Abstract

Introduction: The role of umbilical cord abnormalities has seldom received attention as a cause of intrauterine fetal demise (IUFD). Umbilical cord anomalies are of various types ranging from clinically inconsequential anomalies to those which can result in fetal demise. There can be numerical abnormalities or non-numerical abnormalities or both within the same cord. In this study, we attempted to focus on the abnormalities of the umbilical cord. Aim of the study: To study the various types of abnormalities in umbilical cords in fetal autopsy specimens.

Materials and Methods: This was a prospective study done in the department of Pathology at Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, India, over a period of six years. A total of 83 fetal autopsy specimens were received and studied grossly and microscopically. Autopsies were performed as per standard protocol and included complete anthropometry, external examination, gross and microscopic evaluation of different organs and placenta. Both numerical and non-numerical abnormalities were recorded.

Observations and Results: There were total 83 fetal autopsy specimens with umbilical cords. Primigravida accounted for 53% cases. MTP accounted for 45.7% cases and 54.2% cases were intrauterine deaths. Numerical abnormality of umbilical cord vessels was seen in 16.8% cases and all had single or multiple developmental anomalies. There were 20.4% cases of cord having normal or abnormal number of vessels along with additional other abnormalities. There were 18% cases with numerically normal vessels but with other abnormalities. The commonest numerical abnormality was of two vessels; single umbilical artery and single vein. Hypercoiling of cord and stenosis of cord were the common non-numerical abnormalities.

Conclusion: Ultrasound examination is recommended in all antenatal cases and definite guidelines are required for reporting cord abnormalities on ultrasound. In cases of MTP and/or IUD, a complete autopsy study should be done to detect cord anomalies. Irrespective of pregnancy outcome, examination of all umbilical cords from the labour room or operation theater will be helpful in determining whether further evaluation of the neonates is required or not.

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