3. The umbilical cord forms between 5th and 12th week
of gestation with contributions from the
1 Body stalk.
2 Omphalomesenteric or vitelline duct.
3 Yolk sac.
4 Allantois.
REFERENCE : RADIOGRAPHICS 1995 ( RSNA 1995)
5. 50-60 cms long usually covered by
single layer of amniotic epithelium.
vessels are embeded in Wharton’s
jelly.
The characteristic structure of umbilical
cord is determined by the helical course
of arteries around vein. Between umbilical
ring and placental insertion.
6. WHARTON’S JELLY
Jel like structure.
No proper vasculature.
Functions – gives flexibility and strength to cord.
Transfer of water & metabolites between amniotic fluid and umbilical
cord vessels. active throughout pregnancy.
Helps in remodeling and embryogenesis.
Umbilical vein
Umbilical
artery
7. Cord begins to form at 5 weeks of gestation it becomes longer until
28 weeks of pregnancy until it reaches average length of 22 to 24
inches (55 -60 cm.).
Normal cord length is 50-60 cm.
8. SHORT CORD
< 35 cm is defined as short cord, may lead to foetal
distress, placental abruption, prolonged labour.
LONG CORD
>80 cm is defined as long cord, higher occurrence of cord
around neck, cord around body, cord knot, cord prolapse
and cord compression.
LONG
SHORT
9. (B) LARGE :- If it’s sonographic cross - sectional area is
above 90th percentile for gestational age.
LARGE CORD ASSOCIATED
WITH
1. Umbilical cord tumors
2. Urachal cyst
3. umbilical cord mucoid degeneration
4. Omphalomesenteric cyst.
5. Gestational diabetes mellitus.
6. Macrosomia.
10. Both the hypercoiled and the hypocoiled umbilical cord
can result in the undesirable result of a decrease in the
amount of nutrients sent to the foetus, resulting in
intrauterine growth restriction (IUGR) and increases
the risk of foetal death, poor foetal development or a
stillbirth.
Hypercoiled
Hypocoiled
11.
12. Physiological herniation of bowel into the base of the
umbilical cord is part of the normal developmental
sequence which occurs at about the 6th to 8th, and by
8th to 12th week, mid gut herniates back into the base of
the umbilical cord.
13. Omphalocele is midline abdominal wall defect with herniation of the
abdominal content into the base of the umbilical cord.
U/S FINDINGS:-
Omphalocele looks like a central mass protruding from the anterior
abdominal wall. It varies in size and is covered by a membrane . It
usually contains small intestine and liver. There can be other organs
protruding to the omphalocele such as large intestine, bladder,
stomach, spleen.
Polyhydramnios and ascitis.
14. Colour doppler will be useful for umbilical cord
demonstrated.
Omphalocele with stomach entering the omphalocele sac.
23 weeks liver is within the sac and the hepatic vessels
Are demonstrated by colour doppler.
15. *Cystic lesions within the umbilical cord.
*May be pseudocysts or true umbilical cord.
* Most Umbilical cord cysts disappear by the end of 1st trimester. if they persist
beyond 12 weeks or if the cyst are multiple, they associated with a bad
prognosis. Certain Trisomies and foetal anomalies and linked to the presence
of umbilical cord cysts.
*The cord cyst must be differentiated from the more echogenic yolk sac which
is seen outside the amnion .
ULTRASOUND IMAGES
16.
17. Hemangioma
1. Echogenic structure with demonstrable perfusion
2. Common towards placental end
3. Less common – Fetal end of cord
vitelline capillaries.
D/D – Teratoma
Cord haematoma
18. Teratoma -
1. Usually benign
2. Solid with / without cystic areas
3. Contains tissue from all three germ
cells types.
4. Calcification.
Angiomyxoma
1. Usually benign .
2. Hetrogenous mass
19. Hematoma - Most after appears hyperechoic but
the echotexture may very depending up on age of
haemorrahge. Spontaneous hematomas are usually
due to venous source of bleeding related to umbilical
cord knot’s or torsions
lead to fetal monitoring and possible
emergency delivery involve intrafoetal or
extrafoetal portion of umbilical vein
20. Greek : allanto-sausage,
eidos - shape or similarity
an endodermal evagination of the
developing hindgut
removes nitrogenous waste from the fetal
bladder
allantois is vestigial in humans
21.
22. Urachus
A duct between the bladder and
the yolk sac.
Between the 5th and 7th week
of development, the allantois will become
the urachus.
median umblical ligament – obliterated
urachus
23. Patent urachus is a communication the dome of the bladder and the
umbilicus.
• Also called persistent urachus
• Rare: leads to urination through umbilicus
• May be associated with infections
24.
25. manifests in new
born
one-third
associated with distal
urinary obstruction
urine from umblicus
giant umbilical cord
•Complete excision
of the tract with a
cuff of bladder
26. Commonest urachal anomaly in adults. Due to
persistence of the part of the tract.
Symptoms occur due to
- size ( mass )
- infection( pain, fever, urinary symptoms,
umbilical discharge
- rupture ( peritonitis)
27. diagnosis by clinical , usg , cect
treatment
1) single stage – complete excision of
the tract
2) two stage - I & D
followed by
complete excision after
control of sepsis
28. Due to persistance of the distal urachus
asymptomatic unless infected
pain, fever , pus discharge
Usg , sinogram
excision of the sinus tract
29. least common urachal anomaly
asymptomatic
incidental diagnosis cystoscopy , mcu , usg
treatment usually not required
30.
31. Most common abnormality of the omphalo-
mesenteric duct
antimesenteric border of ileum
50 – 200 cms from ICJ
true diverticulum
mostly asymptomatic
lower GI bleed , inflammation , obstruction
heterotropic mucosa
m99Tc scan
Resection and reconstruction
35. Infection of the retained
umbilical cord
Poor asepsis and umbilical hygiene during
delivery
Staphylococci, streptococci, Gram-negative
organisms, Clostridium tetani
39. Chronic infection of the umbilical cicatrix,
Can occur in any age group, but common in
infants and children.
Presents as umbilical discharge with tender, red,
swelling protruding from the umbilicus which
bleeds on touch.
Mimics umbilical adenoma.
Treatment
Antibiotics,
Silver nitrate
Excision of granuloma
Umbilectomy
40. commonly seen in infants.
due to partially obliterated vitello-intestinal
duct towards umbilical end, causing prolapse
of the mucosa
Appears as a moist, red swelling bleeds on
touch.
Secondary infection
Histologically, it consists of columnar
epithelium rich in goblet cells.
