A Large Tortuous Umbilical Cord with Superficial Abdominal Wall Varicose Veins in a Newborn

Sara Soares; Ana Cristina Freitas; Cidade Rodrigues; Luísa Lopes; Carmen Carvalho; Sandra Pereira

doi:10.1542/neo.21-11-e774

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The Case

Term male newborn presented at birth with a varicose umbilical cord and a collateral abdominal circulation.

Prenatal, Birth, and Family Histories

Born to a 27-year-old gravida 2, para 2 woman
Nonconsanguinity in the family
Normal prenatal maternal laboratory screening and fetal survey
Benign prenatal course
Delivery at 39 weeks’ gestation via vaginal delivery
Apgar scores 9, 10, and 10 at 1, 5, and 10 minutes, respectively
Birthweight: 2,810 g (11th percentile); length: 47.5 cm (8th percentile); head circumference: 33.5 cm (15th percentile)

Presentation

After delivery, the infant’s umbilical cord appeared to be tortuous and twice the normal width; in addition, large centrifugal varicose veins were noted bulging under the adjacent skin and extending to the anterior abdominal wall (Figs 1–3). The infant appeared otherwise well but was transferred to the NICU for monitoring and further evaluation.

Figure 1.

Tortuous and twice the normal width umbilical cord and large centrifugal varicose veins extending to the anterior abdominal wall.

Figure 2.

Detailed frontal view.

Figure 3.

Lateral view of the abnormal umbilical cord.

Progression

Physical Examination (Newborn Day).

General: Active; normal color
Head and neck: Normocephalic; anterior fontanelle open and flat; neck veins not enlarged
Lungs: Regular respiratory rate, breath sounds bilaterally equal, no increased work of breathing
Cardiovascular: Normal S1 and S2, no murmur; femoral pulses present; capillary refill 2 seconds
Abdomen: Umbilical cord was tortuous and engorged to twice the normal width (no increase in vessel size during crying); centrifugal varicose veins were bulging under the …