Prenatal diagnosis of umbilical cord pseudocyst.

The association between umbilical cord anomalies and chromosomal abnormalities has received little attention in the literature. In this report, we present two cases of umbilical cord pseudocyst incidentally detected by ultrasound prior to genetic amniocentesis performed for the indication of advanced maternal age. In the first case it was only the initial abnormal finding in a 21-week fetus ultimately found to have a trisomy 18. In the second case, detected at 26 weeks, the karyotype was normal and a healthy normal neonate was delivered at term. The finding of a umbilical cord cystic mass during prenatal sonographic examination should alert the clinician to the increased risk of aneuploidy.     

Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester.

OBJECTIVE: The purpose of this study was to evaluate the sonographic accuracy to determine the umbilical coiling index (UCI) during the routine fetal anatomic survey in the second trimester. METHODS: In 300 consecutive women with singleton pregnancies and absence of gross fetal anomalies who had a routine second-trimester fetal anatomic survey, a distance between 2 pairs of coils was measured from the longitudinal images of the umbilical cord, and the antenatal UCI (aUCI) was calculated. The aUCI was compared with true UCI results obtained after birth. RESULTS: Two hundred thirty-six patients had adequate sonographic umbilical cord images, and all required demographic, antenatal, and labor data collection to meet the inclusion criteria. A statistically significant correlation between aUCI and true UCI was found (P < .0001; r = 0.643). The mean aUCI was 0.402 (80% confidence interval, 0.382), and the true UCI at birth was 0.203 (80% confidence interval, 0.176). The sonographic evaluation showed 12.3% and 8.9% of hypocoiled and hypercoiled cords, whereas evaluation at birth found 10.6% and 8.1% hypocoiled and hypercoiled umbilical cords, respectively. The sensitivity values of sonography to predict hypocoiling and hypercoiling at birth were 78.9% and 25.4%, respectively. CONCLUSIONS: A sonographic evaluation of umbilical cord coiling in the second trimester correlates with the true UCI at birth, although the sensitivity in predicting coiling patterns as hypocoiled and hypercoiled cords is less accurate. A difference between the aUCI and matched UCI at birth could be explained by a sonographic error in the sampling of different umbilical cord segments with discordant coiling patterns or the possibility of a dynamically evolving UCI with advancing gestational age.     

Sonographic determination of first trimester umbilical cord length

Umbilical cord length was measured sonographically in 53 normal fetuses and 15 fetuses with an intrauterine demise. The age of the fetuses ranged from 6.1 weeks to 11 weeks, menstrual age. Intra- and interobserver differences in measurements were not significantly different from zero. A close linear relationship (r² = 0.89) was found between umbilical cord length and menstrual age in the normal group. The cord lengths of 9 of 15 fetuses (60%) with an intrauterine fetal demise were more than 2 SD below the expected value for menstrual age in normal fetuses. © 1994 John Wiley & Sons, Inc.     

Clinical significance of first trimester umbilical cord cysts.

A cystic mass of the umbilical cord was identified by transvaginal sonography in 10 first trimester pregnancies at a mean gestational age of 8 weeks 4 days (range, 8 weeks 1 day to 9 weeks 3 days) and at a mean crown-rump length of 20.5 mm (range, 15 to 25 mm). The cyst was solitary in all cases, the mean diameter was 4.6 mm (range, 3 to 6 mm), and the location was closer to the fetal insertion in two cases, in the middle of the cord in seven cases, and closer to the placental insertion in one case. Gestational sac and yolk sac diameters as well as the fetal heart rate were within normal ranges for gestational age in all cases. Information on detailed second trimester scans was available in nine cases, demonstrating complete resolution of the cyst and normal fetal anatomic survey in each case. These nine pregnancies were followed to delivery, and normal healthy infants were delivered at term in all cases. This series suggests that the incidental detection of umbilical cord cysts in early pregnancy is not associated with an adverse pregnancy outcome.     

二次剪脐对新生儿脐部护理效果的影响

目的探讨二次剪脐在新生儿脐部护理中的应用效果。方法将400例新生儿随机分为对照组和实验组,每组各200例。对照组新生儿采用传统的气门芯摘脐护理方法,等待残端自然脱落;实验组在气门芯摘脐的基础上,于新生儿出生后48h,在结扎下方用手术剪刀剪去残端脐带。比较两组新生儿脐部并发症的发生率。结果实验组新生儿脐部并发症发生率低于对照组(P0.01)。结论二次剪脐是提高新生儿脐部护理质量、预防并发症的有效措施。     

Umbilical cord cyst detected in the first trimester by two- and three-dimensional sonography

A case of umbilical cord cyst was identified via 2-dimensional and 3-dimensional sonographic examination at 8 weeks' menstrual age. The cyst was solitary, measuring 18.0 mm, and it was located close to the placental insertion on the umbilical cord. The gestational sac and yolk sac diameters and the fetal heart rate were within normal ranges for menstrual age. Follow-up 3-Dimensional sonographic examination in the second trimester showed complete resolution of the cyst. Amniocentesis revealed a normal karyotype, and a normal infant was delivered at term.     

Prenatally detected umbilical cord tumor as a sign of diffuse neonatal hemangiomatosis

We report a case of a prenatally detected hemangioma of the umbilical cord as an early sign of diffuse neonatal hemangiomatosis (DNH). The newborn was diagnosed with multiple hemangiomas in the liver, intestines, skin, and brain. Prenatal ultrasound findings, neonatal appearance of the hemangiomas, and the associated complications are illustrated. Interdisciplinary investigations as well as operative and systemic treatment approaches proved to be challenging. This case illustrates how prenatal ultrasound with color Doppler facilitates the early diagnosis of DNH and can help through the early referral to specialized centers for appropriate treatment.     

改良式二次结扎法对新生儿脐带的影响

目的探讨改良式二次结扎法对新生儿脐带的影响。方法选择我院2009年6月至2010年6月出生的新生儿4516例,在新生儿体重、无感染、脐带直径、气门芯直径、护理方法条件相同选择应用下,按出生先后顺序随机编号分为对照组和观察组各2258例,对照组采用传统气门芯结扎法,即气门芯距脐根上0．5cm处结扎,观察组采用改良式即首次结扎气门芯距脐根处结扎,于新生儿生后24～36h内,在新生儿洗澡时去掉气门芯,在原气门芯位置处行脐带二次结扎,结扎下缘尽量贴近脐根结扎,观察两组新生儿脐带出血、干燥、脱落时间。结果观察组新生儿脐带干燥、脱落时间短于对照组,差异具有统计学意义（P〈0．01）。结论应用改良式脐带二次结扎法结扎脐带,能有效缩短脐带干燥和脱落时间。     

中晚孕期胎儿静脉导管和脐静脉血流量参考范围

目的 建立中晚孕期正常胎儿静脉导管和脐静脉血流量参考范围，计算脐血流人静脉导管的百分比。方法 应用彩色多普勒超声检查138例16-41孕周正常单胎胎儿，记录静脉导管和脐静脉血流波形，测定最大血流速度计算血流量。结果 静脉导管血流量随着孕龄增加而增加（P〈0．01），对应于体质量则随着孕龄增加而减低（P〈0．01）。脐静脉血流速、血管管径、血流量随孕龄增加而增加（P〈0．05，P〈0．01，P〈0．01），对应于体质量脐静脉血流量随着孕龄增加而减低（P〈0．01）。静脉导管与脐静脉血流量（Qdv／Quv）之比随着妊娠进展而减低（P〈0．01）。平均43％脐血流人静脉导管。结论 中晚孕期胎儿脐血流人静脉导管随着妊娠进展而减低，静脉导管在分流含氧高的血到脑和心肌起着次要作用。     

Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia.

OBJECTIVE: To determine whether a large cross-sectional area of the umbilical cord is a predictor of fetal macrosomia. METHODS: Consecutive patients of > 34 weeks' gestation, who presented for sonographic examination and who delivered within 4 weeks of the examination, were included in the study. The sonographic cross-sectional areas of the umbilical cord, the umbilical vessels and the Wharton's jelly were measured in a free loop of the umbilical cord. Logistic regression analysis was used to determine significant predictors of macrosomia (actual birth weight > 4000 g and > 4500 g). Fetal biometric parameters (biparietal diameter, abdominal circumference and femur length), sonographic estimated fetal weight and umbilical cord area > 95(th) centile for gestational age were used as covariates. RESULTS: During the study period, 1026 patients were enrolled. Fifty-three (5.2%) newborns had a birth weight > 4000 g, and 22 (2.1%) weighed > 4500 g. The proportion of cases with a large umbilical cord was significantly higher in the group of macrosomic compared with non-macrosomic infants (54.7% vs. 8.7%, P < 0.0001). Multiple regression models demonstrated an independent contribution of the large cord in the prediction of birth weight > 4000 g and > 4500 g (odds ratio (95% CI), 20.6 (9.2-45.9) and 4.2 (1.2-17.7), respectively). The sensitivity, specificity and positive and negative predictive values of a sonographic large umbilical cord were 54.7%, 91.3%, 25.4%, and 97.4%, respectively. The combination of abdominal circumference > 95(th) centile and large cord predicted 100% of macrosomic infants. The proportion of umbilical cords with a Wharton's jelly area > 95(th) centile for gestation was significantly higher in macrosomic fetuses of diabetic compared with non-diabetic mothers. CONCLUSIONS: Sonographic assessment of umbilical cord area may improve the prediction of fetal macrosomia.     

新生儿二次剪脐最佳时机研究

新生儿脐部是一个易感染部位,若脐带处理不当,易引起脐部感染和出血,严重者可导致败血症、继发腹膜炎.有资料表明,在1 200 例新生儿败血症中,存在脐部感染者占66.0%～87.5%[1],多为第1次剪脐后脐部护理不当造成2次剪脐时局部潮湿或时间延长所致.因此,选择适当的脐部护理方式,建立新生儿脐部干燥程度客观判断依据,把握2次剪脐的最佳时机,能大大降低脐部感染的发生,提高2次剪脐后的脐部护理质量.     

新生儿二次剪脐最佳时机研究

新生儿脐部是一个易感染部位，若脐带处理不当，易引起脐部感染和出血，严重者可导致败血症、继发腹膜炎。有资料表明，在1200例新生儿败血症中，存在脐部感染者占66．0％～87．5％^[1]，多为第1次剪脐后脐部护理不当造成2次剪脐时局部潮湿或时间延长所致。因此，选择适当的脐部护理方式，建立新生儿脐部干燥程度客观判断依据，把握2次剪脐的最佳时机，能大大降低脐部感染的发生，提高2次剪脐后的脐部护理质量。