Assessment of the umbilical cord outside of the delivery room. Part 2.

The umbilical cord is crucial to the growth and development of the fetus. Careful inspection in the delivery room and throughout the newborn period is essential. Part 1 of this 2-part series, entitled "Look Before You Clamp: Delivery Room Examination of the Umbilical Cord" (Advances in Neonatal Care, Vol. 2, No. 1, pp 19-26), reviewed umbilical problems that present in the delivery room. A number of subtle but significant umbilical cord abnormalities present outside the delivery room. These abnormalities will be the focus of Part 2 of this series. A review of the embryologic development of the umbilical cord enhances the clinician's understanding of umbilical abnormalities that present in the newborn period. The process of umbilical cord separation is outlined. Conditions associated with delayed cord separation are discussed. A systematic approach to the physical examination of the umbilicus is offered, with an emphasis on early detection of abnormalities. Common and uncommon physical findings, such as omphalitis, periumbilical necrotizing fascitis, vitelline duct remnants, and urachal anomalies are presented along with select photographs. A brief discussion of the clinical implications for newborn care is provided for the practicing clinician.