This document provides an overview of the umbilical cord, including its structure, development, functions, measurements, and abnormalities. The umbilical cord connects the fetus to the placenta, containing two arteries and a vein enclosed in Wharton's jelly. It normally measures 50cm in length and 1-2cm in diameter. Various abnormalities are discussed such as battledore cord insertion, velamentous insertion, short and long cord, single umbilical artery, true and false knots, and nuchal cord.

1. Unit 2.2
Umbilical Cord
PREPARED BY:
Sapana Dahal
MNC,IOM,TU

2. General Objective
At the end of the session,all participants will be
able to explain about umbilical cord.

3. Specific Objectives
At the end of this session, all participants will be
able to:
introduce umbilical cord
explain process of umbilical cord development
state functions
 list umbilical cord abnormalities

4.  explain battledore cord insertion
describe velamentous cord insertion
state cord length abnormalities
explain single umbilical artery
state true and false knot

5.  state cord stricture and hematoma
explain nuchal cord

6. Umbilical Cord

7. • It is a long vascular connecting structure
between fetus and placenta.
• It extends from the fetal surface of placenta to
the umbilical area of fetus.
• It is formed by the 5th week of pregnancy.
• Inserted at the centre of the fetal surface of
the placenta.

9. Structure
• It contains two arteries and a vein.
• The blood vessels are enclosed and protected
by Wharton’s jelly
• No nerve supply is present in the umbilical
cord, so cutting it following the birth of the
baby is not painful.

10. Measurement
It is approximately 1-2 cm in diameter and 50
cm in length.

11. Development of umbilical cord
Approximately at 5th week of development:
The primitive umbilical ring; (PUR ) develops in
amnio-ectodermal junction
Amnion envelops the structures within PUR
forming primitive umbilical cord.

14. development contd…
Distally , the cord contains the yolk sac stalk
and umbilical vessels
More proximally, it contains some intestinal
loops and the remnant of the allantois
At the end of the 3rd month, the amnion has
expanded so that it comes in contact with the
chorion, obliterating the chorionic cavity.

16. development contd..
The yolk sac then usually shrinks and is
gradually obliterated
When the allantois and the yolk stalk and its
vessels are also obliterated , all the remains in
the cord are also obliterated and, all that
remains in the cord are the umbilical vessels
that is surrounded by wharton’s jelly.

17. Functions
1. It serves as the blood source for the fetus.
2. Exchange of the gaseous materials.
3. It serves as the source of the nutrients.
4. It helps in the removal of the waste products.

18. Abnormalities
a. Battledore cord insertion

19. • It is also called the marginal insertion of the
cord in which the cord is inserted in the edge
of the placental disk.
Incidence
Occurs in about 7% of singleton pregnancy and
25% in twin pregnancy.

21. Risk Factors
1. Monochorionic twin pregnancy
2. Increased maternal age
Cause
Exact cause is unknown but abnormal placental
tissue development may result.

22. Diagnosis
Routine USG early in the first trimester
Treatment
Directed towards managing fetal complications.

23. Complications
1. IUGR
2. Vasa previa
3. Preterm birth
4. Excessive bleeding
5. Blood vessels compression leading to death

25. Prognosis
Its good unless severe complications are
present.

26. b. Velamentous insertion of cord

27. • The cord is attached to the fetal membrane
rather than the placental mass.
• It occurs about 1% in singleton pregnancy and 9%
in twin pregnancy.
Risk factors
1. Smoking
2. Advanced age
3. Multiple pregnancy

28. Cause
Exact cause is unknown but abnormal placental
tissue development may result.

29. Pathophysiology

30. Diagnosis
Routine USG in the 1st trimester is helpful.
Management
Depends upon the condition and usually
directed towards reducing complications.
If fetal bleeding is present early vaginal or
emergency caserean section is preferred.

31. Complications
1. Vasa previa
2. IUGR
3. Increased risk of twin-twin transfusion in
case of twin pregnancy.

33. Abnormal length ( short and long cord )

34. Long cord
• If the length of the cord is over 80 cm, its
called long cord.
• It occurs in about 7% of all pregnancies.
Risk factors
1.Large babies
2. Smoking
3. Diabetic mother

35. Cause
Exact cause is unknown but is more common
with single pregnancy.
Diagnosis
Routine USG
Placental examination

36. Management
If the condition is complicating the fetus, then
emergency LSCS in 1st stage and vaccum/forcep
delivery during 2nd stage.
Complications
1. Fetal distress
2. True knot formation

37. 3. Umbilical cord compression
4. Nuchal cord

38. Short cord
• If length is less than 35-40 cm ,its short cord
Absolute short cord
• If the length is actually short.
Relative short cord
• If the length is average but has become short
due to looping around the body.

39. • It occurs in about 6% of all pregnancies.
Risk factors
1. Smoking/ alcohol consumption
2. Down syndrome
3. Oligohydraminous/Polyhydraminous
4. Gestational diabetes

40. Cause
Exact cause is unknown.
Signs and symptoms
Fetal distress
Non- reassuring fetal heart rate.

41. Diagnosis
FHR monitoring
Routine USG
Placental examination

42. Clinical significance
• Prevents the descent of presenting part
• Contributes to early separation of normally
situated placenta
• Favors malpresentation
Management
It depends upon the maternal and fetal
condition.

43. Complications
1. Retained placenta
2. Prolong labor
3. IUGR
4. Umbilical cord rupture

44. Prognosis
Its prognosis is poor since it may develop
complications so close monitoring is required.

45. d. Single umbilical artery

46. • Umbilical cord with only one umbilical artery
• Left artery is more absent than the right one.
• Is associated with cardiovascular,
gastrointestinal, renal and other anomalies.
• Occurs in about 1% of pregnancies and more
among twin pregnancies.

47. Risk factors
1. Maternal diabetes
2. Chromosomal abnormalities
3. Oligohydraminous/polyhydraminous

48. Signs and symptoms
1. Fetal distress
2. Birth defect in USG
Diagnosis
1. FHR monitoring
2. Routine USG
3. Placental examination

49. Management
Careful monitoring of the condition
Complications
1. IUGR
2. Still birth/Neonatal death
3. Congenital birth defects.

50. Prognosis
Its poor resulting in various congenital defects.

51. e. True knot and false knot

52. True Knot
• Occurs in about 1% of pregnancy
• Most commonly in monoamniotic twin
• It arise from the fetal movements and more
likely to develop during early pregnancy.
• When knot are too much tight, greater
incidence of fetal death occurs.

53. False knot
• Arise from accumulation of the wharton’s
jelly instead of kinking of the blood.No clinical
significance.

54. f. Cord stricture

55. Hematoma

56. Nuchal cord

57. Cord around neck in fetus with long
cord

58. Incidence
About 25% for a single loop
About 2.5% for a double loop
About .5% for more than two loops

59. Risk factors
• Long cord
• Polyhydramnious

60. Signs and symptoms
• Abnormal fetal heart rate
• USG showing cord around neck

61. Management
• If complicating condition is present, then
emergency LSCS is preferred.
• If its not complicating, then during vaginal
delivery can be slipped over baby’s head if its
loose and if tight, cord must be clamped and
cut before shoulder delivery.

62. Complications
• IUGR
• Birth asphyxia
• Umbilical cord prolapse

63. SUMMARY

65. References:
• 1. T.W.saddler ,langman’s textbook of embryology
, 12th edition,Lippincott Williams and wilkins,
south asian edition published by wolters kluwer.
• 2. D.C. Dutta, textbook of obstetrics, 5th edition,
new central book agency Pvt ltd, India.

66. • Subedi durga , Gautam saraswoti, midwifery
nuring part-1, 2nd edition, medhabi publication.
• Indrani T.K(2003) Textbook of midwifery, New
Delhi:Jaypee brothers,medical publishers(P).ltd
• Jacob.A(2005) A Comprehensive Textbook of
Midwifery, Jaypee Brothers , New Delhi

67. • BennettV.R, Brown L.k(2003)Myles textbook for
midwives, 14th edition,churchill,livingstone.
• http:/www.embryology.med.unsw.edu.aw
• 6. Tuitui roshani, manual of midwifery A,
vidyarthi pustak bhandar, Kathmandu.

68. Home assignment

69. Next Class
Amniotic Fluid