Umbilical Cord Problems

Umbilical Cord Presentation

• Definition: The umbilical cord is positioned at the internal cervical os before the fetal presenting part.
• Epidemiology: Occurs in about 0.6% of pregnancies.
• Clinical Features: Often asymptomatic; a soft, pulsatile mass might be palpable during pelvic examination.
• Diagnostics: Identified through obstetric ultrasound.
• Management:
  • Before Labor: Requires close follow-up with an obstetrician to plan for labor and delivery, considering either attempted vaginal delivery or scheduled cesarean delivery based on individual assessment.
  • During Labor: Preparation should be made for the potential of umbilical cord prolapse.

Umbilical Cord Prolapse

• Definitions:
  • Overt Prolapse: The umbilical cord descends into the cervical canal or vagina before the fetal presenting part following membrane rupture.
  • Occult Prolapse: The umbilical cord descends alongside the fetal presenting part into the cervical canal or vagina after membrane rupture.
    
• Epidemiology: Incidence ranges from 0.1% to 0.4%, with an estimated perinatal mortality rate around 10%.|
• Etiology: Can be iatrogenic (e.g., from artificial membrane rupture or insertion of transcervical balloon catheters). Risk factors include fetal malpresentation, prematurity, low fetal weight, long umbilical cord, grand multiparity, and uterine abnormalities.
• Diagnostics: Via pelvic examination (visible or palpable umbilical cord) and fetal heart rate monitoring (prolonged bradycardia or severe variable decelerations).
• Management: Immediate preparation for emergency delivery is crucial. Techniques to relieve cord compression and maintain fetal oxygenation include manually elevating the fetal presenting part, positioning the patient in Trendelenburg or knee-chest position, and considering manual reduction of the prolapsed cord if rapid vaginal delivery is the only option before cesarean delivery can be performed. Minimizing manipulation of the cord is essential to avoid vasospasm and fetal hypoxia.
  

Nuchal Cord

• Definition: The umbilical cord wraps 360 degrees around the fetal neck.
• Etiology: Typically results from fetal movements.
• Epidemiology:
  • Single loop around the neck occurs in about 16% of births.
  • Multiple loops are seen in approximately 4% of births.

Knotting of the Umbilical Cord

• Etiology: Usually due to fetal movements.
• Epidemiology: Occurs in about 1% of births.