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Prolapse of the umbilical cord and small parts of the fetus
Last reviewed: 23.04.2024
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Loss of the loop of the umbilical cord and small parts of the fetus can be observed in case of outflow of amniotic fluid and absence of a contact belt between the mother's pelvis and the presenting part. This occurs with the transverse position of the fetus, anatomically narrow pelvis, large fetus, extensor insertions of the head, polyhydramnios, multiple pregnancies, premature birth. Umbilical cord proliferation is caused by its excessive length - over 75 cm.
The tactics of the doctor in each case is individual and depends on many circumstances.
The prolapse of the umbilical cord, especially in the head presentation of the fetus, is a serious complication for the fetus. It is rare. Preposition of the umbilical cord, according to the opinion of the majority of authors, reveals in 0.6% of births, umbilical cord prolapse - in 0,14-0,4%. Perinatal mortality in case of umbilical cord proliferation reaches 4-16%. About 50% of all cases of umbilical cord prolapse - iatrogenic etiology.
Distinguish between the presentation and prolapse of the umbilical cord. Under the presentation of the umbilical cord is meant to find it below the presenting part, but with a whole fetal bladder. After the outflow of water, a similar arrangement of the umbilical cord is called its fallout. When the umbilical cord falls, its loops may be in the throat of the uterus, into the vagina and even beyond the genital gaps. The prolapse of the umbilical cord contributes to fetal hypoxia, first, because of its cold irritation (bradycardia occurs in the fetus), and secondly, because of the possible squeezing of its present part. The fetal head can completely pinch the umbilical cord, stopping the blood flow and leading to the death of the fetus.
[How to recognize the presentation of the umbilical cord?
Diagnosis of presentation of the umbilical cord can be carried out with ultrasound and with vaginal examination, when the cervix has opened. You-drop of the umbilical cord at the head presentation is characterized by a persistent change in the heartbeat of the fetus after the outflow of amniotic fluid. The diagnosis is specified for vaginal examination.
Conduction of labor in case of prolapse of the umbilical cord and small parts of the fetus
Abaissement of the pulsating umbilical cord with incomplete opening of the cervix with head or other types of presentation of the fetus requires delivery by caesarean section. If the prolapse of the umbilical cord is detected with the full opening of the cervix and the head located in the cavity of the small pelvis, then it is necessary to perform the operation of applying obstetric forceps.
Abaissement of the umbilical cord in the parturient with a pelvic presentation of the fetus with full opening of the cervix is less dangerous, since the umbilical cord is compressed only when the shoulder girdle and fetal head pass. In this case, births are possible through the natural birth canal. However, with the appearance of signs of fetal distress and prolongation of labor, it is urgent to begin the operation of fetal extraction.
Falling of the handle in head prefusion is very rare, most often it is next to the head. With small fetal size and normal pelvic size, this increase in the fetal part usually does not interfere with its birth. If insertion of the presenting part does not occur, then a caesarean section is performed.
Falling of the handle or leg in the oblique or transverse position of the fetus after the passage of amniotic fluid occurs frequently. At present, these fetal positions are an indication to the caesarean section. Therefore, with the fallout of small parts of the fetus and the absence of contraindications to operative labor, a cesarean section is performed. Dropout of small parts and umbilical cord in the presence of a dead fetus is an indication to a fruit-destroying operation.