Ultrasonography of umbilical cord

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U/S of umbilical cord Aboubakr Elnashar

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Transcript of Ultrasonography of umbilical cord

Page 1: Ultrasonography of  umbilical cord

U/S of umbilical cord

Aboubakr Elnashar

Page 2: Ultrasonography of  umbilical cord

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.

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Umbilical Cord in

Cross Section Aboubakr Elnashar

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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.

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Normal cord insersion

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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

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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.

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Normal Twists

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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.

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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

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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.

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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

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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).

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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.

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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.

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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.

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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.

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Aboubakr Elnashar

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Thank you

Aboubakr Elnashar