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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:1341-1347 • 0278-4297

Umbilical Cord Morphologic Characteristics and Umbilical Artery Doppler Parameters in Intrauterine Growth–Restricted Fetuses

Luigi Raio, MD, Fabio Ghezzi, MD, Edoardo Di Naro, MD, Daniela Günter Duwe, MD, Antonella Cromi, MD and Henning Schneider, MD

Department of Obstetrics and Gynecology, University of Bern–Inselspital, Bern, Switzerland (L.R., D.G.D., H.S.); Department of Obstetrics and Gynecology, University of Insubria–Ospedale del Ponte, Varese, Italy (F.G., A.C.); and Department of Obstetrics and Gynecology, University of Bari, Bari, Italy (E.D.N.).

Address correspondence and reprint requests to Luigi Raio, MD, Department of Obstetrics and Gynecology, University of Bern–Inselspital, Effingerstrasse 102, 3012 Bern, Switzerland. E-mail: raio{at}bluewin.ch.

Objective. To compare prenatal morphometric changes of umbilical cord components in intrauterine growth-restricted fetuses with and without abnormal umbilical artery Doppler parameters. Methods. Consecutive singleton intrauterine growth-restricted fetuses at a gestational age of older than 20 weeks were compared with matched appropriate-for-gestational-age fetuses. Intrauterine growth restriction was defined in the presence of a sonographic abdominal circumference below the 5th percentile for gestational age at the time of sonography and a birth weight below the 10th percentile. The sonographic examination included pulsed Doppler measurements of the umbilical artery resistance index and measurements of the umbilical cord cross-sectional area and the umbilical cord vessel area. Results. A total of 84 intrauterine growth-restricted fetuses and 168 appropriate-for-gestational-age fetuses were included in the study. All umbilical cord components (umbilical cord cross-sectional area, vein area, artery area, and Wharton jelly area) were smaller in the intrauterine growth-restricted fetuses. The prevalence of lean umbilical cords (cross-sectional area <10th percentile for gestational age) was significantly higher in intrauterine growth-restricted fetuses compared with appropriate-for-gestational-age fetuses (73.8% versus 11.3%; P < .0001). A significant and progressive reduction of the umbilical vein area corresponding to the degree of umbilical artery Doppler parameter abnormality was found. The umbilical artery area was not related to the hemodynamic changes of the blood flow in the umbilical arteries. Conclusions. The proportion of lean umbilical cords was higher in intrauterine growth-restricted fetuses than in appropriate-for-gestational-age fetuses. Umbilical vein caliber decreases significantly with worsening of umbilical artery Doppler parameters.

Key Words: Doppler sonography • intrauterine growth restriction • umbilical artery • umbilical cord • umbilical vein

Abbreviations: AEDF, absent end-diastolic flow • AGA, appropriate-for-gestational-age • IUGR, intrauterine growth-restricted • REDF, reversed end-diastolic flow • RI, resistive index

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Copyright © 2003 by the American Institute of Ultrasound in Medicine.