EP34.31: Wharton's jelly abundance and placental mass at umbilical cord insertion: a case report

Résumé fourni par la source

Wharton's jelly (WJ) is the mucoid connective tissue surrounding umbilical cord (UC) vessels and providing protection from compression and torsion in response to fetal movements. Its absence has been linked to perinatal death, but little is known about the relationship between ultrasound (US), placental pathology and perinatal outcomes in cases with excessive WJ deposition. We present a case report on abnormal WJ and a placental mass at the UC insertion in a singleton pregnancy. G3 P2 at 37 weeks was referred to our Unit for suspected placental anomaly. On US, the abnormal area was 8.4 × 5.4 cm just behind the UC insertion, slightly separated from the rest of the placenta although within it and with the same echogenicity. the WJ appeared to be prominent in the first tract of the UC. No additional blood flow apart from the UC was noted. The woman was induced at 37+3 weeks and achieved a vaginal delivery. Birthweight was 3780 g (97° p.le, LGA) with a normal Apgar score. In figure 1, the correspondence between US and the placenta after birth is shown. The placental pathology showed an angiomatous mass at fetal insertion of the UC, which further presented a fusiform swelling spanning 15 cm in length. The reddish-tan lobulated solid mass contained macroscopically the umbilical vessels. Histologically, it was composed of a lobular proliferation of clusters of capillaries compatible with a hemangioma of the UC. Currently, the link between birthweight and placental disease in relation to WJ area is not well understood. Decreased WJ area was described to be associated with small for gestational age and pre-eclampsia. No studies have been published about WJ abundance and the relationship with birthweight and in particular with LGA and thus warranting further investigations. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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