Skip to main content
SpringerLink
Log in

Impact of umbilical cord length on fetal circulatory system by Doppler assessment

  • Original Article
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Introduction

Numerous studies have revealed the impact of umbilical cord (UC) length on fetal perfusion; abundant data implicate abnormal UC length to neurological delay and subsequent poor prognoses for fetuses and newborns. Indeed, our group previously developed theoretical approximations that contributed to formulas capable of explaining the impact of UC length on cardiac output.

Methods

We performed an observational study that measured the pulsatility index and flow velocity in umbilical arteries. A special Doppler measured proximal and distal indexes in both arteries. After birth, medical staff measured complete UC length. We obtained maternal and neonatal outcomes from clinical records.

Results

Our study enrolled 20 pregnant mothers. We found that flow velocities in the two edges were different: fetal edges exhibited greater velocity in the majority of cases; but, when we compared pressure differentials (ΔP), the pulsatility index was significantly related to umbilical cord length.

Conclusions

Fetal perfusion, welfare, and viability are related to UC function as the conveyor of all fetal volemia. Excessive UC length affects cardiac dynamics and increases peripheral vascular resistance. Further studies could validate routine use of the differential proximal and distal measurements proposed in this article, and their implications in in utero fetal heart function. We also hope that early diagnosis or UC alterations could alert neonatologists and obstetricians to clinical conditions of the fetus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stefos T, Sotiriadis A, Vasilios D, Tsirkas P, Korkontzelos I, Avgoustatos F et al (2003) Umbilical cord length and parity—the Greek experience. Eur J Obstet Gynecol Reprod Biol 107(1):41–44

    Article  Google Scholar 

  2. Baergen RN (2007) Cord abnormalities, structural lesions, and cord accidents. Semin Diagn Pathol 24:23–32

    Article  Google Scholar 

  3. Tantbirojn P, Saleemuddin A, Sirois K, Crum CP, Boyd TK, Tworoger S et al (2009) Gross abnormalities of the umbilical cord: related placental histology and clinical significance. Placenta 30(12):1083–1088

    Article  CAS  Google Scholar 

  4. Horn L-C, Langner A, Stiehl P, Wittekind C, Faber R (2004) Identification of the causes of intrauterine death during 310 consecutive autopsies. Eur J Obstet Gynecol Reprod Biol 113(2):134–138

    Article  Google Scholar 

  5. Blackburn W (2006) Umbilical cord. In: Oxford University Press (ed) Human Malformation and related anomalies, 1st edn. Oxford University Press, New York, pp 1413–1495

  6. Baergen RN, Malicki D, Behling C, Benirschke K (2001) Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study. Pediatr Dev Pathol 4(2):144–153

    Article  CAS  Google Scholar 

  7. Grafe MR (1994) The correlation of prenatal brain damage with placental pathology. J Neuropathol Exp Neurol 53(4):407–415

    Article  CAS  Google Scholar 

  8. Bernstein D (2020) General principles of treatment of congenital heart disease. In: Kliegman R, St Geme J, Blum N, Shah S, Tasker R, Wilson K (eds) Nelson textbook of pediatrics, 21st edn. Elsevier Health Sciences, Philadelphia, pp 2428–2436

    Google Scholar 

  9. Olaya-C M, Vargas W, Bernal J (2015) Una aproximación desde la física a las consecuencias patológicas de la longitud excesiva del cordón umbilical. Rev Colomb Obs Ginecol 66(1):53–60

    Article  Google Scholar 

  10. Tobinaga CM, Torloni MR, Gueuvoghlanian-Silva BY, Pendeloski KPT, Akita PA, Sass N et al (2014) Angiogenic factors and uterine Doppler velocimetry in early- and late-onset preeclampsia. Acta Obstet Gynecol Scand 93:469–476

    Article  CAS  Google Scholar 

  11. Arduini D, Rizzo G (1990) Normal values of Pulsatility Index from fetal vessels: a cross-sectional study on 1556 healthy fetuses. J Perinat Med 18(3):165–172

    Article  CAS  Google Scholar 

  12. Olaya-C M, Silva JL, Bernal JE (2014) Implementation of a simple method to measure total umbilical cord length. J Neonatal Perinatal Med 7(4):269–272

    Article  CAS  Google Scholar 

  13. Redline RW (2013) Correlation of placental pathology with perinatal brain injury. Surg Pathol Clin 6(1):153–180

    Article  Google Scholar 

  14. Chan JSY, Baergen RN (2012) Gross umbilical cord complications are associated with placental lesions of circulatory stasis and fetal hypoxia. Pediatr Dev Pathol 15:487–494

    Article  Google Scholar 

  15. Khong TY, Mooney EE, Ariel I, Balmus NCM, Boyd TK, Brundler MA et al (2016) Sampling and definitions of placental lesions Amsterdam placental workshop group consensus statement. In: Archives of pathology and laboratory medicine

  16. Vik T, Redline R, Nelson KB, Bjellmo S, Vogt C, Ng P et al (2018) The placenta in neonatal encephalopathy: a case-control study. J Pediatr 202(77–85):e3

    Google Scholar 

  17. Taweevisit M, Thorner PS (2010) Massive fetal thrombotic vasculopathy associated with excessively long umbilical cord and fetal demise: case report and literature review. Pediatr Dev Pathol 13(2):112–115

    Article  Google Scholar 

  18. Roberts DJ (2008) Placental pathology, a survival guide. Arch Pathol Lab Med 132(4):641–651

    PubMed  Google Scholar 

  19. McDonald DGM, Kelehan P, McMenamin JB, Gorman WA, Madden D, Tobbia IN et al (2004) Placental fetal thrombotic vasculopathy is associated with neonatal encephalopathy. Hum Pathol 35(7):875–880

    Article  Google Scholar 

  20. Baergen RN (2005) Pathology of the umbilical cord. In: Manual of and Kaufmann’s pathology of the human placenta, 1st edn. Springfield, New York, pp 249–76

  21. Benirschke K (1994) Obstetrically important lesions of the umbilical cord. J Reprod Med 39(4):262–272

    CAS  PubMed  Google Scholar 

  22. Eger SHW, Sommerfelt K, Kiserud T, Markestad T (2013) Foetal umbilical artery Doppler in small preterms: (IQ) neurocognitive outcome at 5 years of age. Acta Paediatr 102:403–409

    Article  Google Scholar 

  23. Hernández E, Benavides-Serralde C-M, RGE (2010) Conceptos esenciales sobre las bases físicas del Doppler para su utilización clínica. In: Gratacós E, Figueras F, Hernández EPB (ed) Doppler en Medicina Fetal. Madrid: Editorial Médica Panamericana, pp 1–32

  24. Baschat AA (2003) Relationship between placental blood flow resistance and precordial venous Doppler indices. Ultrasound Obstet Gynecol 22:561–566

    Article  CAS  Google Scholar 

  25. Alfirevic Z, Stampalija T, Gyte GML (2013) Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane database Syst Rev 11:CD007529

  26. Di Naro E, Raio L, Ghezzi F, Franchi F, Addario V (2002) Longitudinal umbilical vein flow changes in normal and growth-retarded fetuses. Acta Obs Gynecol Scand. 81:527–533

    Article  Google Scholar 

  27. Abramowicz JS, Sheiner E (2008) Ultrasound of the placenta: a systematic approach. part ii: functional assessment (Doppler). Placenta 29:921–929

  28. Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP (2014) Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis. PLoS One 9(3):e91198

    Article  Google Scholar 

  29. Foo L, Tay J, Lees CC, McEniery CM, Wilkinson IB (2015) Hypertension in pregnancy: natural history and treatment options. Curr Hypertens Rep 17:36

    Article  CAS  Google Scholar 

  30. US Preventive Services Task Force K, Bibbins-Domingo K, Grossman DC, Curry SJ, Barry MJ, Davidson KW et al (2017) Screening for preeclampsia: US preventive services task force recommendation statement. JAMA 317:1661–1667

  31. Salazar JA, Triana JCPF (2004) Characterising 7 hypertensive disorders during pregnancy in Villavicencio, Colombia. Rev Colomb Obs Ginecol 55(4):279–286

    Article  Google Scholar 

  32. Olaya-C M, Salcedo-Betancourt J, Galvis SH, Ortiz AM, Gutierrez S, Bernal JE (2016) Umbilical cord and preeclampsia. J Neonatal Perinatal Med 9(1):49–57

    Article  CAS  Google Scholar 

  33. Demars J, Le Bouc Y, El-Osta A, Gicquel C (2011) Epigenetic and genetic mechanisms of abnormal 11p15 genomic imprinting in Silver-Russell and Beckwith-Wiedemann syndromes. Curr Med Chem 18:1740–1750

    Article  CAS  Google Scholar 

  34. Di Naro E, Raio L, Cromi A, Giocolano A (2012) Sonographic assessment of the umbilical cord. DJUOG 6:66–75

    Google Scholar 

  35. Chen H (2006) Beckwith-Wiedemann syndrome. In: Chen H (ed) Atlas of genetic diagnosis, 1st edn. Humana Press Inc., New Jersey, pp 109–113

    Google Scholar 

  36. Olaya-C M, Fritsch M, Bernal JE (2015) Immunohistochemical protein expression profiling of growth- and apoptotic-related factors in relation to umbilical cord length. Early Hum Dev 91(5):291–297

    Article  CAS  Google Scholar 

  37. Contro E, Cataneo I, Morano D, Farina A (2019) Reference charts for umbilical Doppler pulsatility index in fetuses with isolated two-vessel cord. Arch Gynecol Obs 4:947–951

    Article  Google Scholar 

  38. Olaya-C M, Gil F, Salcedo JD, Salazar AJ, Silva JL, Bernal JE (2018) Anatomical pathology of the umbilical cord and its maternal and fetal clinical associations in 434 newborns. Pediatr Dev Pathol 21(5):467–474

    Article  Google Scholar 

  39. Georgiadis L, Keski-Nisula L, Harju M, Räisänen S, Georgiadis S, Hannila M-L et al (2014) Umbilical cord length in singleton gestations: a Finnish population-based retrospective register study. Placenta 35(4):275–280

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank the Pontificia Universidad Javeriana—Hospital Universitario San Ignacio in Bogota for its indispensable support and participation in this study. We also extend our thanks to the parents who participated in this study.

Funding

None of the authors have any potential or actual interests relevant to the topics discussed in this manuscript. This study constitutes part of the research project titled, “Fetal Doppler of umbilical arteries in proximal and distal umbilical cord windows: relationship with its abnormal length” (Ppta. ID 7050), financed by the Pontificia Universidad Javeriana through its Hospital Universitario San Ignacio. Bogota, Colombia.

Author information

Authors and Affiliations

  1. Pathology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia

    Mercedes Olaya-C

  2. Forensic Physics Group, Instituto Nacional de Medicina Legal y Ciencias Forenses, Bogota, Colombia

    William Vargas

  3. Obstetrics and Gynecology Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia

    Rodolfo Andres Martinez

  4. Pontificia Universidad Javeriana, Bogota, Colombia

    Ivan Felipe Peñaloza, Melissa Sanchez, Ithzayana Madariaga & Sergio Aldana

  5. Instituto de Genetica Humana, Pontificia Universidad Javeriana, Bogota, Colombia

    Jaime E. Bernal

  6. Hospital Universitario San Ignacio, Kra 7 40-62, Bogota, Colombia

    Mercedes Olaya-C, Rodolfo Andres Martinez, Ivan Felipe Peñaloza, Melissa Sanchez, Ithzayana Madariaga & Sergio Aldana

Authors
  1. Mercedes Olaya-C
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodolfo Andres Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan Felipe Peñaloza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melissa Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ithzayana Madariaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sergio Aldana
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jaime E. Bernal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

OCM: participation in the study conception and design, acquisition of data (case search), patient recruitment, in the literature review and drafting of manuscript; approval of the final version the final version. VW: participation in the literature review, interpretation of the physics model, and drafting of manuscript; approval of the final version. MRA: participation in ultrasound performance, patient recruitment, in the literature review and drafting of manuscript; approval of the final version the final version. PIF: participation in patient recruitment, in the literature review and drafting of manuscript; approval of the final version the final version. SM: participation in patient recruitment, in the literature review and drafting of manuscript; approval of the final version the final version. MI and AS: participation in review of clinical records, in the literature review and drafting of manuscript; approval of the final version the final version. BJE: participation in conception of the general idea and direction of the group.

Corresponding author

Correspondence to Mercedes Olaya-C.

Ethics declarations

Human research statement

This study was conducted in accordance with the ethical standards of all applicable national and institutional committees, and the World Medical Association’s Helsinki Declaration.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olaya-C, M., Vargas, W., Martinez, R.A. et al. Impact of umbilical cord length on fetal circulatory system by Doppler assessment. J Ultrasound 23, 585–592 (2020). https://doi.org/10.1007/s40477-020-00495-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-020-00495-2

Keywords

Search

Navigation