Risk Factors and Outcomes Associated with a Short Umbilical Cord
DOI:
https://doi.org/10.51985/Keywords:
Apgar score; Birth weight; Maternal outcomes; Neonatal outcomes; Umbilical cordAbstract
Objectives: To investigate risk factors and outcomes associated with a short umbilical cord.
Study design and setting: This study was conducted cross-sectionally at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital (KTH), Peshawar.
Methodology: A total of 134 pregnant women with singleton pregnancies were included in this study, using consecutive non-probability sampling, over six months from August 2, 2024, to January 31, 2025. Umbilical cord length was measured immediately after delivery and categorized as short (<35 cm), normal (35–80 cm), and long (>80 cm). Maternal outcomes assessed included mode of delivery, labor complications, and intrapartum events. Neonatal outcomes included birth weight, Apgar score, small for gestational age status, NICU admission, and perinatal mortality. Data were analyzed using SPSS version 26. Chi-square test was applied, and a p-value <0.05 was considered significant.
Results: Short cords were associated with higher rates of cesarean delivery (38.8%), fetal distress (29.9%), and NICU admission (16.4%). Long cords were more often linked to intrapartum complications such as cord prolapse (7.5%) and abnormal labor progression (12.7%). Neonatal outcomes revealed 23.1% low birth weight, 14.9% low Apgar scores, 9.7% small for gestational age, 16.4% NICU admissions, and 3.7% perinatal mortality. All associations were statistically significant (p <0.05).
Conclusions: Abnormal umbilical cord length is significantly associated with adverse maternal and neonatal outcomes. Early identification and monitoring may improve perinatal prognosis and guide timely interventions
References
1. Obeagu EI, Obeagu GU. An update on factors affecting
umbilical cord care among mothers: A review. Medicine
(Baltimore). 2024 Jul 12;103(28):e38945. doi: 10.1097/MD
.0000000000038945.
2. Hayes DJL, Warland J, Parast MM, Bendon RW, Hasegawa
J, Banks J, Clapham L, Heazell AEP. Umbilical cord
characteristics and their association with adverse pregnancy
outcomes: A systematic review and meta-analysis. PLoS One.
2020 Sep 24;15(9):e0239630. doi: 10.1371/journal. pone.
0239630.
3. Elsayed W, Sinha A. Umbilical cord abnormalities and
pregnancy outcome. Journal of Fetal Medicine.
2019;6(04):183-9. DOI: 10.1007/s40556-019-00217-7
4. Sherer DM, Al-Haddad S, Cheng R, Dalloul M. Current
Perspectives of Prenatal Sonography of Umbilical Cord
Morphology. Int J Womens Health. 2021 Oct 18;13:939-971.
doi: 10.2147/IJWH.S278747.
5. Kageyama S, Sato T, Iwama N, Hamada H, Saito M, Takase
K. MR Imaging of Umbilical Cord Variations, Abnormalities,
and Associated Placental Findings. Magn Reson Med Sci.
2025 Aug 6;24(3):366-386. doi: 10.2463/mrms.rev.2025-
0036.
6. Thangappah RB, Karnal CS, Ravichandran MR, Sowparnika
AS, Sundaravadivelu P. Clinical significance of umbilical
cord abnormalities: an observational study. International
Journal of Reproduction, Contraception, Obstetrics and
Gynecology. 2022;11(6):1727-34.
7. Beke A, Simonyi A. Association of neonatal and fetal
malformations with polyhydramnios and oligohydramnios -
introduction of a new "association factor". BMC Pregnancy
Childbirth. 2025 Jul 3;25(1):707. doi: 10.1186/s12884-025-
07797-5.
8. Xizi Wu, Da Zhu, Xinwei Shi et al. Clinical analysis of
prenatal stillbirth caused by umbilical cord torsion, 21 July
2025. https://doi.org/10.21203/rs.3.rs-6985153/v1
9. Ebbing C, Rasmussen S, Kessler J, Moster D. Association of
placental and umbilical cord characteristics with cerebral
palsy: national cohort study. Ultrasound Obstet Gynecol. 2023
Feb;61(2):224-230. doi: 10.1002/uog.26047.
10. Calcaterra V, Cena H, Pirazzi A, Sottotetti F, Cordaro E,
Cavallo C, Milanta C, El Masri D, Conti MV, Vandoni M,
Zuccotti G. From Pregnancy to Breastfeeding: The Role of
Maternal Exercise in Preventing Childhood Obesity. Nutrients.
2025 Feb 12;17(4):660. doi: 10.3390/nu17040660.
11. Jasani B, Torgalkar R, Ye XY, Syed S, Shah PS. Association
of Umbilical Cord Management Strategies With Outcomes
of Preterm Infants: A Systematic Review and Network Metaanalysis. JAMA Pediatr. 2021 Apr 1;175(4):e210102. doi:
10.1001/jamapediatrics.2021.0102.
12. Shafqat T, Hussain SS, Rahim R. Length of umbilical cord
and perinatal outcome. J Postgrad Med Inst 2020; 34(2): 115-
8.
13. Krakowiak P, Smith EN, de Bruyn G, Lydon-Rochelle MT.
Risk factors and outcomes associated with a short umbilical
cord. Obstet Gynecol. 2004 Jan;103(1):119-27. doi:
10.1097/01.AOG.0000102706.84063.C7.
14. Olaya-C M, Vargas W, Martinez RA, Peñaloza IF, Sanchez
M, Madariaga I, Aldana S, Bernal JE. Impact of umbilical
cord length on fetal circulatory system by Doppler assessment.
J Ultrasound. 2020 Dec;23(4):585-592. doi: 10.1007/s40477-
020-00495-2.
15. Dias Z, Kore S. Length of the umbilical cord and perinatal
outcomes: a study of 500 deliveries. Journal of OBGYN.
2023;9(2):228-32. DOI - 10.21276/obgyn.2023.9.2.7
16. Kalluru PKR, Kalluru HR, Allagadda TR, Talur M, Gonepogu
MC, Gupta S. Abnormal umbilical cord coiling and association
with pregnancy factors. J Turk Ger Gynecol Assoc. 2024 Mar
6;25(1):44-52. doi: 10.4274/jtgga.galenos.2023.2023-3-3.
17. Jan S, Qamar A, Javed MA, Zulfiqar S, Jamil S, Aziz M.
Umbilical Cord Coiling Index as A Marker of Perinatal
Outcome: Umbilical Cord Coiling Index for Perinatal Outcome.
Pakistan Journal of Health Sciences. 2024:209-14.
https://doi.org/10.54393/pjhs.v5i11.2426
18. Akhtar, N., Ghayur, M. S., Bangash, A. G., Akhtar, Z., Ambreen
Samad, & Riaz, S. (2024). Correlation Of Length Of Umbilical
Cord With Fetomaternal Outcome In Term Pregnancies.
Journal of Medical Sciences, 32(3), 276–280. https://doi.org/
10.52764 /jms.24.32.3.13
19. Li TG, Guan CL, Wang J, Peng MJ. Comparative study of
umbilical cord cross-sectional area in foetuses with isolated
single umbilical artery and normal umbilical artery. J Obstet
Gynaecol. 2022 Jul;42(5):935-940. doi: 10.1080/01443615
.2021.1962818.
20. Farsetti D, Barbieri M, Magni E, Zamagni G, Monasta L,
Maso G, Vasapollo B, Pometti F, Ferrazzi EM, Lees C,
Valensise H, Stampalija T. The role of umbilical vein blood
flow assessment in the prediction of fetal growth velocity and
adverse outcome: a prospective observational cohort study.
Am J Obstet Gynecol. 2025 Jul;233(1):66.e1-66.e14. doi:
10.1016/j.ajog.2025.01.001.
21. Soysal C, fiiflman H‹, B›y›k ‹, Erten Ö, Delilo¤lu B, Geçkalan
Soysal D, Keskin N. The relationship between umbilical cord
measurements and newborn outcomes. Perinatal Journal
2021;29(3):225–230. doi:10.2399/prn.21.0293008
22. Tonni G, Lituania M, Cecchi A, Carboni E, Resta S, Bonasoni
MP, et al., editors. Umbilical cord diseases affecting obstetric
and perinatal outcomes. Healthcare; 2023, 11(19), 2634;
https://doi.org/10.3390/healthcare11192634
23. Liang C, Xu Y. Analysis of factors associated with the umbilical
cord pitch value by ultrasound measurement in late pregnancy.
BMC Pregnancy and Childbirth. 2023;23(1):583.
https://doi.org/10.1186/s12884-023-05894-x
24. Gomes De Melo Tavares Ferreira A. An Evaluation of the
Physiological Variability Inherent in Common Maternal-fetal
Doppler Parameters: UNSW Sydney; 2021.https://doi.org/
10.26190/unsworks/23949
25. Singireddy N, Chugh A, Bal H, Jadhav S. Re-evaluation of
umbilical cord coiling index in adverse pregnancy
outcome–Does it have role in obstetric management? European
Journal of Obstetrics & Gynecology and Reproductive Biology:
X. 2024;21:100265. https://doi.org/10.1016 /j.eurox.2023
.100265
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