Nonneoplastic placental conditions and abnormalities


Necrotizing funisitis

Topic Completed: 1 February 2016

Minor changes: 29 October 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Necrotizing funisitis umbilical cord

Paul J. Kowalski, M.D.
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Cite this page: Kowalski PJ. Necrotizing funisitis. website. Accessed December 3rd, 2021.
Definition / general
  • Definition: in long standing inflammatory processes, a fetal inflammatory response resulting in tissue necrosis and the accumulation of cellular debris that extends into the substance of the umbilical cord
  • Use of "funisitis" as a generic descriptor of inflammation without further comment as to its location (umbilical artery or vein, Wharton jelly, etc.) is generally discouraged
  • Inflammation may be localized to umbilical vein (phlebitis) or umbilical arteries (arteritis)
  • Inflammation at the periphery or surface of the umbilical cord may also be a primary pattern (peripheral funisitis), distinct from necrotizing funisitis
  • Not well documented but seen as a sequela in a minority of severe cases of chorioamnionitis or umbilical vasculitis
  • Microorganisms gain access to the placenta or umbilical cord either by ascending from the endocervical canal, by the maternal bloodstream or by direct inoculation, such as from a diagnostic procedure
  • In response, cytokines IL8, interferon gamma, complement components or leukotriene B4 are released by endothelium, mast cells and macrophages, creating a chemoattractant chemical gradient for neutrophils
  • Chemical gradient may be augmented by certain peptides released by microorganisms
  • Activated neutrophils marginate against the vascular endothelium and transmigrate through the vascular wall into the connective tissue of Wharton jelly
  • Eventually, immune complexes from microbiologic antigens precipitate and elicit a maternal antibody response through the transplacental passage of antibodies
  • Due to various longer term infections involving a wide range of bacteria, viruses, fungi or parasites
  • Classically described with congenital syphilis infection
Clinical features
  • Typically seen in association with chorioamnionitis (maternal inflammatory response including fever, tachycardia, leukocytosis or foul smelling amniotic fluid)
Radiology description
  • Inflammation induced calcifications within Wharton jelly can be distributed as a spiraled "barber's pole" on maternal radiographs
Prognostic factors
  • More severe inflammatory response is seen when funisitis is present in preterm infants, possibly accounting for some differences in gestational age related morbidity (Hum Pathol 2001;32:623)
  • Histopathologic severity may help predict certain neonatal outcomes (Placenta 2015;36:1490)
Case reports
  • Antibiotic therapy, particularly if symptoms of chorioamnionitis are present
Gross description
  • Cut surface of an involved umbilical cord may show concentric circles or chalky calcified arcs surrounding one or more umbilical vessels, distributed in successive "waves"
  • External surface of an involved umbilical cord is generally unremarkable unless accompanying peripheral funisitis is present
Gross images

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Waves of inflammation

Microscopic (histologic) description
  • Tissue necrosis and the progressive accumulation of inflammatory cells, cellular debris and fluid into the umbilical cord substance
Microscopic (histologic) images

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Cellular debris in Wharton jelly

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Various images

Electron microscopy description
  • Necrotic debris and inflammation can be seen surrounding one or more umbilical vessels, often appearing as concentric "waves"
  • Presence of immune complexes aggregated as arcs around vessels are analogous to the precipitin arcs seen in an Ouchterlony immunodiffusion assay
  • Calcification of the immune complexes or cellular debris can be partially or entirely encircling the vessel(s)
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