Relationship between the morphology of the placenta umbilical cord and perinatal outcome

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To determine the relationship between the placenta, umbilical cord and the well being of the foetus, 256 placentae with attached umbilical cords obtained from KNUST Hospital and Victory Maternity home between 2004 and 2008 were studied. Average cord length was 44.8 cm (SD12.9, range 19.5cm-88.5 cm). Short cords, long cords and normal cords (40 to 70 cm) constituted 39.62%, 2.64% and 57.74% respectively. Majority (82.6%) of the cords had a diameter between 1.0 cm and 1.45 cm. Central, eccentric and marginal insertions constituted 60.75%, 21.14% and 18.94% respectively. Occurrence of furcate insertion of umbilical cord vessels into the placenta was 28% and non-furcate insertion was 72%. Placenta weight was 315g- 933g with a mean of 563.47g (SD= 132.31). Placenta diameter was in the range of 14 cm to 25 cm with a mean placenta diameter of 18.69 cm (SD= 2.05). The mean placental thickness was 2.65 cm (SD= 0.55) with a range of 1.3 cm to 6.0 cm. Foetal weight (birth weight) correlated significantly (p<0.01) with weight and diameter of the placenta, gestational age, maternal age, cord length and thickness of the placenta (p<0.05). Foetal length correlated significantly (p<0.01) with the weight and diameter of the placenta and the gestational age. Foetal head circumference also correlated significantly (p<0.01) with the weight and diameter of the placenta, cord length, cord diameter and thickness of the placenta (p<0.05). There was a higher incidence of short cords and marginal insertions among the study population compared to other literature. In addition, the umbilical cord was commonly positioned centrally or eccentrically. Furthermore, a normal cord must have length in the range of 40-70 cm, a diameter range of 1.0 to 2.0 cm and umbilical coiling index in the range of 0.08-0.19 coils/cm. There was no significant correlation between the intrauterine ultrasonographic measurements and the gross anatomical measurements (p>0.05) therefore intrauterine ultrasonography may be used as a guide for the determination of foetal well-being. vi
A thesis submitted in partial fulfilment of the requirement for the degree of Master of Philosophy in the Department of Theoretical and Applied Biology, 2009