Morbidity, mortality, and placental pathology in excessively long umbilical cords: Retrospective study

The purpose of this study was to compare specific fetal, maternal, and plac ental 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 retrospec tive 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 gr oups included univariate and multivariate analyses. ELUCs were significantl y associated with certain maternal factors (systemic diseases, delivery com plications, increased maternal age), fetal factors (non-reassuring fetal st atus, respiratory distress, vertex presentation, cord entanglement, fetal a nomalies, male sex, increased birth weight), gross placental features (incr eased placental weight, fight-twisted cords, markedly twisted cords, true k nots, congestion), and microscopic placental features (nucleated red blood cells, chorangiosis, vascular thrombi, vascular cushions, meconium, increas ed 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 signi ficantly increased risk of brain imaging abnormalities and/or abnormal neur ological follow-up. In addition, mothers with a history of an ELUC are at i ncreased risk of a second long card.