Talk:Placenta - Cord

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Cite this page: Hill, M.A. (2019, September 23) Embryology Placenta - Cord. Retrieved from

Placental Cord

<pubmed limit=5>Placental+Cord</pubmed>

Cord Coiling

<pubmed limit=5>Cord+Coiling</pubmed>

Cord Vessel Number

<pubmed limit=5>Cord+Vessel+Number</pubmed>

Placental Cord

<pubmed limit=5>Placental+Cord+Length</pubmed>


Persistent right umbilical vein: a study using serial sections of human embryos and fetuses

Anat Cell Biol. 2018 Sep;51(3):218-222. doi: 10.5115/acb.2018.51.3.218. Epub 2018 Sep 28.

Kim JH1, Jin ZW2, Murakami G3, Chai OH1, Rodríguez-Vázquez JF4. Author information Abstract Persistent right umbilical vein (PRUV) is a common anomaly of the venous system. Although candidates for future PRUV were expected to occur more frequently in earlier specimens, evaluation of serial horizontal sections from 58 embryos and fetuses of gestational age 5-7 weeks found that only two of these embryos and fetuses were candidates for anomalies. In a specimen, a degenerating right umbilical vein (UV) joined the thick left UV in a narrow peritoneal space between the liver and abdominal cavity, and in the other specimen, a degenerating left UV joined a thick right UV in the abdominal wall near the liver. In these two specimens, the UV drained into the normal, umbilical portion of the left liver. These results strongly suggested that, other than the usual PRUV draining into the right liver, another type of PRUV was likely to consist of the right UV draining into the left liver. KEYWORDS: Gallbladder; Human embryos; Persistent right umbilical vein; Right paramedian sector; Umbilical portion of the left liver PMID: 30310717 PMCID: PMC6172587 DOI: 10.5115/acb.2018.51.3.218


Umbilical cord coiling: clinical outcomes in an unselected population and systematic review

Virchows Arch. 2014 Jan;464(1):105-12. doi: 10.1007/s00428-013-1513-2. Epub 2013 Nov 21.

Jessop FA1, Lees CC, Pathak S, Hook CE, Sebire NJ.


This study was conducted to determine the frequency of pre-defined clinical outcomes in relation to umbilical cord coiling indices >90th percentile and <10th percentile in an unselected population of >1,000 women with a singleton pregnancy resulting in livebirth delivering at or near term and to report these findings in the context of a systematic review. Placentas of consecutive deliveries from an unselected low-risk population with >15 cm attached umbilical cords were included in the study. Clinical outcomes included interventional delivery, birthweight <10th percentile, Apgar score <7 at 1 min, neonatal acidosis (pH<7.2) and admission to neonatal special care. Standard MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines were observed for the systematic review. Umbilical coiling index was determined for 1,082 placentas. Mean maternal age was 30.7 years (standard deviation [SD] =5.7) and 519 women (48 %) were primiparous. Mean cord length was 43 cm (SD=13) and mean cord coiling index 0.20 (SD=0.09). A total of 866 cords were normally coiled, and 108 cases were hypercoiled (>90th centile) and 108 cases were undercoiled (<10th percentile). There were no differences between cases of overcoiled, normally coiled or undercoiled cords for any clinical outcome studied. The systematic review yielded a small number of clinical studies which were too statistically and clinically heterogenous to permit meta-analysis. There is insufficient evidence either from this unselected cohort study or from a systematic review to support the previous suggestion that cord coiling index >90th centile or <10th centile is associated with adverse clinical outcome in an unselected population. Previous studies that draw a link between abnormal cord coiling and clinical outcome are generally too small and/or selective to allow meaningful conclusions or applicability to low-risk populations.

PMID 24259031


Umbilical cord coiling index and perinatal outcome

J Clin Diagn Res. 2013 Aug;7(8):1675-7. doi: 10.7860/JCDR/2013/5135.3224. Epub 2013 Aug 1.

Patil NS1, Kulkarni SR, Lohitashwa R. Author information


Objectives: To evaluate the perinatal outcome with the abnormal umbilical cord coiling index. Study Design: This prospective study was carried out in the department of OBG at Adichunchangiri Institute of Medical Sciences, B.G.Nagara, Mandya, Karnataka, India from January 2008 to August 2010. 200 patients who were in active labour with term gestations, irrespective of their parities, who had singleton pregnancies with live babies who were either delivered by vaginal or LSCS were included in the study. Umbilical cord coiling index was calculated and it was correlated with various perinatal parameters like birth weight, meconium stained liquor, Apgar score, ponderal index and foetal growth restriction. Chi square and Fisher exact tests were used to find the significance of study parameters. Results: There was a significant correlation between the hypercoiled cords (UCI >90(th) percentile) and IUGR of the babies (p value of < 0.001) and low ponderal indices (a p value of 0.022) Hypocoiled cords ( UCI which was < 10(th) percentile) were significantly associated with meconium staining (p < 0.001), Apgar score at 1 min of <4 and at 5 min of <7 (p value 0.065), LSCS rates (p value of 0.008) and NICU admissions (p <0.001). Conclusion: Hypercoiled cords or UCI which was > 90(th) percentile was associated with IUGR and low ponderal indices. Hypocoiled cords or UCI which was <10th percentile was associated with meconium staining, Apgar score at 1 min of <4 and at 5 min of <7, more LSCS rates and more NICU admissions. KEYWORDS: Hypercoiling umbilical cord, Hypocoiling umbilical cord, Umbilical cord coiling index

PMID 24086872


Persistent right umbilical vein: a prenatal condition worth mentioning?

Ultrasound Obstet Gynecol. 2011 May;37(5):543-8. doi: 10.1002/uog.7764. Epub 2011 Mar 25.

Weichert J, Hartge D, Germer U, Axt-Fliedner R, Gembruch U. Source Division of Prenatal Medicine, Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.


OBJECTIVES: To investigate the incidence and clinical impact of prenatally diagnosed persistent right umbilical vein (PRUV) in a referral population and to evaluate the findings together with those from previous publications. METHODS: This was a retrospective analysis of 39 cases with PRUV diagnosed in three tertiary referral centers for prenatal medicine between 1996 and 2009. Fetuses with situs inversus, situs ambiguous and heterotaxy (left and right isomerism) were excluded. During the study period 46 653 consecutive high- and low-risk pregnancies were examined. The prenatal sonograms and neonatal outcome data of affected individuals were reviewed. Our findings were analyzed together with findings retrieved from the scientific literature. RESULTS: Twenty-nine fetuses had an isolated PRUV as a single anomaly, whereas 10/39 (25.6%) were found to have PRUV accompanied by additional minor and major abnormalities. These anomalies comprised mainly cardiovascular, genitourinary and gastrointestinal malformations. In common with our series, previously published cases of isolated PRUV (n = 197) displayed an uneventful course of pregnancy and a favorable postnatal outcome. Sixty-six previously reported cases of PRUV with additional anomalies were identified in the literature. Intrahepatic umbilical drainage is the most frequent type of PRUV. Including our cases, there were 16 cases (5.3%) with extrahepatic drainage of PRUV, all of which had additional anomalies. CONCLUSIONS: Consistent with previous reports, in the majority of cases (74.8%) PRUV is an isolated finding. While these cases carry an excellent prognosis, PRUV can be associated with severe congenital anomalies, so this finding should prompt detailed prenatal assessment of the fetus. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

PMID 20922781

Area of Wharton's jelly as an estimate of the thickness of the umbilical cord and its relationship with estimated fetal weight

Reprod Health. 2011 Nov 4;8:32.

Barbieri C, Cecatti JG, Surita FG, Costa ML, Marussi EF, Costa JV. Source Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de Campinas-UNICAMP, Campinas, São Paulo, Brazil.


BACKGROUND: To build a reference curve for the area of Wharton's jelly (WJ) in low-risk pregnancies from 13 to 40 weeks and to assess its relationship with estimated fetal weight (EFW). METHODS: 2,189 low-risk pregnancies had the area of WJ estimated by ultrasound and the 10th, 50th and 90th percentiles calculated using a third-degree polynomial regression procedure. EFW by ultrasound was correlated with the measurement of the area of WJ. RESULTS: The area of WJ increased according to gestational age (R² = 0.64), stabilizing from the 32nd week onwards. There was a significant linear correlation between area of WJ and EFW up to 26 weeks (R = 0.782) and after that 5t remained practically constant (R = 0.047). CONCLUSION: The area of WJ increases according to gestational age, with a trend to stabilize at around 32 weeks of gestation. It is also linearly correlated with EFW only up to 26 weeks of gestation.

PMID 22054163


Quantitative analysis of the microstructure of human umbilical vein for assessing feasibility as vessel substitute

Ann Vasc Surg. 2008 May-Jun;22(3):417-24. doi: 10.1016/j.avsg.2007.12.021.

Li WC, Zhang HM, Wang PJ, Xi GM, Wang HQ, Chen Y, Deng ZH, Zhang ZH, Huang TZ. Source Institute of Basic Medical Sciences, Yunyang Medical College, Shiyan, People's Republic of China.


We explored the feasibility of human umbilical vein (HUV) as a small-caliber vessel substitute. HUVs of 50 fetuses were collected on spontaneous miscarriage or labor with the pregnant women's permission. Gestational age ranged 24-42 weeks, and parturients were 20-30 years old. Each sample was sliced into 5 mum frozen transverse sections and stained with hematoxylin-eosin (HE), Weigert, aniline blue, and orange yellow G. The geometric morphological indexes and microstructural component were measured by a computer image analysis system. The media thickness was 0.186, 0.203, 0.237, 0.264, and 0.268 mm at 24-27, 28-32, 33-36, 37-40, and 41-42 weeks, respectively (F = 133.35, p < 0.01); diameters were 1.861, 1.962, 2.303, 2.464, and 2.465 mm (F = 37.35, p < 0.01), respectively. The media thickness and diameter of HUVs increased with gestational age. The elastin content of media increased at 24-40 weeks, but the collagen content and collagen/elastin (C/E) ratio decreased. Elastin content in the proximal segment was higher than in the distal segment [10.16, 6.36 Aa%, (Aa% is the unit of relative content, ie, the ratio of absolute areas to the total tested area of smooth muscle, collagen and elastin in the vascular wall) F = 5.77-12.3, p < 0.05], with the collagen to elastin (C/E) ratio increasing from the proximal to the distal segment (F = 7.63-13.4, p < 0.05). Our results suggest that the microstructural component of HUVs (2.0-3.0 mm caliber) at 37-40 weeks of gestation was similar to that of the small-caliber arteries and had moderate amounts of collagen and elastin and good elasticity, i.e., a good C/E ratio; therefore, HUV may be a substitute for small-caliber arteries (e.g., brachial, ulnar, radial, right coronary, anterior tibial, and posterior tibial). HUV is one of several graft materials that may be used when autogenous saphenous vein is absent or inadequate. PMID 18466819


Hofbauer cells in early human placenta: possible implications in vasculogenesis and angiogenesis

Seval Y, Korgun ET, Demir R. Placenta. 2007 Aug-Sep;28(8-9):841-5. Epub 2007 Mar 9.

The stroma of the placental villi contain numerous macrophages, so-called Hofbauer cells which are of mesenchymal origin and are thought to function in many processes. Although there are many studies concerning placental vasculogenesis and angiogenesis, there has been a lack of evidence on the possible roles of Hofbauer cells in these processes. In this study we hypothesized that Hofbauer cell locations and numbers might be correlated with the vascular structures within the placental villi core and therefore may be implicated to play roles in placental vasculogenesis and angiogenesis. Placental tissues were obtained from normal first-trimester pregnancies. Tissues were prepared for light microscopic investigations. Double immunohistochemistry staining with CD31/PECAM1 and CD68 was applied to placental tissues. In placental villous core, majority of the Hofbauer cells were found to be either in close contact with angiogenic cell cords and primitive vascular tubes or located in between them. Moreover, the number of Hofbauer cells and vasculogenic structures were found to be significantly correlated. The findings of this study suggest for the first time that Hofbauer cells might be involved in the processes of vasculogenesis and angiogenesis in the placenta.

PMID 17350092


The umbilical coiling index and adverse perinatal outcome

Int J Gynaecol Obstet. 2006 Oct;95(1):8-13. Epub 2006 Jul 24.

Kashanian M, Akbarian A, Kouhpayehzadeh J. Source Iran University of Medical Sciences, Department of Obstetrics and Gynecology, Akbarabadi Teaching Hospital, Tehran, Iran. <>

Abstract OBJECTIVE: Evaluation of the relationship between umbilical coiling index (UCI) and adverse perinatal outcome. METHOD: A prospective study was performed on 699 pregnant women who were 37-40 weeks. UCI was determined by dividing the total number of the complete vascular coiling by the total umbilical cord length in centimeters. Then the relationship between UCI and neonatal weight, amniotic fluid index, meconium, Apgar score, and fetal distress were evaluated. RESULTS: There was a significant difference between normo- and hypocoiled groups according to the Apgar score less than 7 in minute 5, AFI<or=5; and between normo- and hypercoiled groups according to Apgar score less than 7 in minute 5, AFI<or=5, meconium, and fetal distress. Neonatal weight in normocoiled was higher than hypercoiled group. AFI<or=5, meconium and fetal distress were higher in hypercoiled than hypocoiled group. Neonatal weight in hypercoiled was less than that in the hypocoiled group, respectively. CONCLUSION: Abnormal UCI may relate to adverse perinatal outcome. PMID 16860802


Embryogenesis of fused umbilical arteries in human embryos

Am J Obstet Gynecol. 2005 Nov;193(5):1709-15.

Yamada S, Hamanishi J, Tanada S, Tachibana M, Mimura R, Fujii S, Shiota K. Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.


OBJECTIVE: The objective of this study was to elucidate the embryologic basis of fused umbilical arteries in the human.

STUDY DESIGN: Twenty-nine human embryo specimens at Carnegie stages 11 through 15 (4-5 weeks after fertilization) were examined histologically, with special reference to the development of umbilical arteries.

RESULTS: All embryos at Carnegie stage 11 and 12 had fused umbilical arteries, and 66% of Carnegie stage 13 embryos and 29% of Carnegie stage 14 embryos still had the condition. None of the embryos at Carnegie stage 15 or older had fused umbilical arteries, but there were always 2 arteries present in their umbilical cords. CONCLUSION: Our data suggest that (1) a single umbilical artery splits into 2 as the developmental stage of the embryo advances, (2) that fused umbilical arteries represent a remnant of the embryonic phenotype, and (3) that fused umbilical arteries are embryologically distinct from true single umbilical artery.

PMID 16260215


Pediatr Dev Pathol. 2001 Mar-Apr;4(2):144-53. Morbidity, mortality, and placental pathology in excessively long umbilical cords: retrospective study. Baergen RN, Malicki D, Behling C, Benirschke K. Source Department of Pathology, New York Presbyterian Hospital-Weill Medical College of Cornell University, NY 10021, USA.


The purpose of this study was to compare specific fetal, maternal, and placental factors, including neonatal morbidity and mortality, in infants with umbilical cords (UCs) of normal length to the same factors in infants with excessively long umbilical cords (ELUCs). We performed an 18-year retrospective chart review of the medical records of mothers and infants with ELUCs (926 cases) and normal-length UCs (200 cases) and recorded maternal factors, fetal factors, and neonatal outcomes. Corresponding placental pathologic reports and slides were reviewed. Statistical analysis comparing the two groups included univariate and multivariate analyses. ELUCs were significantly associated with certain maternal factors (systemic diseases, delivery complications, increased maternal age), fetal factors (non-reassuring fetal status, respiratory distress, vertex presentation, cord entanglement, fetal anomalies, male sex, increased birth weight), gross placental features (increased placental weight, right-twisted cords, markedly twisted cords, true knots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increased syncytial knots, single umbilical artery). Some of these histopathologic features have previously been associated with fetal hypoxia and/or altered blood flow in the placenta. Infants with ELUCs were found to be at a significantly increased risk of brain imaging abnormalities and/or abnormal neurological follow-up. In addition, mothers with a history of an ELUC are at increased risk of a second long cord.

PMID 11178630


Isolation and characterization of Hofbauer cells from human placental villi

Arch Gynecol Obstet. 1989;246(4):189-200.

Zaccheo D, Pistoia V, Castellucci M, Martinoli C.

Istituto di Anatomia Umana Normale, Università di Genova, Italy. Abstract Hofbauer cells are a major cell type of the human placental villous core and they are particularly numerous at the beginning of pregnancy. In the present study we describe a method suitable to obtain HC suspensions in a highly purified form. These suspensions have been analyzed for surface markers using a battery of monoclonal antibodies. Of all the surface markers used, Hofbauer cells were only positive for 4F2, LeuM2 and LeuM3 monoclonals which mainly detect cells of the monocyte-macrophage lineage. Hofbauer cells were consistently negative for HLA-DR antigens, C3bR and T- or B-cell markers. Hofbauer cells appeared capable of phagocytosing latex beads, adhering to and spreading over plastic surface and secreting lysozyme. In contrast, they failed to originate an efficient respiratory burst in response to appropriate stimulation. Hofbauer cells were positive for ANAE with a perinuclear localization of the enzyme activity, but consistently negative for peroxidase. These observations suggest that they share a number of features with cells of the monocyte-macrophage lineage and yet have some distinctive properties.

PMID 2482706