The effect of vascular constriction on umbilical venous pulsation

Abstract

Objectives Results The incidence of umbilical venous pulsation was higher at the umbilical ring in the abdominal wall (242/279, 87%, than in the cord (43/198,22%,30%, (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the umbilical ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found. ConclusionThe high incidence of venous pulsation at the umbilical ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins.

Velamentous Cord Insertion With Variable Umbilical Cord Doppler Changes

“…Doppler changes in growth‐restricted fetuses are reflective of a deteriorating circulatory status and are thought to be progressive. Umbilical vein pulsations are usually considered very late signs of fetal asphyxia and impending cardiac failure 4 , 5 . In our patient, the findings of elevated umbilical artery S/D ratios with diastolic flow and umbilical vein pulsations were atypical and in the setting of fetal growth restriction led to increased surveillance (and patient anxiety).…”

“…We considered velamentous cord insertion as a cause of both fetal growth restriction and intermittent abnormal cord Doppler findings. Unrelated to fetal growth restriction and hemodynamic compromise, pulsations of the umbilical vein have also been associated with umbilical cord restriction 5 . Skulstad and colleagues 5 proposed “a congestion in the umbilical vein .…”

Relationship between the umbilical cord coiling index and the umbilical blood flow at 11–13 weeks of gestation

“…The primary origin of venous pulsation is the neighboring umbilical artery. The umbilical ring tightens around the three vessels, thus reducing the compliance at this point and facilitating the transmission and induction of a pulse in the vein . However, no umbilical venous pulsations were observed at 11–13 weeks of gestation, regardless of the strength of the coiling index.…”

Effect of umbilical ring constriction on Wharton's jelly

“…A total of 283 singleton pregnancies were recruited from a low‐risk antenatal clinic for an extensive study of the umbilical circulation. We have previously presented results showing the degree of vascular constriction at the umbilical ring, the accompanying diameter and venous blood velocity, and the occurrence of pulsatile flow16–18. In 237 of these 283 cases we also assessed the cord cross‐sectional area and its vessel areas in order to address the relationship between such a venous constriction and cord cross‐sectional and Wharton's jelly areas.…”