This is a prospective hospital - based study conducted in Wad Madani Maternity Teaching Hospital Gezira State.

This study on the umbilical cord and placenta of 371 neonates who born in the Wad Madani Maternity Teaching Hospital during the period of the study during the period of the study (between July 2014 and March 2018), all these were included criteria. Sample size was calculated according to the following equation formula (7):

n= is the sample size required

N= is the whole target population in question

P= is the average proportion of records expected to meet the various criteria (1-p) is the average proportion of records not expected to meet the criteria

A= is the margin of error deemed to be acceptable

c= is a mathematical constant defined by the Confidence Interval chosen

Data collection:-

Data has been classified into following three categories:

1. Maternal

2. Umbilical cord

3. Neonate details

Maternal details: Maternal details obtained from the case sheets of enrolled subjects, are as follows. Name (for file only), Hospital number, Age, LMP, EDD and term of gestation and Obstetric history.

Umbilical cord: Placental details collected as below:

(A) Umbilical cord diameter measured by Digital Gauge Vernier Calliper.

(B) Umbilical cord lengths measured by plastic meter.

Umbilical cords were collected immediately after the delivery and examined within 30 minutes after delivery. Then, they were measured immediately then washed well with running tap water to remove the blood clots. Gross morphological features, length and diameter of umbilical cord were noted.

Neonate details: The neonate details includes date of delivery (DOD), gender, APGAR Score at 1 minute and 5minutes, total length (Height), head circumference in centimeters, weight in Kilograms and anomalies if present were recorded from neonate s file immediately followed by the delivery. All the neonates followed up for their hospital stay to rule out anomalies. Newborn s birth weight < 2.5 Kg, 2.5 to 3.8 Kg and > 3.8 Kg has been considered as low birth weight, normal birth weight and large for gestational age (LGA) respectively. On the other hand gestational age (GA) less than 37 weeks has been considered as preterm, 37 to 42 weeks as term and more than 42 weeks was post term.

Data was analyzed by statistical package for social science (SPSS). Data was displayed by tables and histogram.

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.