The Role Of Total Umbilical Cord Area And Wharton’s Jelly Area In The Prediction Of Fetal Birth Weight In Late Third Trimester Chinese Patients With Gestational Diabetes Mellitus

Objective:The aim of this study was to investigate the relationship between total umbilical cord area, wharton’s jelly area and estimated fetal weight by ultrasonographic assessment in the late third trimester both in women having gestational diabetes mellitus and normal pregnant women.Materials and methods:The subjects included in the study consisted of37pregnant Chinese women divided into2groups. The first group (GDM group) consisted of13patients who were diagnosed with gestational diabetes mellitus whereas the second group (Control group) consisted of24pregnant women who had normal values on routine antenatal tests. Ultrasound examination was performed on all patients once, after34weeks of gestation and fetal anthropometric parameters such as biparietal diameter, head circumference, abdominal circumference and femur length were recorded for each patient. Estimated fetal weight was also measured according to Hadlock’s formula. In addition, the cross-sectional areas of the umbilical cord, the umbilical cord arteries and the umbilical cord vein were measured in a free loop of the umbilical cord,0.5cm away from the cord’s insertion into fetal abdomen for uniform measurements, making use of the software of the ultrasound machine. The correlation between Hadlock’s estimated fetal weight, total umbilical cord area and wharton’s jelly area was then evaluated in both groups. Results:There was a strong positive correlation between wharton’s jelly area (r=0.92), total umbilical cord area (r=0.85) and Hadlock’s estimated fetal weight in the late third trimester gestational diabetes patients. This same correlation with Hadlock’s estimated fetal weight was found to be weak in the control group of normal pregnant women (r=0.46for Wharton’s jelly area and r=0.32for total umbilical cord area). We also found that the wharton’s jelly area (p=0.02), total umbilical cord area(p=0.02) and Hadlock’s estimated fetal weight (p<0.001)were statistically larger in GDM patients when compared to normal pregnant women. There was also a strong positive correlation between wharton’s jelly area and total umbilical cord area in both GDM (r=0.89) and control group (r=0.91). Patients’clinical parameters such as maternal age, body mass index and gestational age were not statistically significant between the two groups.Conclusion:We came up with a simple yet effective method of predicting fetal birth weight and macrosomia in GDM patients. Umbilical cord and wharton’s jelly area measurement may be combined with the standard fetal biometric parameters to improve the accuracy of fetal birth weight estimation and facilitate the identification of fetal macrosomia in GDM patients, allowing it to be better managed without unnecessary intervention like Caesarian section in all cases, while possibly avoiding maternal morbidity and birth trauma due to operative delivery, shoulder dystocia, and birth asphyxia.