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ARTERIOVENOUS
MALFORMATION OF THE CORD UMBILICAL CORD
STRICTURE UMBILICAL CORD
ANEURYSM |
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ARTERIOVENOUS
MALFORMATION OF THE CORD |
Congenital arteriovenous malformations of the umbilical cord comprise a subset of hemangiomas, but distinguished by communication between arteries and veins without an intervening capillary bed.
Richards and coworkers present a single case report of an arteriovenous
malformation associated with fetal disseminated intravascular coagulation (1).
ULTRASOUND (1) |
- Complex intraamniotic mass, separate from fetus and placenta.
- Mass may contain cystic areas, large calcified areas, large peripheral arteries and veins and pools of slow-moving blood.
- Oligohydramnios.
- Fetal cardiac failure if the shunt is large.
- Evidence of a coagulopathy (echogenic areas in the portal sinus and right lobe of the liver (thought to represent infarcts or thrombi).
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UMBILICAL CORD
STRICTURE |
- Localized constriction of the umbilical cord occurs most commonly at the fetal end.
- Weber (2) and Gilbert and Zugibe (3) have noted an absence of Wharton's jelly in the involved segment of cord.
- Diagnosis has not yet been made antenatally.
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UMBILICAL CORD
ANEURYSM |
Aneurysm of the umbilical cord are rare vascular anomalies that are usually located in the distal cord and usually affect the umbilical vein.
- Arterial aneurysm
- Rare but has been reported (4), as an ellipsoid cystic mass associated with a single umbilical artery.
- Usually near placental cord insertion where the vessels branch into the chorionic plate (and therefore loose the protection of Wharton’s jelly).
- Doppler reveals a non-pulsatile turbulent flow pattern
- Anechoic with a hyperechogenic rim, that correlates with calcification in the wall of the aneurysm (4).
- There may be an associated arterio-venous fistula (5).
- Association with trisomy 18 has been reported (5,7).
- Usually has an associated single umbilical artery (7).
- Complications:
- Thrombosis
- Compression of neighboring vessels (4).
- Venous aneurysm
- Large umbilical cord varicosity (6).
- Doppler reveals umbilical venous flow and thrombus.
Aneurysm of the umbilical cord at its insertion into the placenta – Karyotype trisomy 18 |
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REFERENCES |
- Richards DS, Lutfi E, Mullins D et.al. Prenatal diagnosis of fetal disseminated intravascular coagulation associated with umbilical cord arteriovenous malformation. Obstetrics and Gynecology 1995;85(5):860-862.
- Weber J. Constriction of the umbilical cord as a cause of death. Acta Obstet Gynecol Scand 1963;42:259.
- Gilbert EF, Zugibe FT. Torsion and constriction of the umbilical cord: A cause of fetal death. Arch Pathol 1974;97:58.
- Siddiqi TA, Bendon R, Schultz DM et.al. Umbilical artery aneurysm: prenatal diagnosis and management. Obstet Gynecol 1992;80:530-533.
- Berg C, Geipel U, Germer U et.al. Prenatal diagnosis of umbilical cord aneurysm in a fetus with trisomy 18. Ultrasound Obstet Gynecol 2001;17:79-81
- Shipp TD, Bromley B, Benacerraf BR. Sonographically detected abnormalities of the umbilical cord. Int J Gynecol Obstet 1995;48:179-185.
- Sepulveda W Corral E Kottmann C et.al. Umbilical artery aneurysm: prenatal identification in three with trisomy 18. Ultrasound Obstet gynecol 2003;21:292-296.