number of foldings or tortuorties producing protusions or false knots on the cord surface. -The Wharton jelly protects the vessels from undue torsion and compression.Aboubakr Elnashar
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  • Sonographic anatomy of umbilical cord -late 1st T -The umbilical stalk may occasionally be seen, adjacent to the anterior abdominal wall of the fetus. 2nd and 3rd T: cord is much more readily visualized. -LS: a portion of cord will be seen as a series of parallel lines and sometimes the spiral course of umbilical arteries can be demonstrated. TS: arteries and veins will be seen as three separately circular lucencies. Normally: Two arteries & one vein. Aboubakr Elnashar
  • Umbilical Cord in Cross Section Aboubakr Elnashar
  • 2. Insertion: By scanning near the center of placenta, the insertion site of the cord may be demonstrated as sonolucent area adjacent to the chorionic plate. At the insertion of the cord into the anterior abdominal wall of the fetus, the origin of umbilical vein and hypogastric arteries may be seen. Aboubakr Elnashar
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  • Normal cord insersion Aboubakr Elnashar
  • 3. 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 Aboubakr Elnashar
  • 4. Twisting The normal umbilical cord extends from the placenta to the fetal umbilicus, twisting (coiling) as it traverses the distance between these two points. The umbilical cord contains two umbilical arteries and an umbilical vein which are normally coiled. Aboubakr Elnashar
  • Normal Twists Aboubakr Elnashar
  • Parameters 1.3 vessels 2.Insertion 3.Twisting 4.Position 5.Masses -False knots -True knots -Haematoma -Allantoic duct cyst -Neoplasm -Umbilical hernia -Omphalocele and gastroschisis 6. Stricture: I.U.G.R. Aboubakr Elnashar
  • Abnormalities: 1. Single umbilical artery (SUA) 1% of all singleton births 5% of twins 2.5% of abortuses. 80% normal fetus. 20 % others abnormalities (urinary - Ht - GIT & Ext. ear karyotyping is mandatory if abnormality present). LS: complete parallel course of umbilical artery and vein TS: only two circular lucencies Aboubakr Elnashar
  • TS: normal umbilical cord. Clearly visible is the large-bore umbilical vein and two smaller bore vessels which are the umbilical arteries. TS: the vessel with only one artery. Aboubakr Elnashar
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  • 2. Insertion velamentous insertion of the umbilical cord. umbilical cord inserting into the placental membranes before reaching the placental tissue proper. Aboubakr Elnashar
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  • 3. Coiling: Hypocoiled umbilical cord Uncoiling or hypocoiled umbilical arteries are associated with increased fetal morbidity, including small for gestational age babies (fetuses). an almost straight umbilical cord with almost no coils (hypocoiled cord). Such ultrasound findings are also associated with increased incidence (almost 64 %) of abnormal umbilical cord insertions, ie: marginal or velamentous Aboubakr Elnashar
  • 4. Nucal position Single is safer than multiple umbilical cord loops around the fetal neck. Two types of cord loops around the fetal neck Type A umbilical nuchal cord encircles the fetal neck in a sliding manner (less dangerous) Type B nuchal cord encircles the neck in a locking manner (very dangerous). Aboubakr Elnashar
  • Nucal cord a 360 degree loop around the neck Sagittal section: a single loop of umbilical cord ( arrowheads) around the neck. single cord loop posteriorly- The color Doppler images suggest a single loop of cord in a sliding manner.Aboubakr Elnashar
  • Antenatal ultrasonogram showing umbilical cord around the fetal neck (axial section) in a 25 weeks pregnancy A sonographically detected nuchal cord is not associated with important perinatal complications. Aboubakr Elnashar
  • umbilical cord prolapse 21 week gestation had labour contractions with leaking per vaginum. On color doppler scan, the internal os appears dilated with umbilical cord seen within the cervix. Aboubakr Elnashar
  • 5. Masses umbilical vein varix a cystic lesion in the umbilical cord close to the fetal abdomen. On color doppler scan, flow is present in the cystic area which shows continuity with the umbilical vein. Aboubakr Elnashar
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  • Thank you Aboubakr Elnashar