1
|
Chen H, Jia M, Yang S, Zou J, Xiao X. Umbilical cord cysts: Classification, diagnosis, prognosis, and pregnancy recommendations. Int J Gynaecol Obstet 2024; 164:823-829. [PMID: 37489030 DOI: 10.1002/ijgo.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
Umbilical cord cysts (UCCs)-cysts located in the umbilical cord that are derived from an abnormal embryonic development process-are typically an incidental discovery during prenatal ultrasound. It can be described as either a pseudocyst or a true UCC, which results from focal edema or degeneration of Wharton jelly or the remnants of embryonic development, respectively. Due to the relative rarity of the UCC, the clinical guidance of UCCs is not yet available. Herein, the aim of this paper is to discuss the classification, diagnosis, prognosis, and clinical management of UCCs through a literature review, in order to improve the understanding of UCCs among clinical obstetricians and pediatricians.
Collapse
Affiliation(s)
- Huiling Chen
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Mingzhu Jia
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Shuqi Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Juan Zou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xue Xiao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Suzuki T, Yamamoto Y, Nakamura H, Sei-Okawa K, Maruyama Y, Takeda J, Makino S, Yamataka A, Itakura A. Fetal umbilical cord cyst may evolve to omphalocele during pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:181-183. [PMID: 31724176 DOI: 10.1002/jcu.22786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/26/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
Omphalocele is rarely complicated by umbilical cord cysts. In our case, an umbilical cord cyst and fetal ascites were detected at 26 weeks' gestation in a fetus with trisomy 13. This changed to omphalocele with subsequently absorbed fetal ascites at 35 weeks' gestation. We propose two hypotheses. The abdominal wall may have been physically pierced or an omphalocele might have preexisted, and the intestinal tract in the hernia sac was pushed by fetal ascites.
Collapse
Affiliation(s)
- Toshifumi Suzuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuka Yamamoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroki Nakamura
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kiguna Sei-Okawa
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yojiro Maruyama
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Ruiz Campo L, Savirón Cornudella R, Gámez Alderete F, Martínez-Payo C, Pérez Pérez P, Garrido Fernández P, Lerma Puertas D. Prenatal diagnosis of umbilical cord cyst: Clinical significance and prognosis. Taiwan J Obstet Gynecol 2018; 56:622-627. [PMID: 29037547 DOI: 10.1016/j.tjog.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Clarify the prognosis of the prenatal ultrasound diagnosis of umbilical cord cysts at any gestation trimester and to assess the ultrasound findings and chromosomal alterations associated to this entity. MATERIALS AND METHODS Between 2003 and 2015 a multicenter study was carried out, collecting, in five centers in Spain, the associated findings and perinatal outcomes of 27 cases of umbilical cord cysts, regardless of gestational age of diagnosis. A bibliographic review was conducted to identify previous studies in order to compare them with our data. RESULTS In our sample, the prognosis of this finding and the neonatal outcome, when isolated, is favorable, regardless of gestational age at diagnosis, multiple or unique presentation or vanishing or persistent cysts. CONCLUSIONS It is important to properly assess the umbilical cord cyst and when is diagnosed, it is recommended to conduct a meticulous ultrasound examination searching for other associated malformations. In our study the prognosis of this finding seems to be favorable when isolated. Also, there is no relation between prognosis and gestation weeks at diagnosis. On the other hand, when we find this entity with associated anomalies, it is recommended to assess the need to carry out a karyotype.
Collapse
Affiliation(s)
- Leyre Ruiz Campo
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - Francisco Gámez Alderete
- Department of Obstetrics and Gynecology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Cristina Martínez-Payo
- Department of Obstetrics and Gynecology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
| | - Pilar Pérez Pérez
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Pilar Garrido Fernández
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Diego Lerma Puertas
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| |
Collapse
|
4
|
Haino K, Serikawa T, Itsukaichi M, Numata M, Kikuchi A, Kojima K, Matsunaga M, Takakuwa K, Tanaka K. Large pseudocyst of the umbilical cord detected in the second trimester. J Med Ultrason (2001) 2010; 37:213-5. [PMID: 27278197 DOI: 10.1007/s10396-010-0272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 05/24/2010] [Indexed: 10/19/2022]
Abstract
We present a case of a large umbilical cord cyst detected at 21 weeks of gestation. Serial ultrasonographic examination revealed a single umbilical artery and progression of the cystic mass. A 2,842-g male infant was delivered at 37 weeks of gestation, and we confirmed that the umbilical cord cyst was a pseudocyst in our pathological examination. This case demonstrated an uneventful course of pregnancy despite the large umbilical cord pseudocyst.
Collapse
Affiliation(s)
- Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan.
| | - Takehiro Serikawa
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| | - Mina Itsukaichi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| | - Masahiro Numata
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| | - Akira Kikuchi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| | - Kinuko Kojima
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masamichi Matsunaga
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Takakuwa
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| | - Kenichi Tanaka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi, Chuo, Niigata, 951-8510, Japan
| |
Collapse
|
5
|
|
6
|
Kobayashi S, Santos JFLD, Fernandes VM, Chammas MC, Cerri GG. Correlação entre o achado ultra-sonográfico isolado de cisto de cordão umbilical e anomalias fetais. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Correlacionar o achado ultra-sonográfico isolado de cisto de cordão umbilical com anomalias fetais, como cromossomopatias e alterações estruturais. Segundo a literatura médica, as implicações clínicas do achado ultra-sonográfico de cisto de cordão nos segundo e terceiro trimestres de gestação estão bem estabelecidas, entretanto, quando no primeiro trimestre, o significado ainda permanece controverso. MATERIAIS E MÉTODOS: Foi realizado estudo retrospectivo de gestantes da população geral, consecutivas, com fetos únicos e vivos, que apresentavam apenas o achado de cisto de cordão umbilical, num período de dez anos (1996-2006). Em todos os casos foram realizados exames ultra-sonográficos para o rastreamento de anomalias fetais após o diagnóstico de cisto de cordão. Os recém-nascidos e o cordão umbilical foram examinados após o parto para se verificar a presença de anomalias. RESULTADOS: Foram estudados nove casos que apresentavam cisto de cordão umbilical como único achado, sem outros marcadores ultra-sonográficos de anomalias fetais. Detectaram-se dois casos no primeiro trimestre de gestação e sete nos segundo e terceiro trimestres. Dois casos foram submetidos a estudo citogenético fetal, por meio de amniocentese. Nenhum recém-nascido apresentou anomalias estruturais ou aneuploidia. CONCLUSÃO: O achado ultra-sonográfico isolado de cisto de cordão umbilical não significou aumento de risco para anomalias estruturais ou aneuploidias.
Collapse
|
7
|
Tong SY, Lee JE, Kim SR, Lee SK. Umbilical cord cyst: a prenatal clue to bladder exstrophy. Prenat Diagn 2008; 27:1177-9. [PMID: 17960789 DOI: 10.1002/pd.1872] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
8
|
Yonemoto H, Itoh S, Nakamura Y, Kinoshita K. Umbilical cord cyst detected in the first trimester by two- and three-dimensional sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:150-2. [PMID: 16547996 DOI: 10.1002/jcu.20199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A case of umbilical cord cyst was identified via 2-dimensional and 3-dimensional sonographic examination at 8 weeks' menstrual age. The cyst was solitary, measuring 18.0 mm, and it was located close to the placental insertion on the umbilical cord. The gestational sac and yolk sac diameters and the fetal heart rate were within normal ranges for menstrual age. Follow-up 3-Dimensional sonographic examination in the second trimester showed complete resolution of the cyst. Amniocentesis revealed a normal karyotype, and a normal infant was delivered at term.
Collapse
Affiliation(s)
- Hisashi Yonemoto
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | |
Collapse
|
9
|
Alimoglu E, Simsek M, Ceken K, Mendilcioglu I, Kabaalioglu A, Sindel T. Umbilical cord pseudocyst in a fetus with Down syndrome. Prenat Diagn 2006; 26:193-4. [PMID: 16470563 DOI: 10.1002/pd.1376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
10
|
Hargitai B, Csabai L, Bán Z, Hetényi I, Szucs I, Varga S, Papp Z. Rare case of exomphalos complicated with umbilical cord teratoma in a fetus with trisomy 13. Fetal Diagn Ther 2006; 20:528-33. [PMID: 16260890 DOI: 10.1159/000088045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 11/10/2004] [Indexed: 01/07/2023]
Abstract
An exomphalos containing unusual solid and cystic mass was diagnosed during a routine ultrasound examination in the 17th week of gestation. Further investigations were planned but the pregnancy was terminated. The fetopathological examination revealed an umbilical cord teratoma. Although this entity is very rare it should be emphasized as a possible differential diagnosis when cystic lesion of the cord is detected. Large teratomas associated with abdominal wall defect may have poor fetal outcome and can be associated with structural and chromosomal abnormalities. In our case trisomy 13 was diagnosed.
Collapse
Affiliation(s)
- B Hargitai
- Ist Department of Obstetrics and Gynecology, Semmelweis University Budapest, Budapest, Hungary.
| | | | | | | | | | | | | |
Collapse
|
11
|
Kilicdag EB, Kilicdag H, Bagis T, Tarim E, Yanik F. Large pseudocyst of the umbilical cord associated with patent urachus. J Obstet Gynaecol Res 2004; 30:444-7. [PMID: 15566460 DOI: 10.1111/j.1447-0756.2004.00228.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cystic masses of the umbilical cord have been detected in the second and third trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. We present a case of an umbilical cord pseudocyst diagnosed using routine ultrasound at the 20 weeks of gestation. Serial sonography followed the progression of the cystic masses. A 2960-g male infant was delivered at term, in whom a patent urachus was detected. The infant underwent repair with closure of the patent urachus and plastic reconstruction of the abdominal wall, and the postoperative course was uneventful. This case demonstrated an uneventful outcome despite the persistent multiple cord cysts.
Collapse
Affiliation(s)
- Esra Bulgan Kilicdag
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey.
| | | | | | | | | |
Collapse
|
12
|
Emura T, Kanamori Y, Ito M, Tanaka Y, Hashizume K, Marumo G, Goishi K. Omphalocele associated with a large multilobular umbilical cord pseudocyst. Pediatr Surg Int 2004; 20:636-9. [PMID: 15449087 DOI: 10.1007/s00383-004-1247-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2003] [Indexed: 10/26/2022]
Abstract
The prevalence of umbilical cord cysts at 7-13 weeks' gestation is approximately 3%. More than 20% of such cases are complicated by structural defects and/or chromosomal abnormalities such as trisomy 18. These cysts usually have a single cavity and are <5 cm in size. Therefore, when an umbilical cord cyst is detected in the 2nd trimester, the examination of fetal karyotype is recommended. Omphaloceles are also well known to be complicated by many anomalies, especially trisomy 18. We report a case of an omphalocele associated with a large multilobular umbilical pseudocyst (diameter >5 cm) in a patient with a normal karyotype, 46XY. These anomalies were diagnosed by fetal ultrasonography. However, the cyst was difficult to diagnose as an umbilical cord pseudocyst because it was very large and multilobulated. At 38.5 weeks of gestation, the patient was delivered by Cesarean section. The cyst was resected, and the omphalocele was closed by staged surgeries. Pathologic diagnosis of the cyst was the degeneration of Wharton's jelly. This diagnosis was made by the absence of epithelial lining inside the cyst wall, since the existence of epithelial cells correlates with true cysts.
Collapse
Affiliation(s)
- Takaki Emura
- Department of Pediatric Surgery, University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, 113-8655, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
13
|
Sepulveda W. Beware of the umbilical cord 'cyst'. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:213-214. [PMID: 12666212 DOI: 10.1002/uog.80] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- W Sepulveda
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Hammersmith Hospitals NHS Trust, Du Cane Road, London, W12 0HS, UK.
| |
Collapse
|
14
|
Sepulveda W, Corral E, Kottmann C, Illanes S, Vasquez P, Monckeberg MJ. Umbilical artery aneurysm: prenatal identification in three fetuses with trisomy 18. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:292-296. [PMID: 12666226 DOI: 10.1002/uog.69] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Aneurysm of the umbilical artery is an extremely rare anomaly of the umbilical cord, with only two cases being documented in the English language literature. We report three cases diagnosed prenatally by ultrasound in the third trimester, all associated with single umbilical artery and multiple structural fetal anomalies. Prenatal karyotyping revealed trisomy 18 in all three cases. Umbilical cord anomalies, although rare, are associated with significant fetal morbidity and mortality. This report identifies umbilical artery aneurysm as an additional prenatal feature of trisomy 18.
Collapse
Affiliation(s)
- W Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile.
| | | | | | | | | | | |
Collapse
|
15
|
Weissman A, Drugan A. Sonographic findings of the umbilical cord: implications for the risk of fetal chromosomal anomalies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 17:536-541. [PMID: 11422981 DOI: 10.1046/j.1469-0705.2001.00408.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this review we summarize current knowledge on sonographic findings of the umbilical cord and the risk they impose for chromosomal abnormalities of the fetus. A Medline search of the literature was performed and the pertinent English-language literature was reviewed. Anatomical and Doppler abnormalities of the umbilical cord may be associated with an increased risk of chromosomal aberrations in the fetus. Therefore, level II prenatal sonography should also include a careful examination of the umbilical cord.
Collapse
Affiliation(s)
- A Weissman
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
| | | |
Collapse
|
16
|
Abstract
This article begins with a presentation of the embryology of the anterior abdominal wall and umbilical cord. Abnormal embryology and resulting anomalies are presented in tabular form and later reviewed in chronologic order of embryologic development. Techniques involved in the prenatal diagnosis of these abnormalities are also described.
Collapse
Affiliation(s)
- J N Robinson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, New York, USA
| | | |
Collapse
|
17
|
|
18
|
Sherer DM, Anyaegbunam A. Prenatal ultrasonographic morphologic assessment of the umbilical cord: a review. Part II. Obstet Gynecol Surv 1997; 52:515-23. [PMID: 9267869 DOI: 10.1097/00006254-199708000-00023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ultrasonographic assessment, although not always possible throughout the entire length of the umbilical cord, may assist in the diagnosis of congenital and functional anomalies of this structure. In such fashion, prenatal ultrasound may outline normal anatomy or alternatively depict various congenital abnormalities of the umbilical cord including: cysts; pseudocysts umbilical vein varix; persistent right umbilical vein; angiomyxomas; aneurysm (arterial or venous); single, hypoplastic or fused umbilical artery; hematomas (spontaneous or iatrogenic); velamentous insertion; vasa previa. The umbilical cord coiling index, an additional ultrasonographic morphologic feature, may identify patients at risk for adverse perinatal outcome. Conditions of potential fetal compromise due to umbilical cord compression including nuchal cords, true knots, occult prolapse, cord presentation, fetal grasping, and cord entanglement in monoamniotic twins, may be detected prenatally; and impaired umbilical flow can be confirmed with Doppler flow velocimetry. Ultrasound has been widely used to guide invasive diagnostic and therapeutic procedures involving access to umbilical circulation. We conclude that the review of current literature supports that precise prenatal ultrasonographic depiction of the morphology of the umbilical cord may enhance perinatal management.
Collapse
Affiliation(s)
- D M Sherer
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461-2373, USA
| | | |
Collapse
|
19
|
Sherer DM, Anyaegbunam A. Prenatal ultrasonographic morphologic assessment of the umbilical cord: a review. Part I. Obstet Gynecol Surv 1997; 52:506-14. [PMID: 9267868 DOI: 10.1097/00006254-199708000-00022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our objective was to review current data pertaining to prenatal ultrasonographic morphology of the umbilical cord. To this goal we identified studies published in the English language regarding prenatal ultrasonographic morphology of this structure. The studies were obtained from a MEDLINE search from 1966 through May 1997; additional sources were identified through cross-referencing. All published reports, case studies, and articles regarding ultrasonographic morphology of the umbilical cord were reviewed. Data pertaining to Doppler flow velocimetry in association with umbilical cord structural anomalies and umbilical cord compression, were also included. Review of the literature supports that prenatal ultrasound may outline normal anatomy or alternatively depict various congenital abnormalities of the umbilical cord including: cysts; pseudocysts; umbilical vein varix; persistent right umbilical vein; hemangiomas; umbilical vessel aneurysm (arterial or venous); single, hypoplastic, or fused umbilical artery; hematomas (spontaneous or iatrogenic); velamentous insertion; and vasa previa. The umbilical cord coiling index, an additional ultrasonographic morphologic feature may identify patients at risk for adverse perinatal outcome. Conditions of potential fetal compromise due to umbilical cord compression including nuchal cords, true knots, occult prolapse, cord presentation, fetal grasping, and cord entanglement in monoamniotic twins, may be detected prenatally and impaired umbilical flow confirmed with Doppler flow velocimetry. Ultrasound has been widely applied to guide invasive diagnostic and therapeutic procedures involving access to umbilical circulation. In conclusion, precise prenatal ultrasonographic depiction of the morphology of the umbilical cord may enhance perinatal management.
Collapse
Affiliation(s)
- D M Sherer
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461-2373, USA
| | | |
Collapse
|
20
|
Smith GN, Walker M, Johnston S, Ash K. The sonographic finding of persistent umbilical cord cystic masses is associated with lethal aneuploidy and/or congenital anomalies. Prenat Diagn 1996; 16:1141-7. [PMID: 8994251 DOI: 10.1002/(sici)1097-0223(199612)16:12<1141::aid-pd2>3.0.co;2-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Advancements in sonographic technology have led to improved prenatal detection of fetal anomalies. Umbilical cord cystic masses are being detected prenatally and several case reports have appeared in the literature. We report three new cases in which umbilical cord cystic masses were detected prenatally; two cases in the later half of pregnancy and one case in the first trimester. The literature was reviewed and summaries of the 23 reported cases of persistent second- and third-trimester umbilical cord cystic masses and their implications are discussed. There is a high association (18 of 23 cases) with lethal chromosomal anomalies and/or congenital malformations suggesting that the finding of an isolated umbilical cord cystic mass should lead to further detailed sonographic evaluation.
Collapse
Affiliation(s)
- G N Smith
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | | | | | | |
Collapse
|
21
|
Ramirez P, Haberman S, Baxi L. Significance of prenatal diagnosis of umbilical cord cyst in a fetus with trisomy 18. Am J Obstet Gynecol 1995; 173:955-7. [PMID: 7573278 DOI: 10.1016/0002-9378(95)90376-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An umbilical cord cyst was detected in a fetus who underwent ultrasonography at 38 weeks' gestation for clinical suspicion of intrauterine growth retardation. Such an association should alert the clinician to the possibility of aneuploidy, thus guiding clinical management. This case represents the second report of a cystic umbilical lesion in a fetus with trisomy 18.
Collapse
Affiliation(s)
- P Ramirez
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | |
Collapse
|
22
|
Shipp TD, Bromley B, Benacerraf BR. Sonographically detected abnormalities of the umbilical cord. Int J Gynaecol Obstet 1995; 48:179-85. [PMID: 7789592 DOI: 10.1016/0020-7292(94)02297-c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study was undertaken as a retrospective chart review to evaluate the range of umbilical cord abnormalities detected by prenatal sonography, as well as the outcome and pathologic correlation. METHODS We identified 13 cases of umbilical cord abnormalities detected sonographically over a 46-month period. We evaluated the ultrasound appearance, size, location, and color Doppler characteristic in each case. RESULTS There were 4 instances of clear cysts on the umbilical cord, 8 with complex masses, and 1 with complete, cystic encasement of the cord throughout its length. The pathology included vascular abnormalities (hemangioma, hematoma, varicosity), edema of the umbilical cord with pseudocysts, and syncytial knots. There was 1 known karyotypic abnormality (trisomy 13). Twelve of the 13 newborns survived; the neonatal death occurred in the fetus with trisomy 13. CONCLUSION The presence of umbilical cord abnormalities may represent a variety of pathologic entities. Clinical outcome is usually favorable.
Collapse
Affiliation(s)
- T D Shipp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
| | | | | |
Collapse
|
23
|
|
24
|
Jauniaux E, Jurkovic D, Campbell S. Sonographic features of an umbilical cord abnormality combining a cord pseudocyst and a small omphalocele; a case report. Eur J Obstet Gynecol Reprod Biol 1991; 40:245-8. [PMID: 1715298 DOI: 10.1016/0028-2243(91)90127-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The perinatal findings of a pregnancy complicated by an umbilical cord abnormality associated with a small omphalocele are presented. The lesion was first observed at 18 weeks of gestation and was associated with elevated maternal serum alpha-fetoprotein. Serial ultrasound examinations showed major changes in the cord appearances and an associated small omphalocele was identified during the third trimester. Colour flow imaging showed no blood flow within the lesion and no obstruction nor involvement of the main umbilical vessels. Postnatal investigations demonstrated focal myxoid degeneration of the cord, a small omphalocele and no other fetal abnormalities.
Collapse
Affiliation(s)
- E Jauniaux
- Department of Obstetrics and Gynaecology, King's College Hospital, King's College School of Medicine and Dentistry, Denmark Hill, London, U.K
| | | | | |
Collapse
|
25
|
|
26
|
|
27
|
Jauniaux E, De Munter C, Vanesse M, Wilkin P, Hustin J. Embryonic remnants of the umbilical cord: morphologic and clinical aspects. Hum Pathol 1989; 20:458-62. [PMID: 2707797 DOI: 10.1016/0046-8177(89)90011-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Embryonic vestiges of the umbilical cord are classic findings in routine morphologic examination of the placenta. In order to evaluate their clinicopathologic significance, we examined samples from the fetal and placental ends of 1,000 umbilical cords and collected the principal clinical findings of the corresponding newborns. Microscopic evidence of embryonic remnants were found in 231 cases (23.1%) divided into remnants of the allantoic duct (63%), the omphalomesenteric duct (6.6%), and the embryonic vessels (30.4%), including one case of hemangioma and an accessory small artery. There were no significant clinical differences between the three vestigial groups, and no particular association with congenital malformations or perinatal complications. In 70.9% of the cases, the embryonic remnants were found at the fetal end of the umbilical cord, where most tumors of the cord develop.
Collapse
Affiliation(s)
- E Jauniaux
- Department of Gynecology and Obstetrics, Hôpital St. Pierre, Free University of Brussels, Belgium
| | | | | | | | | |
Collapse
|