[pathology of the umbilical cord in relation to gestational age:. Findings in 4,267 fetal and neonatal autopsies].

Unlabelled: The umbilical cord is the "foetal lifeline". Pathological changes of the umbilical cord may strongly threat foetal life. Otherwise there are many morphological abnormalities without any influence on foetal well-being. There is poor knowledge about many special pathologic-anatomical features of the cord.

Aims: Our aim was to study the incidence and relevance of pathological changes of the umbilical cord, including so-called "cord accidents", in our large autopsy series.

Methods: Our study is a review of 4267 cases, including 1301 aborted foetuses and 2966 stillborns and lifeborns less than 7 days of age, autopsied from 1971 to 1996 in our department.

Results: Of 1301 aborted foetuses, 94 (7.2%) had abnormalities of the umbilical cord. Most of them (about 59%) showed torsion, stricture or "Thin-cord-Syndrome". Other important lesions of the cord in aborted foetuses are omphaloceles and constrictions of the cord secondary to Streeter bands. Most of all changes of the cord found in aborted foetuses were lethal factors. Of 2966 stillborn and lifeborn children, which died before day 7 of life, 456 (15.4%) had abnormal findings in relation to umbilical cord. 228 children showed umbilical cord accidents (i.e. true knots, cord prolapse, cord entanglement). Likewise in 228 children, we found especially changes of cord vessels like singular umbilical artery and others, cord oedema, insertion anomalies and other changes. This findings often represent no lethal factors.

Conclusions: Torsion, stricture, and the complex of the thin umbilical cord play the most important role especially in abortion, but is also the most important cause of death of the older foetus in relation to true umbilical cord pathology.