Antenatal ultrasound is an established technique to identify foetal abnormalities, which may lead to increased perinatal morbidity or mortality. As machine resolution has improved, detection of umbilical cord anomalies has increased. Recent studies have highlighted that two vessel cords are associated with congenital abnormalities, growth restriction and small placental size and that identifying them is important in determining pregnancy outcome.
During the past 12 months the authors have detected eight patients with two vessel cords in routine 12- and 20-week antenatal ultrasound scans.
Following the identification of a two-vessel cord, a level 3 scan was done and antenatal surveillance was increased. Renal hydronephrosis was queried in two foetuses and growth velocity was slow in one.
Obstetric outcomes were obtained, including gestation, mode of delivery, weight at birth, cord pH and associated abnormalities. All deliveries occurred after 36 weeks, including a pair of twins. There were two elective Caesarean sections and one ventouse delivery. Cord pHs were normal for all neonates. Only one baby had an abnormality identified in the form of an undescended testis. All babies, except the twins, had weights above 3 kilos. No renal problems were identified in neonatal scans carried out in the two cases of foetal hydronephrosis.
This case series suggests that two vessel cords identified on ultrasound does not directly correlate with adverse pregnancy outcomes. The authors suggest that the finding of a two-vessel cord in the absence of other abnormalities does not need increased ultrasound surveillance unless growth is suboptimal using customised growth charts.
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