In Denmark, a Pure Pork concept for raising pigs without antibiotics was initiated in 2015 by the Danish Crown slaughterhouse cooperative. Pure Pork herds are characterised by minimal use of antibiotics and pigs are mainly treated individually. An increased prevalence of pigs suffering from umbilical outpouchings (UO) is a considerable challenge for Pure Pork producers. Umbilical outpouchings in pigs are challenging due to reduced welfare and increased workload and cost for the farmer. Therefore, Pure Pork producers require means other than antibiotic treatment to prevent UO. The primary objective of this study was therefore to evaluate the effect of autogenous sow vaccines based on bacteria isolated from the inflamed umbilici of piglets and a 7% iodine treatment at birth on the risk of pigs developing UO during the first 12 weeks of life. In addition, umbilical clinical and necropsy findings were presented, including variation over time and an identification of risk factors. A total of 5852 live-born piglets were included at birth from two Pure Pork herds. In this study, UO was defined as the presence of a rounded outpouching and/or a small firm protrusion at the umbilical area. Among 5614 pigs examined at weeks 5 and 12 and/or at death a total of 534 (9.5%) pigs were recorded with UO. The incidence of outpouchings was 10.2% for Herd A and 8.8% for Herd B. In the present field trial, neither autogenous vaccination of sows nor a 7% iodine spray on the umbilical area of new-born piglets had a statistically significant effect on the incidence of UO, but there was a tendency for a lower risk of UO in pigs treated with iodine spray at birth in one herd (OR = 0.7, p = 0.07), which might be worth investigating further. The risk factors for UO identified in this study included sow parity in one herd with more UO pigs from second parity sows and older compared to gilts (OR = 2.0, p = 0.02), batch in the second herd, and sex in both herds with male pigs at lower risk of UO development compared to female pigs (OR = 0.8, p = 0.006). Furthermore, antibiotic treatment as an indicator of the presence of other diseases resulted in a higher risk of UO compared to untreated pigs (OR = 1.9, p<0.0001). The presence of UO in one pig varied over time; For UO pigs examined alive at both week 5 and 12, 136 pigs (2.4%) had an UO record at week 5 but not at week 12 and 179 pigs (3.2%) did not have an UO at week 5 but a UO record at week 12. For 115 pigs (2.0%) an UO was recorded both at week 5 and week 12.