ABNORMALITIES OF CORD LENGTH

NORMAL CORD LENGTH

Link to Normal Cord Length

ABNORMAL CORD LENGTH

This is a subjective assessment as there is no accurate technique for measuring. Extremities of cord length may occur from no cord (acordia) (1) to lengths of up to 300cm (2).

• Excessively long cords (longer than 80 cm):
• Predispose to vascular occlusion by thrombi.
• Predispose to vascular occlusion by true knots.
• Predispose to presentation or prolapse during labor.
• Predispose to nuchal cords (25% of deliveries).
• May be associated with polyhydramnios.
• Associations:
• Maternal factors:
1. Systemic diseases.
2. Delivery complications.
3. Increased maternal age.
• Fetal factors:
1. Non-reassuring fetal status during labor.
2. Respiratory distress.
3. Vertex presentation
4. Cord entanglement.
5. Fetal anomalies.
6. Male sex.
7. Increased birth weight.
• Placental factors:
1. increased placental weight.
2. Right twisted cords.
3. Hyper-coiled cord.
4. True knots

• Excessively short cords (less than 35 cm in length):
• Predispose the fetus to cord rupture, failure to descend during labor and placental abruption.
• Associated Anomalies (3-10):
• Oligohydramnios.
• Restricted space (especially in multiple gestations or congenital uterine anomalies).
• Tethering of the fetus by an amniotic band.
• Cord compression, fetal distress.
• Arthrogryposis.
• Intrafunicular hemorrhage (2).
• Body-stalk anomaly.
• Pena-Shokeir phenotype.
• Fetal akinesia deformation sequence (FADS)
• Restrictive Dermopathy.
• Acardiac twin of a twin pregnancy (TRAP sequence).
• Spinal muscular atrophy (SMA).
• Body-stalk anomaly (also known as short cord umbilical cord syndrome).
• Lateral meningocele syndrome (also known as "familial osteosclerosis").
• Neu-Laxova syndrome.

REFERENCES

1. Browne FJ. On the abnormalities of the umbilical cord which may cause antenatal death. J Obstet Gynaecol Br Emp 1925;32:17.
2. Prichard JA, McDonald PC. Williams obstetrics. 16th edition. New York: Appleton-Century-Crofts 1980.
3. Ho NC. Monozygotic twins with fetal akinesia: the importance of clinicopathological work-up in predicting risks of recurrence. Neuropediatrics 2000 Oct;31(5):252-6.
4. Hall JG. Analysis of Pena Shokeir phenotype. Am J Med Genet 1986 Sep;25(1):99-117.
5. Gonzalez De Dios J, Martinez Frias ML, Arroyo Carrera I, Fondevilla Sauci J, Sanchis Calvo A, Hernandez Ramon F, Martinez Guardia N, Garcia Gonzalez MM. Role of signs of fetal hypokinesia in the diagnosis of spinal muscular atrophy of neonatal onset. An Esp Pediatr 2002 Mar;56(3):233-240.
6. Daskalakis GJ, Nicolaides KH. Monozygotic twins discordant for body stalk anomaly. Ultrasound Obstet Gynecol 2002 Jul;20(1):79-81.
7. Negishi H, Yaegashi M, Kato EH, Yamada H, Okuyama K, Fujimoto S. Prenatal diagnosis of limb-body wall complex. J Reprod Med 1998 Aug;43(8):659-664.
8. Gripp KW, Scott CI Jr, Hughes HE, Wallerstein R, Nicholson L, States L, Bason LD, Kaplan P, Zderic SA, Duhaime AC, Miller F, Magnusson MR, Zackai EH. Lateral meningocele syndrome: three new patients and review of the literature. Am J Med Genet 1997 Jun 13;70(3):229-239
9. Philip et al. Familial osteosclerosis. J Pediatr 1977 90:49-54.
10. King JA, Gardner V, Chen H, Blackburn W. Neu-Laxova syndrome: pathological evaluation of a fetus and review of the literature.Pediatr Pathol Lab Med 1995 Jan-Feb;15(1):57-79.