Looking for a 3-Vessel Cord in Your Ultrasound

Cutting the Umbilical Cord of a Newborn Baby

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You may have heard at your ultrasound that you had a three vessel cord or that they were looking for a three vessel cord. What is a three vessel cord?

Let's start with the basics of the umbilical cord. The umbilical cord is the connection between your baby and the placenta. 

A normal umbilical cord has two arteries and one vein. This is known as a three vessel cord. It is covered by a thick gelatinous substance known as Wharton's Jelly.

The vein brings in oxygen and nutrients to the baby from the mother. The arteries are used to transport waste away from the baby to the mother via the placenta. The waste is then filtered through the maternal kidneys.

The umbilical cord starts to form early in pregnancy, around the fifth week of gestation. It will get longer and take the famous coil shape as it does. The average length of an umbilical cord is about 22 to 24 inches.

Placental Exam and Umbilical Cord Via Ultrasound

If you are having a mid-pregnancy ultrasound, also known as a fetal anatomy survey, your ultrasonagrapher will examine the placenta. They are looking for many things. They will try to see both the arteries and vein during your exam. This is easier with color Doppler ultrasounds, but blood flow can be shown with your average ultrasound machine. The size and location of the placenta and umbilical cord will be noted.​

Wharton's Jelly and Knots in the Umbilical Cord

The Wharton's Jelly is very thick and helps protect the arteries and vein from being compressed. The umbilical cord can loop around fetal parts and potentially knot in about 1% of all births. This is more common in identical twin pregnancies where one sac is shared or if your baby's umbilical cord is longer than normal.

Most knots remain loose and do not pose a threat to your baby, but these knots are believed to be the cause about 5% of stillbirths.

Fetal monitoring might suggest significant cord compression, and at times, if the fetal heart pattern is concerning, a cesarean birth may be recommended.

Umbilical Cord Cysts

Umbilical cord cysts are found in less than 1% of cords. There are two main types: true cysts and false cysts. False cysts are related to the Wharton's Jelly and filled with fluid. True cysts contain what's left over from early parts of the pregnancy. Management of cysts depends on the type, size, location, gestational age at detection and any associated anomalies. Most cysts resolve and do not predict poor outcome.

Single Umbilical Artery

About 1% of all babies will have a two vessel umbilical cord, which is a single artery (single umbilical artery) rather than two. You will also see this in about 5% of pregnancies where there is more than one baby (twins, triplets, etc.). When this is found, a more detailed ultrasound is advised to check for other abnormalities and to follow fetal growth. About 20% of babies who only have one artery in the umbilical cord will have malformations.

Vasa Previa

This is where a blood vessel from the cord is not protected by the Wharton's Jelly and actually crosses the cervix. This can lead to the tearing of the vessel during birth, dilation, or even simply pressure at the end of pregnancy.

Vasa previa is a very serious complication. Thankfully, it is rare, occurring in only 1 in 2000 to 3000 births.

Early diagnosis via ultrasound is the key to safe birth for this pregnancy. When diagnosed earlier in pregnancy, a cesarean is typically done around week 35 to prevent damage to the vessel. Typically, you may see painless bleeding in the second or third trimesters, or it is picked up at a routine ultrasound.

Velamentous Insertion

A velamentous insertion of the cord means that it inserts into the actual membranes rather than the center of the placenta. This leaves the vessels exposed in places, making it possible for them to become compressed as the baby gets bigger.

A Word From Verywell

The good news is that the vast majority of the time there are no complications with the umbilical cord. It is a fascinating structure that works with the placenta and baby.

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Article Sources
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  1. Balkawade NU, Shinde MA. Study of length of umbilical cord and fetal outcome: a study of 1,000 deliveries. J Obstet Gynaecol India. 2012;62(5):520-5. doi:10.1007/s13224-012-0194-0

  2. March of Dimes. Umbilical cord conditions. Updated June 2016.

  3. Weiner E, Fainstein N, Schreiber L, Sagiv R, Bar J, Kovo M. The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol. 2015;35(11):919-23. doi:10.1038/jp.2015.102

  4. Thummala MR, Raju TN, Langenberg P. Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg. 1998;33(4):580-5. doi:10.1016/s0022-3468(98)90320-7

Additional Reading
  • Gabbe, SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies, 5th edition. Churchill Livingstone Elsevier, 2007.

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