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American Journal of  
Life Science and Innovation (AJLSI)

Case Report Isolated Umbilical Cord Cyst in Second and Third Trimesters
Khadeeja Yahya Othman Idrees1*, Hassan Osman Ali Hemet2

Volume 2 Issue 1, Year 2023
ISSN: 2833-1397 (Online)

DOI: https://doi.org/10.54536/ajlsi.v2i1.1261
https://journals.e-palli.com/home/index.php/ajlsi

Article Information ABSTRACT

Received: February 01, 2023

Accepted: February 14, 2023

Published: February 19, 2023

The cyst might be solitary or numerous (more frequent). While single cysts are attributed 
to favorable perinatal outcomes during the initial stages of  pregnancy, the presence of  
numerous different umbilical cord cysts, their persistence in the second and third 
trimesters, and their conjunction with other ultrasonographic anomalies are linked to a 
higher probability of  a miscarriage, aneuploidy, or other complexation. The majority of  the 
material on postoperative complications and treatment adherence of  foetuses with 
umbilical cord cysts is minimal.  We wanted to show the result of  a third-trimester foetus 
with an isolated umbilical cord cyst. Due to foetal distress, the baby was delivered by 
emergency caesarean surgery at 39 weeks gestation. The infant seemed fine and cried 
immediately. It should be taken into account that large umbilical cysts, in the event of  rapid 
proliferation, may pressure the cord vessels and cause foetal discomfort. It is essential to 
consider the ultrasound examination of  the umbilical cord as one of  the essential aspects 
of  the test. In addition, it is advised to ascertain that a karyotype is necessary when we 
discover this issue with related abnormalities.

Keywords

Umbilical Cord Cysts, Allantoic 
Cysts, Foetal Abnormalities, 
Congenital Malformation, 
Prenatal Diagnosis

INTRODUCTION
The umbilical cord stands as an important link between 
the placenta and the developing foetus. It keeps a constant 
connection at the maternal-fetal interface. The umbilical 
cord allows the foetus to move, acquire motor skills, and 
mature. High-resolution obstetric ultrasonography is 
frequently used, which has made it possible to thoroughly 
examine the foetus, placenta, and umbilical cord (Hayes et 
al., 2020)The clinical significance of  an umbilical cord cyst 
in a pregnant woman is debatable. The long-term outlook 
and outcome of  infants with this cord anomaly are yet 
unknown because the details of  affected pregnancies are 
mostly based on case report findings. The purpose of  
this study was to characterize a foetus’ prognosis with an 
isolated umbilical cord in the third trimester(Zangen et 
al., 2010).

LITERATURE REVIEW
Umbilical cord abnormalities (UCA) are conditions in 
which fetal blood flow is diminished or terminated due to 
changes in the anatomy or function of  the umbilical cord. 
UCA was associated with adverse pregnancy outcomes 
such as stillbirth, birth hypoxia, and emergency Caesarean 
section. However, estimates of  UCA’s involvement in 
these outcomes differ; for example, UCA is said to cause 
3.4% to 20% of  stillbirths. Some variations could be 
attributed to several stillbirth classification systems, not 
all of  which specify UCA as a cause of  death (Hayes et 
al., 2020). The study (Zangen et al., 2010) evaluated the 
prognosis and clinical approach for fetuses with umbilical 
cord cysts during the second and third trimesters of  

pregnancy. Parental Karotype testing was employed to 
analyze umbilical cord cysts during pregnancy.  According 
to the study, it was determined that umbilical cord cyst 
occurrence during the first trimester ranges from 0.4% to 
3.4%. The incidence of  umbilical cord cysts in the second 
and third trimesters was unknown, and prior research 
has been limited to case reports. There is a variation in 
diagnostic value and prognosis of  umbilical cord cysts 
in the first and second trimesters (Zangen et al., 2010). 
Most studies conclude that most first-trimester cysts are 
transitory and have no negative impact on pregnancy 
outcomes (Rempen, 1989; Skibo et al., 1992). 
Additionally, a study (Zangen & Yaffe, 2009) elucidated 
that sonographic advances have enhanced parental 
detection of  foetal umbilical cord and placental 
abnormalities. In the first trimester, the prevalence of  
umbilical cord cystic masses ranges from 0.4% - 3.4%. 
Umbilical cord cysts in the second and third trimesters 
are a rare sonographic finding, and their prevalence is 
unknown. There is a strong link between umbilical cord 
cysts and fetal abnormalities, but it is not ubiquitous 
(Zangen & Yaffe, 2009). 
Furthermore, another study (Campo et al., 2017) indicated 
the complexity of  parental diagnosis of  umbilical 
cord cysts. The study stated that small cysts could be 
identified in up to 3% of  first-trimester pregnancies. 
They are typically accompanied by additional structural 
or chromosomal anomalies (up to 20%). If  they grow in 
size and persist, they potentially endanger the fetus by 
restricting blood flow through the umbilical cord, either 
through compression or thrombosis (Campo et al., 2017). 

1 MBBS University of  Science and Technology, Specialist Obstetrics and Gynecology at King Fahad Hospital, Saudi Arabia
2 Master Degree Advanced Ultrasound in Obstetrics and Gynecology, Consultant Obstetrics, and Gynecolog, Saudi Arabia
* Corresponding author’s e-mail: khadeejaosman2@gmail.com

https://doi.org/10.54536/ajlsi.v2i1.1261
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Case report
History
A 35 years old lady with gravida 6, para 3, and abortus 2, 
all through normal vaginal delivery (NVD), came to King 
Fahad Hospital for Antenatal Care (ANC) at 26 weeks 
gestational age according to her last menstrual period of  
induced pregnancy due to 6 years of  secondary infertility. 
The patient had a regular antenatal visit at a private 
health center which made her pregnancy uneventful 
throughout. Her vital signs and physical assessment were 
unremarkable. The patient has not been prescribed any 
chronic medication except for some health tonics. The 
medical, surgical, and family history of  the patient is 
unexceptional.

Examination
The patient appears quite well, not pale or cyanosed. 
Her blood pressure was recorded at 100/80 mm 
Hg. Her pulse rate was 100 per minute, whereas the 
respiration rate, body temperature, and Body Mass Index 
measurements were 20, 30°C, and 30 kg/m2, respectively. 
The fetus’s gestational age was observed to be 30 weeks, 
corresponding to the date.

Investigation
The investigations revealed the patient’s hemoglobin to 
be 11 gm/dl. The blood group was determined to be 
AB+ve, and the urine profile was clear. A liver function 
test and renal function test were conducted, and the result 
of  both appeared to be normal. Karyotyping was not 
done due lack of  the facilities
U/S: During the early ultrasound, a 3cm unilocular cyst 
in the cord surrounding the umbilicus was noticed. The 
linear ventral wall was not affected. The cyst’s echo 
texture was homogeneous and resembled amniotic fluid. 
Umbilical veins emerge from the cyst (Figure. 1, 2, and 
Figure. 3).

Figure: 1 Unilocular cyst within the cord with homogenous 
echo texture similar to amniotic fluid, the ventral wall is intact

Figure: 2 Umbilical vessels seen splay around the cyst. 
The cord’s allantoic cyst was presumed to be diagnosed. 
At 30 weeks, a second ultrasound revealed that the cyst 
had grown to 4.6 cm in diameter (Figure. 3).

Figure: 3 Umbilical cord at 30 weeks’ Cross sections 
of  the cord can be seen in the diagram above, with 
vessels splaying around a core cyst and a more peripheral 
pseudo cyst. Serial sonograms revealed normal foetal 
development, fluid, and Doppler assessment of  the 
umbilical cord, but cord oedema appeared at 30 weeks’ 
gestation. Fetal monitoring and amniotic fluid evaluations 
were carried out twice a week, which was promising.

Management 
The patient was referred to Fetal Medicine Unit (FMU) 
for a routine scan, and the congenital malformations were 
ruled out, so she went for a 2-week ANC to monitor fetal 
growth and to check for any symptoms of  Intrauterine 
growth restriction (IUGR), abnormal umbilical artery 
Doppler). Also, the patient opted to have a normal 
vaginal birth unless there is a fetal cause for Caesarean 
section (C.S.), such as severe IUGR. 

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An emergency C.S. delivered the baby due to fetal 
distress at the gestation week of  39 weeks. The baby 
cried immediately after birth, weighed 3.1 kg, and 
looked healthy and normal with no apparent congenital 
malformation. All the tests, including abdominal, pelvic, 
and bladder ultrasound conducted, came out normal, 
and a urologist and pediatrician saw the baby, and all 
investigations were normal. The patient was discharged, 
and the baby was followed up after four months with no 
complications and looked healthy.
 
DISCUSSION
Allantoid cysts are real umbilical cord cysts. They grow 
from persistent allantois structures, and due to their 
connection to the bladder, the cysts contain urine. The 
cord vessels are divided by the central allantoid cysts 
of  the umbilical cord. A correct prenatal diagnosis is 
essential since allantoid cysts are not associated with 
chromosomal abnormalities (Bouariu et al., 2021). 
Despite having a connection to the bladder of  the urine, 
allantois disappears during the seventh embryonic week. 
(Bunch et al., 2006a; Sadler, 2018). Urine passing through 
a patent allantois may cause the development of  allantoid 
cysts with their centers in the urethra. These cysts 
frequently divide the vasculature of  the umbilical cord. 
Third-trimester spontaneous rupture of  allantoid cysts 
is the norm (Matsui et al., 2007; Weichert et al., 2009). 
With ultrasonography, a patent allantois can be identified 
(Bunch et al., 2006b; Fuchs et al., 2008; Matsui et al., 2007; 
van der Bilt et al., 2003).
Any cystic lesion, or fluid-filled sac, on the umbilical 
cord is regarded as an umbilical cord cyst. They can be 
discovered in any place along the umbilical cord and 
commonly appear between blood vessels. They have 
uneven forms. A patient could have one or more than 
one cysts. Doctors use ultrasound technology to identify 
umbilical cord cysts most prevalently during the first 
trimester. First-trimester umbilical cord cysts typically 
have no repercussions on pregnancy, foetal development, 
or delivery. If  a placental cyst is connected near where the 
umbilical cord is attached, it may slow the development 
of  the foetus. To guarantee the proper flow of  blood via 
the umbilical cord, a doctor should keep a close watch on 
any placental cysts that are present close to the placement 
of  the chord. (Babay et al., 1996). However, complications 
are more likely to occur if  cysts persist into the second or 
third trimester. (Chen et al., 2020). They may come with 
an increased risk of  miscarriage or structural anomalies 
if  they are combined with other abnormalities. There are 
two kinds of  cysts in the umbilical cord (Ross et al., 1997).

True cysts 
A real cyst forms at the placental end of  the umbilical 
cord just before it joins the baby. The embryo’s fluid is 
contained in a tiny strand of  the umbilical vesicle. They 
typically range in size from four to sixty millimeters. True 
cysts typically disappear by themselves (Zangen et al., 
2010).

False cysts
False cysts, also known as pseudo cysts, are more 
prevalent than real cysts. They can arise at any point 
along the umbilical cord. A false cyst contains fluid from 
Wharton’s jelly or the cushiony substance between blood 
vessels. (Kausha et al., 2019) They can grow as large as 
six centimeters. False cysts may relate to chromosomal 
anomalies or genetic conditions in the baby (Nicolaides, 
2004).
At various stages of  pregnancy, umbilical cord cysts can 
be detected with ultrasound. During the first trimester, the 
frequency of  occurrence of  umbilical cord cysts ranges 
from 0.4 to 3.4% (Ghezzi et al., 2003). It is unknown 
how frequently umbilical cord cysts occur during the 
second and third trimesters, and previous research has 
only focused on case reports or small series. Umbilical 
cord cysts in the first and second trimesters vary in 
their clinical significance and prognosis. The majority 
of  studies conclude that most first-trimester cysts are 
brief  and do not affect the outcome of  a pregnancy. 
However, the prognosis appears to be comparable to that 
of  second-trimester cysts in cases of  chronic cysts (Fox, 
1978). Nevertheless, a few case reports/studies examine 
the outcomes of  pregnancies involving umbilical cord 
cysts, and these may provide some insight into the matter.
13 cases of  abnormalities in umbilical cord cysts in the 
second and third trimesters were found in a U.K. study. 
Similar to the findings of  our case report, they reported 
two isolated, clear cysts on the umbilical cord with no 
apparent congenital malformation.
(Sepulveda, 2003) reported very different results. 13 
foetuses with umbilical cord cysts throughout the second 
and third trimesters of  pregnancy were reported, along 
with their results. Further sonographic observations 
were recorded in 11 of  them. Ten of  these foetuses 
underwent prenatal karyotype testing, which detected 
aneuploidy in 7. There were several abnormalities in two 
of  the three cases, with normal karyotypes and an isolated 
omphalocele in one of  the cases.  In a further case with 
isolated omphalocele, karyotyping was not performed. All 
chromosomally aberrant babies died in utero or during 
the neonatal period, as did two chromosomally normal 
foetuses with numerous concomitant morphological 
abnormalities. 
Even though the (SMITH et al., 1996) study detailed the 
results of  three cases involving umbilical cord cysts, one 
cannot be compared to this study because the patient 
did not provide the first-trimester report, and the cyst 
continued to grow until the third trimester. In that study, 
a transient cyst was discovered at the end of  the first 
trimester, and it disappeared in the second trimester with 
a typical outcome.
According to a 2015 study from the United Kingdom, 
after the exceedingly rigorous anatomical screening, the 
umbilical cord cyst was the sole abnormal diagnosis in 
seven of  the 10 cases reported, while polyhydramnios 
and suspected IUGR without structural problems were 
also detected in one case. In each of  these scenarios, 

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normal newborns were delivered. Moreover, this is what 
this study is expected to reveal. Findings support previous 
results that second and third-trimester umbilical cord 
cysts are related to foetal abnormalities. However, the 
prevalence of  anomalies appears to be significantly lower, 
and the clinical outcome is frequently good.
Taking into account all of  these diverse study findings and 
assuming that there is no obvious congenital abnormality 
and no IUGR, it is appropriately considered to marginalize 
chronic urachus by a specialized doctor after delivery. 
All studies show a link between second- and third-
trimester umbilical cord cysts and foetal abnormalities. 
Fetal abnormalities were seen in 80-85% of  the cases 
reported by (Sepulveda, 2003; SMITH et al., 1996). (Ross 
et al., 1997) found a perfect association between chronic 
second-trimester cysts and abnormalities. In 38% of  the 
instances, (Shipp et al., 1995) found foetal abnormalities. 
Unfortunately, karyotyping was not performed on 
our patient due to a lack of  facilities; nonetheless, the 
absence of  obvious congenital abnormalities minimizes 
the possibility of  having chromosomal abnormalities 
(Kilicdag et al., 2004).

CONCLUSION 
An umbilical cord cyst is a medical condition that affects 
fewer than one percent of  women and typically does 
not represent a risk to the infant. Accurate evaluation 
of  the embryo, fetus, placenta, and umbilical cord has 
been made possible by the widespread use of  high-
resolution obstetric ultrasound. In isolated cases, there is 
no increased risk of  recurrence of  umbilical cord cyst. 
Performing an accurate evaluation of  the umbilical cord 
during the routine ultrasound pregnancy examination is 
essential. The need for a fetal karyotype must be taken 
into consideration if  other abnormalities are found during 
a comprehensive ultrasound examination in the event of  
a cord cyst diagnosis.

RECOMMENDATIONS
To reduce maternal and neonatal morbidity and mortality 
due to umbilical cord cysts, I recommend that obstetricians 
and gynecologists be well-trained in obstetric ultrasounds. 
Suppose a patient is diagnosed with an umbilical cord 
cyst. In that case, she should have a detailed ultrasound 
examination of  fetal karyotyping for non-isolated cases. 
If  any cord cyst is suspected, it should be immediately 
referred to FMU to confirm the diagnosis. In case of  
congenital malformation associated with umbilical cord 
cyst, the problem should be ruled out on priority.
There should be close growth monitoring for the 
detection of  IUGR. A multidisciplinary team should be 
appointed to determine the mood of  delivery, and the 
presence of  a pediatrician must be assured at the time of  
delivery. Assessment of  persistent urachus or any urachus 
abnormalities should be ruled out after delivery. Most 
important of  all, the mother should be schooled about 
the process and the case after that. 

Acknowledgment 
I sincerely thank my family and appreciate my professors 
and instructors for their help and dedication and for 
providing their endless skillful support aiming to improve 
our skills and knowledge.

Competing interests  
There is no conflict of  interest, financial or otherwise.

Consent for publication
The authors agree to the final version of  the paper.

Funding
No funding sources are reported. 
 
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