Oedema of the Umbilical Cord and Respiratory Distress in the Newborn

Abstract

Summary Oedema of the umbilical cord, defined as visible oedema in a cord wish a minimal cross sectional area of 1.3 cm2, is found in 10 per cent of deliverieo. It is seen more frequently in certain complications of pregnancy such as abrupti placentage, maternal diabetes, macerated intrauterine death and in conditions affectint the infant including prematurity, rhesus isoimmunization, respiratory distress syndrome (RDS) and transient respiratory distress (TRD). There is a higher incidence in infants delivered by Caesarean section. There is no significant association between cord oedema and either fetal distress or neonatal asphyxia nor is there any correlation with maternal hypertension or oedema. The mechanism of production of the oedema is discussed; low oncotic pressure, raised hydrostatic pressure in the placenta and umbilical cord, and an increase in total water in the feto‐placental unit are considered. The presence of oedema of the cord may reflect similar changes in the lungs which antenatally predispose an infant whose pathway for production of surfactant is immature to develop RDS and the mature infant to develop TRD. The value of cord oedema as a warning sign is stressed.

Anatomy and Pathology of the Umbilical Cord and Major Fetal Vessels

“…On rare occasions cysts arise within Wharton's jelly. They are most obvious in the edematous umbilical cords that have been associated with respiratory distress syndrome of newborns (Coulter et al, 1975). Coulter and colleagues found 10% of babies to have edematous cords; the occurrence is more common in premature infants.…”

Effect of umbilical ring constriction on Wharton's jelly

“…It is conceivable that subtle sex differences in endocrine function and hemodynamic details (such as the present physiological constriction of the umbilical vein) can modify Wharton's jelly and cord cross‐sectional area in addition to other determinants. Such determinants could be genetic, as seen in aneuploidy22, or placental malfunction mediating a differently composed Wharton's jelly7–9, or metabolic disorders such as diabetes mellitus23, 24.…”

Further studies on the umbilical cord and its water content.

“…Four lines of investigation were instituted: 1 Umbilical cords from 57 cases were examined, measured, and graded as before (Scott and Jordan, 1972;Coulter et al, 1975). Diameters were measured at right-angles in the same plane, in segments where vessels wer%.…”

“…The various types of umbilical cord have already been defined macroscopically (Scott and Jordan, 1972;Coulter et al, 1975), and it was decided to compare and contrast them histologically. All 57 cords were examined as described.…”

“…For example, oedema can be a warning of pending respiratory distress or transient respiratory distress, depending on maturity (Coulter et al, 1975), and a thin, wrinkled cord is frequently associated with a light-for-dates or postmature infant (Scott and Jordan, 1972). Wharton's jelly, which surrounds the vessels of the cord, has the properties of a thyxotropic gell (Bacsich and Riddell, 1945) and is capable of holding large amounts of water.…”