Dr.

ARCHANA ASOK

UMBILICAL CORD
CONTENTS
DEFINITION
ANATOMY
DEVELOPMENT
FUNCTIONS
 DEFINITION
The Umbilical cord or Funis forms the connecting link between the
fetus and the placenta through which the fetal blood flows to and from
the placenta.This can be described as foetal life line.
ANATOMY
Location Attaches to the fetus at the umbilicus and center of the
placental bulk
Structure Blood vessel bundle surrounded by a tubular sheath of amnion

Composed of Two paired umbilical arteries and one umbilical vein

Function Vital passage for nutrients, oxygen and waste products to and
from the fetus
 Distal portion Medial
of Umbilical umbilical
artery ligament
Umbilical
cord Urinary bladder
Proximal portion Anterior Superior Ureter
of the Umbilical internal iliac vesical
artery Ductus deferens
arteries arteries
Seminal vesicles
• After birth, a significant distal portion of the umbilical artery degenerates and
the remnants later obliterate forming the medial umbilical ligament

• The proximal portion of each umbilical artery serves as a branching point for
the development of the anterior internal iliac arteries.

• The internal iliac arteries later give rise to the superior vesical arteries that
supply the urinary bladder and ureters as well as the ductus deferens and
seminal vesicles in males
 DEVELOPMENT
The umbilical cord is developed from the connective stalk or body stalk, which
is a band of mesoblastic tissue stretching between the embryonic disk and the
chorion.
 Connecting link between placenta and foetus
Extends from foetal umbilicus and inserted on the foetal surface of
placenta at its centre

Length : 35-50cm | Diameter : 1.5-2 cm

Formed by 5th week

Develops from amnioticectoderm conataining vitello-intestinl duct
and yolk sac
Contains 2 Umbilical Vein, 1 umbilical artery and mucoid
connective tisssue(Wharton’s jelly)

Umbilical arteries are spirally twisted from L to R

 FUNCTIONS

Supplying oxygen and nutrients:

Removing waste products:
The umbilical vein carries oxygen and
The umbilical arteries carry waste products,
nutrients from the placenta to the fetus. These
such as carbon dioxide and urea, from the fetus
nutrients include glucose, amino acids, and
to the placenta, where they can be removed
essential fatty acids that are necessary for the
from the mother's body.
growth and development of the fetus

Regulating temperature: Providing stem cells:

The umbilical cord helps to regulate the The umbilical cord contains stem cells that can
temperature of the fetus by transferring heat be used for medical treatments, such as bone
between the fetus and the placenta. marrow transplants.
 CORD PATHOLOGY
ACCIDENTAL ABNORMALITIES OF
PATHOLOGIES DEVELOPMENT
Cord coiling
Loops
Four - vessel cord
Knots
Single umbilical artery
Prolapse
Abnormal cord length Thrombosis
Abnormal cord diameter Ruptures
Abnormalities of cord insertion

Torsion and strictures

Haematoma

Cysts
 1) ABNORMAL CORD LENGTH
Normal cord length is 50-60cm (on an average of 55cm)

Feotal distress
Cord <35 SHORT
Prolonged labor
cm CORD
Placental abruptio

True cord knot

Cord >80 LONG
Cord prolapse
cm CORD
Cord compression
ABNORMAL CORD LENGTH
 2) ABNORMAL CORD DIAMETER
• Lean cords are associated with IUGR

• Large diameter cords are associated with microsomia

3) ABNORMALITIES OF CORD INSERTION

• Usually the cord is inserted near or at the centre of the fetal surface
of placenta
MARGINAL INSERTION/ BATTLEDORE PLACENTA

FURCATE INSERTION

VELAMENTOUS INSERTION

VASA PRAEVIA
MARGINAL INSERTION/ BATTLEDORE PLACENTA
A condition in which the umbilical cord is inserted at or near the placental
margin rather than in the center

Complications associated with battledore placenta are preterm labor, fetal

distress, and intrauterine growth restriction.
 FURCATE INSERTION

Furcate umbilical cord insertions are rare obstetrical findings. This variant
is defined by an umbilical cord which branches prior to contacting the
placental surface.
VELAMENTOUS INSERTION

Velamentous cord insertion is a pregnancy complication that happens when

the umbilical cord from a fetus doesn’t insert into the placenta correctly.
VASA PRAEVIA

There are two types of vasa previa:

Type I, vasa previa with velamentous cord insertion. Vasa previa

sometimes happens with velamentous cord insertion, where the
umbilical cord doesn’t insert into the placenta as it should.
Instead, the umbilical cord blood vessels travel outside the
placenta, where they’re unprotected and at risk of breaking. If
your placenta sits low in your uterus so that it’s near your cervix,
the exposed blood vessels are especially vulnerable to bursting
once labor begins and the fetus starts moving toward your cervix.

Type II, vasa previa with a bilobed placenta. Vasa previa can
happen when your placenta splits into two lobes, with the
umbilical cord connecting one lobe to the other. If the exposed
blood vessels traveling between the lobes lie close to your cervix,
they can burst and bleed once labor starts.
 4) CORD COILING

• The abnormal umbilical coiling index is associated with adverse perinatal

outcomes.

• UCI which is > 90th percentile is termed as hypercoiling and it is associated

with foetal growth restriction. It was found that a ponderal index of < 2.5 was
associated with hypercoiling of cord.

• UCI which is < 10th percentile is termed as hypocoiling and it is associated

with meconium staining, low Apgar scores and NICU admissions of babies.
5) FOUR VESSEL CORD
• Four vessel umbilical cord
anomaly commonly seen are 2
umbilical arteries and 2 umbilical
veins.
 6) SINGLE UMBILICAL ARTERY
The umbilical cord typically contains two arteries and
one vein. Single umbilical artery (SUA) refers to a
variation of umbilical cord anatomy in which there is
only one umbilical artery.
 7) TORSION AND STRICTURES
Stricture of the umbilical cord was defined as a Torsion is the excessive twisting of the umbilical cord
decrease in diameter in relation of the remaining which leads to blockage of the blood supply and the
umbilical cord subsequent death of the fetus
8) HEMATOMA
Umbilical cord hematoma is defined as the extravasation of blood, mainly venous,
in the Warton's jelly that covers the umbilical vessels
9) CYSTS
Umbilical cord cysts (UCCs)—cysts located in the umbilical cord that are
derived from an abnormal embryonic development process