It is estimated that more than 7.6 million perinatal deaths occur each year worldwide; 4.3 million of these are foetal deaths 1. Ninety-eight percent of perinatal deaths have been said to take place in developing countries, and the perinatal mortality rate is estimated to exceed 55 per 1000 births, which is five times higher than in developed countries 2. The occurrence of foetal compression risk based on umbilical cord location and placental malformations are also unknown 23. After about four weeks of gestation the only link of the foetus to the placenta is the umbilical cord which begins to form around this time replacing the yolk sac. It develops from the extra embryonic mesoderm and becomes the channel for blood vessels, through which all exchanges and other activities of the mother and the foetus via the placenta are carried out. It is a cylindrical structure made up of a single layer of amniotic epithelium within which are two arteries and one vein embedded in a gelatinous ‘Wharton’s jelly’ which is mainly a mucopolysaccharides 4. At term the normal umbilical cord is about 55-65 cm in length with a diameter of 2.0-2.5 cm which normally insert centrally or eccentrically on the foetal side of the placenta 2. The umbilical cord is the mean by which oxygen, carbon dioxide, steroids and other products are carried to and from the foetus, and it also allows free movement of the foetus within the uterus and protects the umbilical blood vessels from mechanical injury 5. Due to its peculiar role of being the link between the placenta and the foetus, any abnormality of this cord, be it in the length, the amount of Wharton’s jelly, number of vessels or its amniotic epithelium may lead to abnormal foetal outcome 6. The study. It aimed to assess the morphological study on placenta and its relation to the neonatal outcomes.

Among 371 umbilical cords10 (2.7%) of were uncoiled Figure 1. (3.6) and 1 (0.3%) cords were with absent Wharton’s Jelly Figure 2. The mean diameter of the 371 umbilical cords was 2.1±0.24cm. Length was 53.8±3.8 cm length ranging from 48 – 62 cm as Table 1.

The mean gestational age of 371 neonates was 38 weeks ± 1.5 week. 138 (37.2%) were Preterm. APGAR score at 1 min and 5 min was 7, 8, 9 and 10 out of 10. Mean weight of 371 neonates was 2.9 ±.5 kg with 33.1±1.5 cm head circumference and 44.4±7cm of total length of the neonates. (Table 2).

In measure of neonates there were 72 (19%) were Low Birth Weight neonates (LBW). The mean birth weight of 371 neonates was 2.95±.5 Kg. Figure 3.

When umbilical cord parameters and neonatal outcomes were analyzed with Pearson’s correlation to find out the association between them, There was just significant strong positive correlation (r) between umbilical cord length (M=53.8 SD= 3.8 cm) and length of neonates (M=44.4 SD=7cm),(r= 0.72, p = 0.000). Increased umbilical cord length was associated with increased fetal length.

Umbilical cord diameter (M=2.1 SD=0.24cm) had a positive correlation with length of neonates (M=44.4 SD=7cm), (r= 0.45, p = 0.000) and negative correlation with weight of neonates (M=2.9 SD=.5 kg), (r= - 0.32, p = 0.000) and APGAR Score (M=8.9 SD=.5), (r= - 0.15, p = 0.05). That mean increased umbilical cord diameter is associated with increased fetal length and decreased fetal weight and their APGAR score. (Table 3)

In the present study, the minimum cord length was 48 cm and the maximum was 62 cm with a mean of 53.81 cm ± 3.82. There was just significant strong positive correlation (r) between umbilical cord length (M=53.8 SD= 3.8 cm) and length of neonates (M=44.4 SD=7cm), (r= 0.72, p = 0.000). The categorization of umbilical cords in the present study was based on previous studies. Umbilical cords less than 40 cm in length were considered short and between 40 cm to 70 cm were classified as normal with those longer than 70 cm being long. The present study showed that all the lengths of the umbilical cord in the normal range.

Although reference standards for the length of the umbilical cord have been reported, variations exist in the classification of short and long umbilical cords 58910. Classically, the umbilical cord continues to grow in length until birth with majority of umbilical cords nearly equally the same in length as the neonate. An observation made by Benirschke 11 showed that human umbilical cords develop steadily with growing gestation and foetal crown-rump length; and measures approximately 55 cm long at term with human neonates exhibiting wider variations in terms of the length of their umbilical cords. Results of several studies support this finding 1213. In spite, of these reports which try to address the issues of umbilical cord development, the control mechanisms of the length of the umbilical cord are still unclear 11.

The mean umbilical cord diameter in this study was 2.12 ± 0.24 cm with a range of 1.9 - 2.5 cm. The umbilical cord diameters obtained in the present study were different to the findings of Collins 160 who reported an average diameter of a normal cord to be 1.2 cm, it also appeared (1.2 and 1.4 cm) observed in another studies 1415. However, about 86.44% of the cords had diameters ranging from 1.0 cm to 2.0 cm. Based on previous studies by Eze et al. 15 and Collins 16, the mean umbilical cord diameter of 2.12 cm obtained in the present study appears to be within the normal range. Limitations of the study include that only the umbilical cord itself was investigated. Hegazy 17 stated that the anomalies of the cord include also its attachment to the fetal body such as omphalocele as well as its insertion in the placenta including eccentric, marginal and membranous insertions.

The present study suggests that ‘normal’ cord length should be between 40 cm and 70 cm in length. Umbilical cord diameter had a positive correlation with fetal length and negative correlation with fetal weight and APGAR score. The diameter range of 1-2 cm suggests that a normal cord must not exceed 2 cm in diameter. However the umbilical cord index had negative correlation with length of neonates.