I have never seen a fetal treasure with such tenacious vitality, and he is still a master of weaving! This kind of umbilical cord, it is estimated that few people have even seen obstetricians~
Netizens ridiculed:
"Baby: I'm afraid of the cold, so I'll knit a scarf first."
"The umbilical cord is twisted, and this child's life is too hard."
"It's okay to weave, it's very measured, and you won't hang yourself."
Fetal umbilical cord knotting is a relatively common phenomenon during pregnancy, and the fetus and umbilical cord coexist in the amniotic fluid, which inevitably causes the phenomenon of entanglement and knotting. However, it is rare for the above twists and knots to be so serious.
When the fetus is in the mother's womb, the nutrients for growth and development and the oxygen that sustains life are transported from the mother's body through the "lifeline" of the umbilical cord. The umbilical cord plays a key role, so how harmful is it to the fetus when the umbilical cord detects abnormalities?
1. Umbilical cord presentation and umbilical cord prolapse
胎膜未破时脐带位于胎先露部前方或一侧，称为脐带先露（ presentation of umbilical cord） 或隐性脐带脱垂。 胎膜破裂时脐带脱出于宫颈口外，降至阴道内甚至露于外阴部，称为脐带脱垂（ prolapse ofumbilical cord）。
01
pathogen
1. When the fetal head is not connected, such as the head and basin are not symmetrical, and the fetal head is difficult to enter the basin.
2. Abnormal fetal position, such as buttocks and shoulders first, occipital posterior position.
3. The fetus is too small or has too much amniotic fluid.
4. The umbilical cord is too long.
5. Abnormal umbilical cord attachment and low-lying placenta, etc.
02
Impact on mother and child
●Maternal effects:
Increase the rate of caesarean section and surgical delivery.
●Effects on the fetus:
The umbilical cord presentation occurs when the fetal presentation is not connected and the fetal membranes are not broken, and the fetal presentation decreases during contractions, and transiently compresses the umbilical cord, resulting in abnormal fetal heart rate.
If the fetal presentation has been connected and the fetal membranes have been broken, the umbilical cord is compressed between the fetal presentation and the pelvis, causing fetal hypoxia and even the complete disappearance of the fetal heartbeat; The head presentation is the most severe, and the shoulder presentation is the lightest. If the blood circulation of the umbilical cord is blocked for more than 7~8 minutes, the fetus can die in utero.
03
diagnosis
When there are risk factors for umbilical cord prolapse, the occurrence of umbilical cord prolapse should be alerted. If the fetal membranes are not broken, the fetal heart rate suddenly slows down after fetal movement and contractions, and the fetal heart rate recovers quickly after changing the position, pushing the fetal presentation upwards and elevating the buttocks, the possibility of umbilical cord presentation should be considered, and fetal heart rate monitoring should be performed after labor.
If the fetal membranes have been ruptured and the fetal heart rate is abnormal, a vaginal examination should be performed immediately to check for umbilical cord prolapse and umbilical cord vascular pulsation. The diagnosis is confirmed by palpation of the umbilical cord near or in front of the fetal presentation, in the vagina, or in the absence of the umbilical cord from the vulva.
Ultrasound, particularly color Doppler ultrasonography, can help confirm the diagnosis.
04
treat
●Umbilical cord presentation:
Multiparous women, those with unbroken membranes and good contractions can give birth vaginally if the head is lowered and the buttocks are high, the fetal heart rate is closely observed, the fetal head is connected, the uterine opening is gradually expanded, and the fetal heart rate continues to be good. First-time women or those with foot presentation or shoulder presentation should undergo cesarean section.
●Umbilical cord prolapse:
If umbilical cord prolapse is found, the fetal heart rate is still good, and the fetus is alive, the fetus should be delivered as soon as possible.
(1) Open uterine opening: the fetal head has entered the pelvis, and forceps are performed; Gluteal traction is performed with gluteal presentation first.
(2) The cervix is not fully opened: the mother immediately takes the head and hips high, pushes the fetal presentation up, and applies drugs that inhibit uterine contraction to relieve or reduce the pressure of the umbilical cord; Closely monitor the fetal heart rate and perform a cesarean section as soon as possible.
05
prophylaxis
In the third trimester of pregnancy and after labor, ultrasonography can help detect umbilical cord presentation as early as possible. For those who delay the presentation of the fetus after labor, try not to do anal examination or vaginal examination.
2. Umbilical cord winding
When the umbilical cord surrounds the neck, limbs, or trunk of the fetus, it is called cord entanglement. 90% of them are around the neck with the umbilical cord, and most of them are around the neck for a week, accounting for about 20% of the total number of deliveries. The causes are related to the long umbilical cord, small fetus, polyhydramnios and frequent fetal movements.
The effect of umbilical cord wrapping on the fetus is related to the tightness of umbilical cord winding, the number of weeks of winding and the length of the umbilical cord. Clinical features include:
(1) Obstruction of the descent of the fetal presentation: the umbilical cord is wound and the umbilical cord is relatively shortened, which affects the fetal presentation into the pelvis, which can prolong or stagnate the labor process.
(2) Fetal distress: When the umbilical cord is stretched due to the number of weeks of winding, too tight, or the umbilical cord is compressed due to uterine contractions, the fetal blood circulation is obstructed and the fetus is hypoxic.
(3) Fetal heart rate variability: When the fetus is hypoxic in utero, frequent variable deceleration can occur.
(4) During color Doppler ultrasonography, the umbilical cord blood flow signal was found in the fetal neck.
(5) Ultrasound examination showed that there was obvious indentation on the skin at the umbilical cord entanglement, and the umbilical cord was wound for 1 week in a U-shaped indentation, containing a small circular attenuation mass, and a small short light strip was visible; The umbilical cord is wound for 2 weeks and is W-shaped; The umbilical cord is zigzag when wound for 3 weeks or more, and there is an attenuated band-like echo on it.
In the above situation, we should be highly vigilant about umbilical cord entanglement, especially when there is frequent deceleration of fetal heart rate monitoring, and the pregnancy should be terminated in time when the position cannot be relieved by oxygen inhalation. Prenatal ultrasound diagnosis is umbilical cord entanglement, and monitoring should be strengthened during delivery, and fetal distress should be dealt with in a timely manner.
3. Abnormal umbilical cord length
脐带正常长度为30～100cm，平均长度为55cm。 脐带短于30cm者，称为脐带过短（excssivelyshort cord） ；脐带超过100cm者，称为脐带过长（ excessively long cord）。
During pregnancy, the umbilical cord is too short and often has no clinical signs, and after labor, the umbilical cord is stretched too tightly due to the decline of the fetal presentation, which obstructs the fetal blood circulation, and the fetal heart rate is abnormal due to hypoxia; In severe cases, it can lead to placental abruption.
The descent of the fetal presentation is blocked, resulting in prolongation of labor, and the second stage of labor is the most prolonged. If the fetal heart rate does not improve after oxygen, the labor should be ended immediately by cesarean section. If the umbilical cord is too long, it is easy to cause the umbilical cord to wrap around the neck, tie knots around the body, prolapse or compress the umbilical cord.
Fourth, the umbilical cord is knotted
There are two types of umbilical cord knots: falseknot and trueknot. Umbilical cord pseudoknot refers to the fact that the umbilical cord blood vessel is longer than the umbilical cord, and the blood vessel is curled like a knot, or because the umbilical vein is longer than the umbilical artery, which is usually not harmful to the fetus.
The umbilical cord true knot is mostly the umbilical cord wrapping around the fetus first, and then the fetus passes through the umbilical cord sleeve to form a true knot. True cord knots are less common, occurring in 1.1% of patients. If the true knot of the umbilical cord is not tightened, there are no symptoms, and the obstruction of fetal blood circulation after tightening can lead to intrauterine fetal death. Most diagnoses are made after delivery.
5. Umbilical cord torsion
Lorsion of cord, fetal activity can cause the umbilical cord to twist in a spiral shape along its longitudinal axis, and physiological torsion can be up to 6-11 weeks. Excessive twisting of the umbilical cord narrows and becomes cord-like necrosis in the umbilical chakra near the fetus, causing vascular occlusion or thrombosis, and the fetus can die due to interruption of blood circulation.
6. Abnormal attachment of the umbilical cord
The umbilical cord is attached to the fetus and placenta. When the umbilical cord is abnormally attached to the fetus, omphalocele and gastroschisis can occur, and ultrasound examination can often confirm the diagnosis, and the choice of continuation or termination of pregnancy can be made according to whether the fetus has structural abnormalities and the prognosis is evaluated.
Normally, the umbilical cord attaches to the proximal center of the fetal surface of the placenta. If it is attached to the edge of the placenta, it is called the attledore placenta, and it does not have a great impact on the mother and child during delivery, and is usually found during the postpartum examination of the placenta. If attached to the fetal membranes, the umbilical cord blood vessels enter the placenta through the amniotic membrane and chorion, which is called cordvelamentous insertion.
Because the vasculature previa lacks the protection of Huatong gum, it is susceptible to compression by fetal presentation during contractions or rupture of blood vessels during rupture of membranes. It will lead to obstruction of umbilical cord blood circulation, fetal blood loss and fetal distress, and even sudden death. Because the velatic attachment of the umbilical cord is very harmful to the fetus, attention should be paid to the part of the umbilical cord attached to the placenta during ultrasound. In particular, if the placenta is found to be lower than normal on ultrasound in the third trimester of pregnancy, the placement of the umbilical cord should be further evaluated.
Important reminder: For pregnant women with high-risk factors for vasa previa, such as low umbilical cord or clamar attachment, bilobe placenta or paraplacenta, or pregnant women with vaginal bleeding, transvaginal Doppler ultrasonography can be performed. Pregnant women who have been diagnosed with umbilical cord sail attachment and vasa previa should be closely observed during pregnancy, and elective cesarean section should be performed after the fetus matures to reduce perinatal mortality.
7. The number of umbilical cord blood vessels is abnormal
A normal umbilical cord has three blood vessels, one umbilical vein, and two umbilical arteries. If the umbilical cord has only one artery, it is a single umbilical artery. Most cases can be detected by prenatal ultrasonography.
If ultrasonography reveals only a single umbilical artery and no other structural abnormalities, the neonatal prognosis is good, but if there are other structural abnormalities on ultrasound, there is an increased risk of chromosomal aneuploidy and other abnormalities such as renal hypoplasia, absence of anus, and vertebral defects.
Text and pictures come from the Internet