52 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Can you make the right diagnosis? Picture Quiz Quiz Figure 2 Figure 4 Figure 3 Figure 1 Answers and Discussion Figure 1. Narrow Umbilical Cord Without Wharton’s Jelly In neonates born at postmaturity and with oligohydramnios, the umbilical cord is narrow and lacks Wharton’s jelly. As there is no Wharton’s jelly to cushion the cord, cord compression is observed. Figure 2. Fusion at the Thorax and Upper Part of the Abdomen in Thoracopagus Conjoined Twins Thoracopagus conjoined twins are attached at the thorax and upper part of the abdomen, with a single site of umbilical cord insertion. This is a typical posture of conjoined twins, in whom the heads are hyperextended, and the backs are relatively straight. Figure 3. Calcification of Scalp Veins Intravenous infusion of sodium bicarbonate and calcium gluconate results in calcification of scalp veins. Necrosis can be deep in some areas after infiltration from intravenous solutions containing calcium. Figure 4. A Chest Radiograph of a Neonate With Down’s Syndrome, Showing 11 Ribs, Cardiac Enlargement, and Enlarged Thymus Although 11 ribs are seen in normal neonates also, this condition is very common in neonates with Down syndrome, including the cardiac enlargement and enlarged thymus. Normally, healthy neonates may even have 13 ribs.
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