Is there any significance to a two vessel cord?

[Lisky90]

As a student, I worked as a CNA on a postpartum floor, spending a majority of my time in the well baby nursery. I did not do newborn assessments, however because I was a student, many times nurses would point out interesting things they would see during their assessments. I remember seeing some, not alot of babies whose cords would have only two vessels. They were usually normal, and there was usually not alot of concern over this...from what I remember, I think I may now be wrong.

I am currently taking an ACLS class with some girls I graduated with...one works in a newborn nursery, and came across this situation the other day. She mentioned the baby had a full renal workup and was sent to the special care nursery. I just don't remember this situation ever being a big deal...while it was not common, it always seemed sort of benign. However, after looking this up, I have read several times that this anomaly is frequently associated with renal, GI, issues. But, this information keeps repeating itself with nothing further. Does anyone have more experience with this issue...we're both too new at nursing to know how frequently this occurs and if it is worth worrying about

[EricJRN, MSN, RN]

Check out the link below. It says that at least 70% (and probably more, due to reporting issues) of babies with two-vessel cords end up 'normal.'

http://www.medhelp.org/forums/maternal/archive/2020.html

[33-weeker]

You see 'a lot' of babies with 2-vessle cords? That's odd. I've been a nsy. nurse for nearly 16 years. I could probably count on one hand the # of 2's I've seen.

The few times I have seen it, the concern (as I recall) is it can be related to kidney or heart defects, but all the babies I've seen have checked out OK. The vessel can also become clotted off and whither away during pregnancy. From what I remember, in that case it is not related to defects. I think the time it is a concern is when it never forms in the first place -- but when you're counting them at delivery, there's no way to know why it's missing.

[HappyNurse2005, RN]

i've had one pregnant lady who had a 2 vessel cord and iugr. she was on the antepartum side, though, so i dont know about how it affected her baby after birth. (i never found out)

here is something copied and pasted from emedicine website

single umbilical artery occurs in fewer than 1% of cords in singletons and 5% of cords in at least one twin. incidence can be underestimated with gross examination of the cord, especially if the portion close to the placenta is examined, because the arteries often fuse close to the placenta.

single umbilical arteries are found twice as often in white women than in african american and japanese women. diabetes increases the risk significantly. two-vessel cords are found more frequently in fetuses aborted spontaneously. the male-to-female ratio is 0.85:1.

single umbilical artery is believed to be caused by atrophy of a previously normal artery, presence of the original artery of the body stalk, or agenesis of one of the umbilical arteries.

the vessels in the cord are clearly identifiable with ultrasound. the vein usually is larger than the arteries. the presence of only 2 vessels on an ultrasound cross section is highly suggestive of a single umbilical artery.

of infants with a single umbilical artery, 20-50% have associated fetal anomalies, including cleft lip, cardiovascular abnormalities (especially ventricular septal defects and conotruncal defects), ventral wall defects, central nervous system defects, esophageal atresia, spina bifida, diaphragmatic hernia, cystic hygroma, hydronephrosis, dysplastic kidneys, polydactyly, syndactyly, and marginal and velamentous insertion of the cord.

with single umbilical arteries, a 20% perinatal mortality rate exists. two thirds of deaths occur before birth. of the one third of neonates who die postnatally, most have associated congenital abnormalities. many of those without overt abnormalities are premature or have intrauterine growth retardation.

prenatal diagnosis of a single umbilical artery should prompt examination for other anomalies. echocardiograms may be considered because heart defects are common. thirty percent have congenital anomalies, which may include trisomy 13, trisomy 18, and triploidy; trisomy 21 is uncommon. because associated anomalies can occur in any organ system, conduct a detailed anatomy survey whenever a 2-vessel cord is discovered. if anomalies are found, consider fetal karyotyping. because growth is retarded in 30% of affected fetuses, consider a third trimester ultrasound for fetal growth. twenty percent are delivered prematurely. the perinatal mortality rate is approximately 20%. use neonatal ultrasound liberally to examine for anomalies.

[color=#ffffff]quick find [color=#ffffff][color=#333399]author information

[color=#333399]introduction

[color=#333399]cord length

[color=#333399]single umbilical artery

[color=#333399]velamentous insertion and vasa previa

[color=#333399]cord knots, nuchal cord, and cord stricture

[color=#333399]cord hematoma, cord cysts, and cord varix

[color=#333399]hemangiomas and teratomas

[color=#333399]cord prolapse

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[klone, MSN, RN]

In and of itself, it is not a problem. However, 2-vessel cords are often associated with other fetal anomalies, so the presence of a 2-vessel cord should alert the provider to check for other problems.

[LizzyL&DRN]

I have a good friend who delivered a baby with a 2 vessel cord at 32 weeks. She was delivered due to oligo and IUGR. Baby had a cleft palate, imperforated orifice and has turned out to be developmentally delayed. She is now 5 and isn't walking yet. She seems to be very smart just her motor skills are poor as well as her speech. I have seen babies born at term with a 2 vessel cord and appear completely normal. It's interesting how what appear to be similar instances can produce such a dramatic difference. My friends child has had genetic studies which did reveal some genetic abnormalities.

[SmilingBluEyes]

My sister's baby had a 2 vessel cord. She called me immediately, freaked out that something was wrong w/her baby. (my own son had been born with a rare cranial defect but a 3 vessel cord). We had no family history of any sort of defects prior to the birth of my son, so, I reassured her that the majority are a-ok . I also urged her to try to wait til the Level-2 U/S before getting too worked up. Turned out I was right. Her baby was a normal, healthy baby boy, born right at 39 weeks w/o incident.

Noting a 2-vessel cord always should prompt health care providers to "dig deeper" and be sure all is ok with the fetus/baby. But the majority DO turn out just fine.

[Burnt Out, ASN, RN]

My first child, a boy, was born at 32 weeks due to preeclampsia. He had a bilateral cleft lip and palate along with a 2 vessel cord. Testing showed the next day that he had CHD-Tetralogy of Fallot/VSD with Double Outlet Right Ventricle. Chromosomal studies were done and were essentially normal; however, when I was pg with our second child, we went to see a genetic counselor and we were told that the chances that our son had Velocardiofacial Syndrome (aka DiGeorge Syndrome) were very high-it will never be confirmed 100% as the testing for VCFS requires a specialized test (a FISH study) and our son died at 12 days of age, so we have no access to his blood. DH and I have been tested for carrier status and that was all normal.

A few years back when I worked in OB, I remember several babies with 2 vessel cords-1 had a CHD and the others were fine. But I can guarantee you that when I hear "2 vessel cord" I get chills up and down my spine.

[mitchsmom]

I had a friend whose baby had a 2 vessel cord and previa but everything was fine.

[33-weeker]

my first child, a boy, was born at 32 weeks due to preeclampsia. he had a bilateral cleft lip and palate along with a 2 vessel cord. testing showed the next day that he had chd-tetralogy of fallot/vsd with double outlet right ventricle. chromosomal studies were done and were essentially normal; however, when i was pg with our second child, we went to see a genetic counselor and we were told that the chances that our son had velocardiofacial syndrome (aka digeorge syndrome) were very high-it will never be confirmed 100% as the testing for vcfs requires a specialized test (a fish study) and our son died at 12 days of age, so we have no access to his blood. dh and i have been tested for carrier status and that was all normal.

a few years back when i worked in ob, i remember several babies with 2 vessel cords-1 had a chd and the others were fine. but i can guarantee you that when i hear "2 vessel cord" i get chills up and down my spine.

bless your heart! i bet you do get chills.

'once bitten', as they say...