EP17.05: Clinically useful classification of umbilical cord pathology

Often linked with structural or chromosomal abnormalities, umbilical cord pathology is also associated with poorer pregnancy outcomes as well as fetal intrauterine growth restriction. Umbilical cord pathology can lead to prematurity, placentation insufficiency, being also a risk factor for an elevated index of Caesarean delivery as a result of fetal distress, increased risk of neonatal intensive care unit admission, and also an increased index of prenatal mortality. There are several pathologies that increase fetal morbidity and mortality peri- and intrapartum, despite their decreased incidence, such as vasa previa, velamentous insertion, and umbilical knots. The societies' guidelines present different opinions concerning the umbilical cord scanning. We propose the introduction of placental cord insertion evaluation as a mandatory part of the first and second trimester structural ultrasonographic scan into the current practice guidelines for fetal ultrasound monitoring. Furthermore, during the second trimester scan, our recommendation is to assess transvaginal using the 2D ultrasonographic and colour Doppler mode the internal cervical os for vasa previa of velamentous or marginal cord insertion anomalies and low-lying placentas; the entire scan of the umbilical cord should evaluate the presence of umbilical cord entanglement. Using the fetal and neonatal outcome communicated for each and every pathology and also the pathology reports, we finalise our descriptive review by proposing a new, clinically useful classification of the umbilical cord abnormalities in order to further guide the pregnancy monitoring in order to obtain the best neonatal outcomes.