Abnormalities of the umbilical cord: correlation with placental histology and perinatal outcome

Background: The purpose of this study was to evaluate gross umbilical cord abnormalities and to examine its relationship with placental pathological features and perinatal outcome.Methods: We retrospectively collected 101 singleton placentas with gross umbilical cord abnormalities over 3-year period (delivered on or after 20 weeks of gestational age). Association between gross umbilical cord abnormalities such as hypercoiled cords, hypocoiled cords, thin cords, true knot, strictures, excessively long cord, and abnormal cord insertions were reviewed and evaluated for placental histology, clinical parameters and perinatal outcome.Results: The most common umbilical cord abnormality (UCA) observed was coiling abnormality (hypercoiling, hypocoiling and strictures). Gross UCAs were associated with maternal factors (preeclampsia, oligohydramnios and gestational diabetes), foetal factors (intrauterine foetal death, SGA and intrapartum complications such as NRFHR tracing and low Apgar scores) and histologic placental features (maternal vascular malperfusion, foetal vascular malperfusion, villous capillary lesions and inflammation). Cords with multiple abnormalities were significantly correlated with histologic evidence of foetal vascular obstruction and intrauterine foetal death.Conclusions: Gross UCAs, especially when multiple were associated with clinically significant placental findings and adverse perinatal outcome. Therefore, our study reinforces that all placentas with gross UCAs should be submitted for examination with complete (full length of the) umbilical cord.