MALFORMATION OF THE CORD
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).
- 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.
- 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).
- 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
Aneurysm of the umbilical cord are rare vascular anomalies
that are usually located in the distal cord and usually affect the umbilical
- Arterial aneurysm
- Rare but has been
reported (4), as an ellipsoid cystic mass associated with a single
- 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).
- Compression of
neighboring vessels (4).
- Large umbilical cord
- Doppler reveals
umbilical venous flow and thrombus.
Aneurysm of the umbilical cord at its insertion into the placenta – Karyotype
- 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.