A study of umbilical cord in 50 specimens in Tamil Nadu population

INTRODUCTION: The umbilical cord is the linkage between the fetus and the mother. It initially presents as the connective stalk at the caudal end of the embryo before folding and later shifted to the ventral surface of embryo to the umbilical ring after the folding of the embryo. It is lined by fetal membranes the main constituent being the extra embryonic mesoderm containing the extra embryonic coelom, it contains the left umbilical vein with right and left umbilical arteries with differentiation of nerves in the extra embryonic mesoderm. The allantois and the vitello intestinal duct are incorporated in the cord at its fetal end. The study on umbilical cord has been taken as my dissertation work since umbilical cord is one and only communication between the mother and the fetus and is the only structure through which nutrients and all other metabolic exchanges in the fetus occur. In day to day life it is noted that complications during delivery of the fetus, any malformations in the fetus, perinatal and postnatal complications in mother are attributed to the umbilical cord abnormalities and variations. MATERIALS AND METHODS: The study was conducted at Madurai Medical College, Madurai. VENUE OF STUDY: 1. Institute of Anatomy, Madurai Medical College, Madurai. 2. Institute of Obstetrics and Gynecology, Govt. Rajaji Hospital, Madurai. SAMPLE OF STUDY: 50 Human placentae with umbilical cord without any damage were collected from the labor ward including operation theatre in obstetrics and Gynecology Department. The Specimens were collected without any socioeconomic status, religion, educational and pathological bias. AGE DISTRIBUTION: Placenta with umbilical cord specimens were collected from the mother in the age group between 19 to 32 years as follows. 1. > 20 years old 2 specimens. 2. Between 21 – 30 years 47 specimens. 3. Above 30 years one specimen. PARITY DISTRIBUTION: Parity distribution of 50 specimens was as follows. 1. 30 Placentae with umbilical cord specimens were collected from primigravida. 2. 12 specimens from second gravida. 3. 8 specimens from third gravida. In the present study soon after delivery uniformly 10 cm of umbilical cord was left at fetal end and then cord was clamped, cut and numbered serially. CONCLUSION: At the outset it is concluded that as per the regular teaching that longer cords are usually associated with presentation of cord around neck which leads to intrauterine death of the fetus. But from the previous literature it is deduced that cord around the neck was an uncommon cause of antepartum fetal death. Short cords, as remarked usually, are associated with difficulty in the delivery of the placenta. But in the previous literature, no comments on short cord associated with complications in the delivery of the placenta has been given as an important complication. But it is given that short cords are associated with adverse prenatal outcome such as fetal growth restriction, congenital malformation, intrapartum distress and a twofold risk of death. If hypocoiled we could expect pre term birth and fetal distress. It is concluded from the previous study that hypocoiled cords are associated with pre term delivery and low birth weight. It is brought into light that low umbilical coiling index associated with low apgar score, meconium staining and pregnancy induced hypertension. It could be also said that in the cords cysts and haematomas may be present. It is clear from the present collection that whatever may be the attachment of the cord to the placenta, it need not be associated with complications. It has been arrived from the previous literature that single umbilical artery may be associated with malformation and low birth weight. If two vessel pattern, we have to look for chromosomal abnormality and tracheo esophageal fistula. In the same cases we have to investigate for renal aplasia, limb reduction defects and atresia of hollow organs. As per the previous literatures single vessel pattern may be associated with twining. Finally it has to be stated, that there may be hidden facts, in relation to umbilical cord study. Which have to be brought into light so as to enlighten and enrich the statistical data available at present