Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2012  |  Volume : 55  |  Issue : 4  |  Page : 597--598

Multiple vessels in the umbilical cord: A report of four cases


Neha Singh, Seema Rao, Parul Sobti, Nita Khurana 
 Department of Pathology, Maulana Azad Medical College, New Delhi, India

Correspondence Address:
Seema Rao
Department of Pathology, Maulana Azad Medical College, New Delhi - 110 002
India




How to cite this article:
Singh N, Rao S, Sobti P, Khurana N. Multiple vessels in the umbilical cord: A report of four cases.Indian J Pathol Microbiol 2012;55:597-598


How to cite this URL:
Singh N, Rao S, Sobti P, Khurana N. Multiple vessels in the umbilical cord: A report of four cases. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Oct 28 ];55:597-598
Available from: https://www.ijpmonline.org/text.asp?2012/55/4/597/107846


Full Text

Sir,

The umbilical cord normally contains three vessels - two umbilical arteries and one umbilical vein (UV). Abnormalities leading to multiple vessels in the cord are rare with majority of the reported cases in literature highlighting four vessels due to a persistent right UV. [1],[2],[3] There are only occasional reports mentioning the presence of five vessels in the cord. [3] Out of the 432 placentas examined in our laboratory over a period of 2 years (2009-2011), 4 (0.93%) showed the presence of more than three vessels on cross section of the umbilical cord [Table 1]. We found three cases with five vessels in the cord and one case with four vessels [Figure 1]. In all the four cases, the diagnosis of multiple vessels in the cord was made postnatally on gross examination, and was confirmed by histopathologic examination. The details of the cases are enumerated in [Table 1]. One out of the four cases in the present study showed the presence of five vessels running along the central portion of the cord, while the maternal and fetal ends showed only three vessels; branching of the vessels could be a possible explanation for this finding.{Figure 1}{Table 1}

The umbilical cord is an important vascular appendage which plays a key role in fetal well-being and development. The prenatal as well as postnatal examination of the placenta has contributed significantly to the current knowledge of umbilical cord anomalies and their impact on fetal outcome. Examination of the cord for the number of vessels is a standard part of routine prenatal ultrasonography (USG). Current guidelines emphasize on the utility of gross examination of the placenta for determining the number of vessels. [4] Thus, a careful gross examination and proper sectioning of umbilical cord is extremely important.

The most common cause of four vessels in the cord is a persistent right UV, which normally involutes at 6 th -7 th week of intrauterine life. This condition is often associated with congenital malformations (in around 18% cases) like duodenal atresia, imperforate anus, bowel malrotation, annular pancreas, atrial septal defect, and situs inversus. [1],[2],[3] There are many reports describing the presence of four vessels, and their possible mechanisms have been discussed in detail. [1],[2],[3],[5] However, literature regarding significance of five vessels in the umbilical cord is sparse.

The association of five-vessel cord with congenital anomalies is not clearly understood due to the scarcity of literature pertaining to this condition. However, five or more vessels in the cord have mostly been described as a part of conjoined twinning. [5] Out of the three cases of five-vessel cord encountered by us, only one had an unfavorable clinical outcome in the form of anencephaly. The other two patients delivered twins with no evidence of any congenital malformations. None of our cases had conjoined twinning.

To summarize, simple tests like USG examination of placenta and color Doppler are valuable for prenatal diagnosis, which can alert the radiologist to look for congenital malformation and twinning. However, a simple gross examination of the cord postnatally for the number of blood vessels provides a valuable clue for a thorough examination of the neonate to look for subtle anomalies. Five vessels in the cord are frequently associated with twinning, not necessarily of conjoined type only, and do not always herald an adverse perinatal outcome.

References

1Shen O, Tadmor OP, Yagel S. Prenatal diagnosis of persistent right umbilical vein. Ultrasound Obstet Gynecol 1996; 8:31-3.
2Pérez-Cosio C, Sheiner E, Abramowicz JS. Four-vessel umbilical cord: Not always a dire prognosis. J Ultrasound Med 2008; 27:1389-91.
3Schimmel MS, Eidelman AI. Supernumerary umbilical vein resulting in a four-vessel umbilical cord. Am J Perinatol 1998; 15:299-301.
4Sepulveda W. Time for a more detailed prenatal examination of the umbilical cord? Ultrasound Obstet Gynecol 1999; 13:157-60.
5Meyer WW, Lind J, Moinian M. An accessory fourth vessel of the umbilical cord. A preliminary study. Am J Obstet Gynecol 1969; 105:1063-8.