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Anatomy of the Umbilical Cord

  • Mohamed Fahmy
Chapter

Abstract

Umbilical cord or the thread of life is not just a tube or a pipe; it is a unique organ with complicated architectures and sophisticated structures which enabled it to perform its vital function to supply the fetus with his requirement during the period of pregnancy. The remarkable feature of the umbilical cord that it is devoted of any nerve supply, so the regulation and mediation between the mother and fetus is mainly hormonal; also the umbilical blood vessel is without branches. This is unique compared to the large blood vessels of the adult body, the aorta and vena cava. Umbilical cord properties, therefore, are different in some respects and alike in others. It has two-way traffic: the arteries carry blood pumped by the heart away from the fetus, and this circulation surrounds the vein normally; the umbilical vein returns blood to the fetus from the placenta rejuvenated with oxygen and nutrients and devoid of waste products. How this happens is still surrounded by mystery. The fetal heart cannot expand or work harder because it is surrounded by a fluid-filled lung, like pushing against a water bed. Therefore, as the fetus steadily grows exponentially and three-dimensionally, how does it accommodate the increased blood volume it needs over time? As the fetus grows, the cord elongates and grows in diameter. The fetus has to work against a larger column of fluid and tissue resistance at the placental end. It has been estimated that by 31 weeks, the umbilical cord must carry 70 quarts of blood per day, moving at 4 miles an hour. This remarkable organ also must participate in fetal growth milestones; additionally, it may act as an assist pump to the fetal heart, which is designed to help the fetus over difficult growth proportions which may exist. The extra stress on the fetus may require that the cord be designed correctly so that it can have properties of an assist mechanism or pump. In order to begin the process of creating solutions to umbilical cord-related complications, understanding cord function and design must be thorough. Throughout human history, stillbirths have been associated with variable umbilical cord anomalies.

Keywords

Wharton’s jelly Cord design Velamentous insertions Bifurcated Cord design Spiral turns Helical configuration and single umbilical artery 

References

  1. 1.
    Stefos T, Sotiriadis A, Vasilios D, et al. Umbilical cord length and parity–the Greek experience. Eur J Obstet Gynecol Reprod Biol. 2003;26:41–4.CrossRefGoogle Scholar
  2. 2.
    Arvy L, Pilleri G. Le Cordon Ombilical. Funis Umbilicalis. Bern: Verlag Hirnanatomisches Institut, Ostermundigen; 1976.Google Scholar
  3. 3.
    Naeye RL. Umbilical cord length: clinical significance. J Pediatr. 1985;107:278–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Soernes T. Umbilical cord encirclements and fetal growth restriction. Obstet Gynecol. 1995;86:725–8.CrossRefGoogle Scholar
  5. 5.
    Shepherd AJ, Richardson CJ, Brown JP. Nuchal cords as a cause of neonatal anemia. Am J Dis Child. 1985;139:71–3.PubMedGoogle Scholar
  6. 6.
    Clapp JF, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol. 2003;189:488–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Baergen RN, Malicki D, Behling C, Benirschke K. Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study. Pediatr Dev Pathol. 2001;4:144–53.CrossRefGoogle Scholar
  8. 8.
    Moessinger AC, Blanc WA, Marone PA, Polsen DC. Umbilical cord length as an index of fetal activity: experimental study and clinical implications. Pediatr Res. 1982;16:109–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Soernes T, Bakke T. The length of the human umbilical cord in vertex and breech presentations. Am. J. Obstet. Gynecol. 1986;154:1086–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Calvano CJ, Hoar RM, Mankes RF, Lefevre R, Reddy PP, Moran ME, Mandell J. Experimental study of umbilical cord length as a marker of fetal alcohol syndrome. Teratology. 2000;61:184–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Gilbert-Barness E, Drut MR, Grange DK, Opitz JM. Developmental abnormalities resulting in short umbilical cord. Birth Defects Orig Artic Ser. 1993;29(1):113–40.PubMedGoogle Scholar
  12. 12.
    Gilbert E. The short cord syndrome. Pediatr Pathol. 1986;5:96.Google Scholar
  13. 13.
    Hempel E. Die ultrastrukturelle Differenzierung des menschlichen Amnionepithels unter besonderer Berücksichtigung des Nabelstrangs. Anat Anz. 1972;132:356–70.PubMedGoogle Scholar
  14. 14.
    Parry EW, Abramovich DR. Some observations on the surface layer of full-term human umbilical cord epithelium. J Obstet Gynaecol. 1970;77:878–84.CrossRefGoogle Scholar
  15. 15.
    Gebrane-Younes J, Minh HN, Orcel L. Ultrastructure of human umbilical vessels: a possible role in amniotic fluid formation? Placenta. 1986;7:173–85.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hertig AT, Richardson MV. Studies of the function of early human trophoblast. II. Preliminary observations on certain chemical constituents of chorionic and early amniotic fluid. Am J Obstet Gynecol. 1955;69:735–41.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nanaev AK, Shirinsky VP, Birukov KG. Immunofluorescent study of heterogeneity in smooth muscle cells of human fetal vessels using antibodies to myosin, desmin and vimentin. Cell Tissue Res. 1991;266:535–40.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Mitchell KE, Weiss ML, Mitchell BM, Martin P, Davis D, Morales L, Helwig B, Beerenstrauch M, Abou-Easa K, Hildreth T, Troyer D, Medicetty S. Matrix cells from Wharton’s jelly form neurons and glia. Stem Cells. 2003;21:50–60.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Pennati G. Biomechanical properties of the human umbilical cord. Biorheology. 2001;38:355–66.Google Scholar
  20. 20.
    Ghezzi F, Raio L, Di Naro E, Franchi M, Buttarelli M, Schneider H. First-trimester umbilical diameter: a novel marker of fetal aneuploidy. Ultrasound Obstet Gynecol. 2002;19:235–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Kelber R. Gespaltene “solitäre” Nabelschnurarterie. Arch Gynakol. 1976;220:319–23.CrossRefPubMedGoogle Scholar
  22. 22.
    Bell AD, Gerlis LM, Variend S. Persistent right umbilical vein—case report and review of literature. Int J Cardiol. 1986;10:167–76.CrossRefPubMedGoogle Scholar
  23. 23.
    Gebrane-Younes J, Minh HN, Orcel L. Ultrastructure of human umbilical vessels: a possible role in amniotic fluid formation? Placenta. 1986;7:173–85.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sexton AJ, Turmaine M, Cai WQ, Burnstock G. A study of the ultrastructure of developing human umbilical vessels. J Anat. 1996;188:75–85.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Arts NFT. Investigations on the vascular system of the placenta. General introduction and the fetal vascular system. Am J Obstet Gynecol. 1961;82:147–58.CrossRefPubMedGoogle Scholar
  26. 26.
    Fujikura T. Fused umbilical arteries near placental cord insertion. Am J Obstet Gynecol. 2003;188:765–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Hyrtl J. Die Blutgefäße der menschlichen Nachgeburt in normalen und abnormen Verhältnissen. Wien: Braumüller; 1870.Google Scholar
  28. 28.
    Hoboken W. Anatomia secundinae. Ultrajecti: Ribbium; 1669.Google Scholar
  29. 29.
    Spivack M. On the presence or absence of nerves in the umbilical blood vessels of man and guinea pig. Anat Rec. 1943;85:85–109.CrossRefGoogle Scholar
  30. 30.
    Kernbach M. Existe-t-il du tissu nerveux dans le placenta? Rev Fr Gynécol. 1969;64:357–61.Google Scholar
  31. 31.
    Fox H, Jacobson HN. Innervation of the human umbilical cord and umbilical vessels. Am J Obstet Gynecol. 1969;103:384–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Pearson AA, Sauter RW. The innervation of the umbilical vein in human embryos and fetuses. Am. J. Anat. 1969;125:345–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Ellison JP. The nerves of the umbilical cord in man and the rat. Am J Anat. 1971;132:53–60.CrossRefPubMedGoogle Scholar
  34. 34.
    Fox H, Khong TY. Lack of innervation of human umbilical cord. An immunohistochemical and histochemical study. Placenta. 1990;11:59–62.CrossRefPubMedGoogle Scholar
  35. 35.
    Drut R, Quijano G. Heterotopic neurons in the umbilical cord. Pediatr Dev Pathol. 2005;8:124–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Mohamed Fahmy
    • 1
  1. 1.Pediatric SurgeryAl Azher University Pediatric SurgeryCairoEgypt

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