Review of Literature on Epidemiology, Diagnostics, Complications of Umbilical Cord Pathology and Management Tactics

Аннотация

This review systematizes current knowledge about umbilical cord abnormalities (UCAs) — a heterogeneous group of anomalies including length abnormalities, number of vessels, attachments, nodes, cysts, and vascular malformations. Based on the analysis of scientific literature (2000–2024), the epidemiological data are presented: UCAs occur in 15–35% of pregnancies, with single umbilical artery (SUA) — in 0.5–5%, velmen insertion — up to 50% in monochorionic twins, and true nodes — in 0.3–1.2%. The review details complications: fetal growth restriction (FGR), chronic and acute hypoxia, antenatal death, risks during childbirth (vascular rupture in vasa praevia, asphyxia). Particular attention is paid to early diagnostic methods: ultrasound with Doppler (blood flow assessment, EAP), color Doppler mapping (Velmen attachment), 3D/4D ultrasound in STIC mode (nodes, spatial anomalies), CTG monitoring. Differentiated management tactics are substantiated: from dynamic observation at low risk to planned cesarean section for vasa praevia or IUGR. It is emphasized that timely diagnostics and an individualized approach reduce perinatal mortality and improve outcomes. Keywords: Umbilical cord abnormalities; Single umbilical artery; Velamentous cord insertion; Vasa previa; True umbilical cord knot; Umbilical cord entanglement; Umbilical cord cysts; Umbilical artery Doppler; Prenatal diagnosis; Pregnancy complications; Perinatal outcomes; 3D/4D ultrasound; Fetal growth restriction (FGR); Pregnancy management; Cord structure pathology. management tactics of pregnant women with various Introduction: Umbilical cord abnormalities (UCAs) are umbilical cord abnormalities. a heterogeneous group of anomalies that include deviations in length, number of vessels, type of METHODS attachment, presence of nodes, cysts and vascular An analysis of scientific literature data published for the malformations. Despite the fact that many UCAs have period 2000-2024 was conducted using the PubMed, no clinical consequences, some types are associated MEDLINE, Scopus, Cochrane Library, and eLibrary with an increased risk of fetal growth restriction (FGR), databases. Key words: "umbilical cord pathologies", hypoxia, birth asphyxia, stillbirth and the need for "umbilical cord anomalies", "umbilical cord emergency operative delivery [1, 2]. entanglement", "true cord knot", "velmen insertion of The prevalence of UCAs in the population varies, the umbilical cord", "diagnosis of umbilical cord reaching significant numbers, which emphasizes the pathologies", "pregnancy complications with umbilical relevance of the problem for perinatology [3, 4]. cord anomalies". Systematic reviews, meta-analyses, Modern methods of prenatal diagnostics, primarily randomized controlled trials, large cohort studies, and ultrasound, play a key role in early detection and clinical guidelines were selected. determination of pregnancy and childbirth