Prenatal sonographic diagnosis of short umbilical cord in a dichorionic twin with normal fetal anatomy

Abstract

Short umbilical cords are associated with fetal anomalies, often including those with decreased or absent fetal movement, fetal akinesia/hypokinesia sequence, and restrictive dermopathies and aneuploidy. In normal fetuses, abnormally short umbilical cords have been associated with an increased risk of umbilical vessel hematomas, thrombosis, rupture, thrombocytopenia, cord compression, variable fetal heart rate decelerations, instrumental and operative deliveries, and fetal demise. We report a 24-year-old gravida 2, para 0 with a concordant dichorionic twin gestation, at 26 weeks' gestation, in whom sonography depicted fetuses with normal-appearing anatomy as well as short umbilical cord of the 1st twin. Increased fetal surveillance was conducted. Following delivery at 36 weeks' gestation, the presence of a short umbilical cord of the 1st twin measuring 19 cm was confirmed. Systematic review of the literature confirms that this is the first report of prenatal diagnosis of a short umbilical cord in an otherwise normal fetus.

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…These reports have mainly been limited either to the first-trimester of pregnancy, or of rare cases involving markedly shortened umbilical cord length. [48][49][50] Ugurlucan and Yuksel suggest that sonographically tracing the entire length of the umbilical cord "from the fetal insertion site to the placental insertion" is feasible, with only one unsuccessful case (0.2%) during the secondtrimester, an observation, which regretfully, is not our experience and to our knowledge has not been replicated. 51 Recently, in an unconfirmed report, Gur et al investigated whether Doppler resistance indices obtained at different points of the umbilical cord (fetal and placental insertions, free loop, and intra-abdominal portion between 37 and 42 weeks' gestation in low-risk, singleton pregnancies, are related to umbilical cord length (measured after delivery)).…”

“…Since placenta previa is detected in the middle of the second trimester that later resolves and low-lying placenta even if it later resolves are associated with vasa previa and consequently high perinatal mortality rates, transvaginal ultrasonography with color and pulsed Doppler is recommended to rule out vasa previa". 50 Specific MR imaging criteria for utilization of detailed depiction of umbilical cord entanglement (nuchal, true knots and complex entanglement) remain to be determined. 282 Thus, these governing bodies support:…”

“…Since placenta previa is detected in the middle of the second trimester that later resolves and low-lying placenta even if it later resolves are associated with vasa previa and consequently high perinatal mortality rates, transvaginal ultrasonography with color and pulsed Doppler is recommended to rule out vasa previa”. 50 …”

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

“…78 Otherwise, rare reports of sonographic depiction of the entire length of the umbilical cord have been limited either to the first trimester of pregnancy or cases of markedly shortened umbilical cord length. 79,80 Interestingly, it appears that these cases of short umbilical cord length, are also those in which the formation of true knots of the umbilical cord would be highly unlikely. 2.…”