Absence of Wharton’s jelly: an association with feto-maternal morbidity

Abstract

Umbilical cord contains two arteries and one vein connecting fetus to the placenta and is responsible for blood flow between the two. It is surrounded by Wharton’s jelly which is a gelatinous substance and functions as adventitia layer of umbilical vessels, thereby providing insulation and protection to the umbilical cord. Umbilical cord abnormalities are associated with poor perinatal outcomes. Very few cases of absent Wharton’s jelly are reported in literature. Ours might be the 8th one in which we did a lower segment caesarean section for meconium stained liquor but the baby died after 12 hours.

Absence of Wharton's jelly around an umbilical artery

“…5 Complications of this anomaly are particularly neonatal, from restricted intrauterine growth to in utero fetal death in severe forms. 4,7,8,10 The absence of Wharton's jelly is also correlated with the occurrence of a low Apgar score at birth as was the situation in our case. 4,5 Some clinical situations such as hypertension in pregnancy, smoking, prematurity and over term would expose to quantitative alterations of Wharton's jelly.…”

“…4,7,8,10 The absence of Wharton's jelly is also correlated with the occurrence of a low Apgar score at birth as was the situation in our case. 4,5 Some clinical situations such as hypertension in pregnancy, smoking, prematurity and over term would expose to quantitative alterations of Wharton's jelly. 11,12 The differential diagnosis will be made with some anomalies of umbilical cord insertion such as "insertion funiculi furcata" in which the cord insertion site is normal but, before insertion, the vessels lose their protective Wharton's jelly envelope.…”

“…1 The absence of Wharton's jelly is an exceptional situation with a few rare cases described in the literature. [2][3][4][5][6][7][8] This situation, while rare, can cause acute fetal distress and even perinatal death due to compression of unprotected vessels. We report a case of absence of Wharton's jelly around an umbilical artery.…”

Ausencia de gelatina de Wharton

“…No se ha comunicado una relación familiar y su recurrencia debe ser muy pequeña (4) . La etiología es desconocida, pero se postulan varias hipótesis, como la degeneración mucoide de la GW alrededor de los vasos (3) , la fusión incompleta de la cubierta amniótica y el mesénquima umbilical durante el desarrollo temprano (4) , hipoplasia de la membrana amniótica con pérdida secundaria de la GW (5,6) , una forma más grave de formación de quistes del CU (4) o el resultado de digestión proteolítica de la membrana amniótica alrededor del cordón por las enzimas meconiales pues se ha hallado líquido amniótico teñido de meconio en muchos casos (4) .…”

“…La gelatina de Wharton es un tejido mesenquimal especializado que rodea y protege los vasos del cordón umbilical. Su 'ausencia' o disminución se la asocia con un mayor riesgo de restricción del crecimiento intrauterino, distrés fetal en el trabajo de parto o morbimortalidad perinatal (6) .…”