Umbilical Cord

Normal Umbilical Cord

This infant is 7 hours old. The cord is plump and pale yellow in appearance. One of the umbilical arteries is visible protruding from the cut edge. A normal cord has two arteries (small, round vessels with thick walls) and one vein (a wide, thin-walled vessel that usually looks flat after clamping).

photo by Janelle Aby, MD

Normal Umbilical Cord

Looking at the cut edge more clearly shows the normal vessels of the umbilical cord. The two arteries are to the left and the vein, with a spot of blood in its large lumen, is on the right.

photo by Janelle Aby, MD

Normal Umbilical Cord

The dark stripes within the cord in this picture are examples of intravascular clots -- a normal finding in newborns. In some cases, the vessels are so full of clotted blood that all three may be clearly identified as they wind around through the umbilical stump.

photo by Janelle Aby, MD

Normal Umbilical Cord

This infant is 19 hours old. The cord is beginning to dry and darken as it makes its transition into a non-functioning organ.

photo by Janelle Aby, MD

Normal Umbilical Cord

After a couple of days, the cord is a stiff, dry stump. The bulge of skin around the edge is a normal variant and does not represent an abnormality.

photo by Janelle Aby, MD

Normal Umbilical Cord

Just minutes after the cord falls off, some of the remaining moist debris is still visible on the skin. A spot of blood or a slight amount of moist, yellow material may be present on the diaper or clothing after cord separation. Any bleeding or discharge that persists should be evauated, as this is not a normal finding.

photo by Janelle Aby, MD

Meconium Stained Umbilical Cord

This cord is also about 7 hours old at the time of the photo, but the normal light yellow color is not visible, even though the cord is still plump. This cord was stained by the presence of meconium in utero, which gives it a dark green color. When an infant shows signs of meconium staining, it is evidence that meconium has been present in the amniotic fluid for some time. In addition to the umbilical cord, meconium staining is also frequently seen on the nails.

photo by Janelle Aby, MD

Umbilical Hernia

When the umbilical ring is weak or large, an umbilical hernia can result. With increased abdominal pressure (the infant was crying for this photo), a bulge of intra-abdominal contents through the ring can be seen. This does not require treatment, as most hernias of this type resolve spontaneously during the first year of life. Complications, such as strangulation of bowel, are extremely rare. Surgical correction is only considered for those who have large defects that are still open at several years of age.

photo by Janelle Aby, MD

Umbilical Hernia

In this view, the hernia has been reduced with slight digital pressure on the bulged area. The infant is now quiet, and intra-abdominal pressure low, so the hernia is no longer visible. Parents are often concerned about the degree of elevation of the bulge, but the severity of the hernia is determined solely by the size of the umbilical ring. The visibility of the bulge is related to intra-abdominal pressure and is therefore constantly changing.

photo by Janelle Aby, MD

Skin Irritation from Dry Cord

The redness superior to the umbilical cord in this photo is simply irritation from the hard, dry umbilical stump rubbing against the abdomen. Because omphalitis (an infection of the cord itself) is a dangerous condition, redness in this area should be carefully evaluated. However, the localized nature of the redness here, along with the fact that it is somehat removed from the actual insertion of the cord and appears very superficial is reassuring that infection is not the underlying etiology.

photo by Janelle Aby, MD

Periumbilical Erythema

When "dry cord care" is the standard practice (no application of alcohol or triple dye), there are a number of infants who have a small rim of erythema around the drying cord. Although this should be monitored to be sure progression does not occur to omphalitis, this minimal redness is thought to be related to the normal wbc infiltration that occurs naturally in the process of cord separation. These otherwise well infants do not need evaluation.

photo by Janelle Aby, MD

Omphalitis

For comparison, this is the appearance of a full-blown case of omphalitis. The progression of erythema over time can be clearly seen from the circles marked on the abdomen. The first circle was drawn less than 12 hours after redness was initially seen, and the second circle was drawn several hours after that. Omphalitis of this degree can be fatal, even with aggressive antibiotic therapy, so infection in this area should always be taken seriously.

photo by JoDee Anderson, MD

Umbilical Cord Hematoma

Umbilical hematomas are fortunately very rare (incidence approximately 1:5000). They may be spontaneous or related to trauma from prenatal procedures or birth, but they are caused by rupture of the umbilical vessels, usually the umbilical vein. When the rupture occurs in utero, fetal distress is common, and up to 50% of cases result in fetal death. The etiology is thought to be either hypoxia secondary to the venous mass occluding the umbilical vessels or exanguination. When noted as a physical finding in an otherwise well newborn, the hematoma is expected to resolve spontaneously and requires no additional evaluation.

photo by David A Clark, MD

Umbilical Cord Hematoma

Here is another example of an umbilical hematoma. Risk factors for this condition include short cord, vilamentous insertion, cord prolapse or torsion, traction on the cord, chorio-amnionitis, or post-dates delivery leading to thinning of the cord components with secondary aneurysm formation. In this case, the infant had no distress either before or after birth, so no further evaluation was needed.

photo by Janelle Aby, MD

Umbilical Cord Hematoma

This is the underside view of the cord in the previous photo. From this angle, the bruised appearance of the internal structures can be more easily seen. Spontaneous resolution and normal cord separation is expected.

photo by Janelle Aby, MD

Umbilical Cord Hemangioma

A very rare anomaly of the cord, hemangiomas can be quite serious. Large hemangiomas can comprise the vasculature or completely obstruct flow in the cord in utero or lead to high output cardiac failure. Fetal deaths have been reported.

photo by Janelle Aby, MD

Wharton's Jelly Cyst

Also known as a "false cyst" of the cord, a Wharton's jelly cyst is an area where liquefaction of the jelly has occured. Up to 20% of infants with this condition have associated anomalies.

photo by David A Clark, MD

Wharton's Jelly Cyst

With backlighting, the homogeneous nature of the "cyst" can be seen.

photo by David A Clark, MD

Wharton's Jelly Cyst

Here is another example of a Wharton's jelly cyst. Again, the affected area is translucent and homogeneous in appearance. Although some infants with this finding have associated anomalies, this patient was otherwise well.

photo by Janelle Aby, MD

Wharton's Jelly Cyst

This is the same cord as in the previous photo. Viewed from the side, one can see the difference in appearance of the "cystic" area as compared with the normal cord. By the following morning, the distended area had completely deflated as the cord was starting to dry and could no longer be distinguished from the rest of the umbilical cord.

photo by Janelle Aby, MD

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Umbilical Cord

Normal Umbilical Cord

Normal Umbilical Cord

Normal Umbilical Cord

Normal Umbilical Cord

Normal Umbilical Cord

Normal Umbilical Cord

Meconium Stained Umbilical Cord

Umbilical Hernia

Umbilical Hernia

Skin Irritation from Dry Cord

Periumbilical Erythema

Omphalitis

Umbilical Cord Hematoma

Umbilical Cord Hematoma

Umbilical Cord Hematoma

Umbilical Cord Hemangioma

Wharton's Jelly Cyst

Wharton's Jelly Cyst

Wharton's Jelly Cyst

Wharton's Jelly Cyst

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