Umbilical cord hazard 1: umbilical cord surrounding
There are many possible problems with umbilical cord, among which umbilical cord around the neck is the most common problem for expectant mothers. With the development and wide application of ultrasonic technology, it is not difficult to find umbilical cord around the neck. Once expectant mothers know that the baby is wrapped around the neck with umbilical cord, they will inevitably panic. It is difficult to generalize whether this panic is necessary because of fear of the baby's danger.
Six diseases easily caused by fetal umbilical cord during pregnancy
Frequency of umbilical cord around neck
According to statistics, about 20%~25% of the fetuses have umbilical cord around the neck, and only a few fetuses are deprived of oxygen or die because of umbilical cord around the neck. In other words, although a quarter of babies are bypassed by umbilical cord, most babies are born safely. Therefore, there is no need to worry too much.
Danger caused by umbilical cord around neck
Why is the umbilical cord wrapped around the neck? Under what circumstances will there be danger? Let's imagine.
In the second trimester of pregnancy, the baby floats comfortably in the warm amniotic fluid in the mother's womb, and the umbilical cord also floats. When the baby develops to a certain extent, it will move in the amniotic fluid, stretch its hands and feet, and even somersault. Most of the time, he can get along with the umbilical cord, but if he is not careful, he will be entangled in his hands, feet or body.
When the space is large enough, he can turn over and come out again, so sometimes the ultrasound examination sees the umbilical cord around the neck, and the next examination finds that it is not there. When the baby grows up, the swimming pool of amniotic fluid will become smaller for him, and he can't do much exercise. At this time, if he has an umbilical cord around his neck, it will not be so easy to come out.
Fortunately, the umbilical cord has a certain length. Many times, the umbilical cord around the baby's neck is loosely wrapped like a scarf. In this case, the umbilical cord and the baby's neck are not compressed and there is no danger. If the umbilical cord is not long enough, or the naughty baby wraps around the neck several times, the umbilical cord will tighten, affecting the baby's blood supply, and then the danger will come quietly. Because the umbilical cord is compressed, the supply of nutrition and oxygen is reduced, and the supply needed for baby growth is scarce, fetal growth retardation and even fetal distress will occur.
Another danger occurs during childbirth. During natural delivery, the fetus will open the cervix under the pressure of uterine contraction and descend along the birth canal. With the gradual decline of fetal position, the umbilical cord will gradually tighten. Under normal circumstances, the umbilical cord is long enough for the fetus to give birth safely. If there is an umbilical cord around the neck, its length will be relatively reduced, and it may be too tight to make the fetus hypoxic.
Diagnosis and treatment
When umbilical cord winding occurs, prenatal diagnosis can be made by checking whether the fetus has umbilical cord impression, and experienced B-ultrasound doctors can accurately measure the number of umbilical cord winding weeks. Check whether the entanglement affects the health of the fetus, and observe the changes of the fetal heart rate through electronic monitoring of the fetus. If the fetal heart slows down irregularly or the variation is too large, the umbilical cord should be considered to be pulled and squeezed.
The management of umbilical cord entanglement mainly depends on the progress of labor and the influence of umbilical cord entanglement on fetus. At the beginning of labor, if the fetus has hypoxia, cesarean section should be performed immediately. If abnormalities are found in the second stage of labor, the fetus should be delivered quickly. If the umbilical cord is found to be too tightly wound during delivery, it should be immediately clamped and cut.
Umbilical cord danger 2: Umbilical cord prolapse
One kind of umbilical cord abnormality is critical, and that is umbilical cord prolapse. We know that the normal fetal position is head position, that is, the fetus is head down. When the fetal position is incorrect or the fetus is too small, the umbilical cord is easy to slip from the gap to the lower part of the fetal presentation. At this time, once the membranes rupture prematurely, the umbilical cord will slide down first. If there is uterine contraction, the umbilical cord will be strongly compressed, so that the blood supply of the fetus will be sharply reduced or even interrupted, and the fetus will suffocate or even die in a short time.
What about umbilical cord prolapse during childbirth?
If the fetal membrane is intact and the umbilical cord is below the fetal presentation, it is called umbilical cord presentation; Umbilical cord prolapse is called umbilical cord prolapse after rupture of fetal membrane. Umbilical cord prolapse often occurs in abnormal fetal position, such as transverse position, breech position, polyhydramnios, pelvic stenosis or head-basin asymmetry. It often happens in patients with polyhydramnios, where the fetal membrane suddenly breaks, the umbilical cord rushes out with amniotic fluid, or the fetal membrane breaks prematurely, and the fetal presentation has not yet entered the basin.
Umbilical cord prolapse itself has no effect on parturient, and the risk of parturient is mainly caused by factors that induce prolapse. Moreover, due to the urgent situation, the operation rate of the fetus that needs to be delivered quickly has increased significantly, and the probability of maternal injury has also increased accordingly, such as cervical laceration and infection. For the fetus, the life of the fetus is seriously threatened, and the mortality rate is extremely high, reaching 40%, which is reported from 9% to 49% abroad. Its prognosis is obviously related to the time from prolapse to delivery. If the time from the beginning of fetal heart rate decline to fetal delivery is less than 20min minutes, the prognosis is better. Otherwise, the mortality rate is very high, and survivors will have neurological sequelae. Early detection and treatment of umbilical cord prolapse is the key.
Treatment of umbilical cord prolapse during delivery
1, the cervix is fully open, the fetus is alive, the headless basin is not weighed, the exposed part is low, and the head position can be assisted by surgery, including low forceps, and the breech position can be pulled.
2. If the uterus is not fully opened, the delivery conditions are not available, the fetal heart is good, and the family members are present, their consent should be obtained. If they are not present, they can explain the situation to the pregnant woman. After obtaining the consent and/or signature, cesarean section should be performed immediately. At this time, the pregnant woman lowers her head, and the examiner pushes the fetal head with the hand examined by * * * to make it leave the umbilical cord, so as to reduce the pressure on the umbilical cord and quickly perform in-situ cesarean section under local anesthesia. But be sure to listen to the fetal heart again before disinfecting the skin. Such as fetal heart rate
3, femoral heart and umbilical cord pulse has disappeared, the fetus is dead or dying, then * * * delivery.
4, postpartum umbilical cord length should be measured and check whether there is a low placenta.
Umbilical cord danger 3: the umbilical cord is too long and too short.
The average length of umbilical cord of normal full-term fetus is 55 cm. More than 70 cm is called umbilical cord too long, and less than 30 cm is called umbilical cord too short. Too long umbilical cord can easily lead to complications such as umbilical cord entanglement, knotting, prolapse and umbilical cord vascular compression. However, if the umbilical cord is too short, the pregnant woman and the fetus will not have any symptoms during pregnancy, but the fetus will be difficult to descend because of the short umbilical cord during delivery, or the fetus will be embarrassed because of the tight umbilical cord and the placenta will be peeled off early.
Diagnosis and treatment
By observing the changes of fetal heart rate by B-ultrasound and electronic monitoring, the umbilical cord can be diagnosed early. Too long umbilical cord itself does not need treatment, only when it causes complications such as winding, knotting and prolapse.
But if the umbilical cord is too short, it is difficult to diagnose by B-ultrasound. If the fetal descent is difficult and the labor process is prolonged, the fetal heart should be closely observed. If the fetal heart is abnormal, it can be diagnosed as fetal distress caused by umbilical cord factors at an early stage. Once these problems occur, cesarean section should be performed immediately. If there is any abnormality after entering the second stage of labor, it can be delivered quickly from * * *, and the umbilical cord should be clipped immediately after the delivery of the fetal shoulder.
Umbilical cord hazard 4: Umbilical cord torsion
Umbilical cord torsion means that the umbilical cord rotates and twists along the longitudinal axis, just like twisting hemp rope, it can return to normal as long as it rotates in the opposite direction. Umbilical cord torsion is related to fetal activity. In general, umbilical cord torsion can occur, but it should not be too much or too dense. Excessive torsion will interrupt blood circulation and lead to high fetal mortality.
Diagnosis and treatment
When severe umbilical cord torsion occurs, fetal movement first becomes frequent and then disappears. People with abnormal fetal movement should pay attention. If umbilical cord torsion is suspected, it should be decided according to whether the fetus is hypoxic and pregnancy.
Umbilical cord danger 5: Umbilical cord knotting
There are two kinds of umbilical cord knots, one is umbilical cord false knot, which is caused by the inconsistency between umbilical blood vessels and umbilical cord and the distortion of blood vessels in umbilical cord. It's not a real knot, and the fake knot can't be tightened, which is harmless to the fetus. The other is umbilical cord true knot, which is related to fetal activity. Usually occurs in the second trimester of pregnancy. First, the umbilical cord turns around, and then the umbilical cord knot is formed because the fetus passes through the umbilical cord. If the knot is not tight, it has no effect on the fetus. If tightened, it will block blood circulation and cause intrauterine asphyxia, or cause stillbirth during delivery.
Umbilical cord danger 6: single umbilical artery
Normal umbilical cord has two umbilical arteries and one umbilical vein. If the embryo develops abnormally, there is only one umbilical artery in the umbilical cord called single umbilical artery. Obviously, the fetal single umbilical artery blood flow is less than normal, so the chances of premature delivery, growth retardation and intrauterine hypoxia increase.
Diagnosis and treatment
Now most of them can be diagnosed by prenatal B-ultrasound. At present, there is no treatment for this abnormality, so we should pay close attention to the fetus. If there is no ischemia or hypoxia in the fetus, we can continue to be pregnant until delivery.