umbilical cord prolapse
Introduction
Introduction to umbilical cord prolapse If the membrane is broken, the umbilical cord is further removed from the underside of the fetus, enters the vagina through the cervix, and even appears in the vulva through the vagina, called the prolapse of the cord. The umbilical cord is located in front of or on the side of the exposed part of the fetus, and the membrane is not broken, which is called the presentationofcord. The first exposure of the umbilical cord is actually a mild umbilical cord prolapse, also known as recessive umbilical cord prolapse. basic knowledge Sickness ratio: 2% Susceptible people: maternal Mode of infection: non-infectious Complications: fetal distress
Cause
Cause of umbilical cord prolapse
Heterosexual exposure (30%):
It is the main cause of umbilical cord prolapse. According to the statistics, 1 out of 500 cases (only 0.2%) occurred, and 1 case of 25 cases occurred in 4 cases (4%). The rate is higher. There is 1 case (14%) in every 7 cases. The ratio of umbilical cord prolapse is about 1:20:70 in the head position, breech position and transverse position. It can be seen that the umbilical cord prolapse and abnormality are exposed first. There is a close relationship, most of the gluteal first dew occurs in the foot first exposed, and the single hip first exposed can often be closely connected with the pelvic cavity, there are fewer umbilical cord prolapses, the posterior position of the pillow, the facial position and other abnormal heads first exposed or compound exposed , often does not completely fill the pelvic entrance, after the rupture of the membrane, the fetal head is connected, it is easy to induce umbilical cord prolapse.
Fetal head floating (20%):
Pelvic stenosis or excessive fetal development, the fetal head is not compatible with the pelvic entrance (the head basin is not called), or the maternal abdominal wall is loose. The fetal head is still high after the start of labor, the membrane is ruptured, and the impulse of amniotic fluid can cause the umbilical cord to escape. Especially flat pelvis, there is often a gap between the first exposed part and the entrance of the pelvis, and the fetal head is difficult to enter the basin, and the premature rupture of the membrane is easy to induce umbilical cord prolapse.
The umbilical cord is too long or the placenta is low (or has umbilical marginal attachment) (15%):
If the exposed part is commensurate with the pelvis, the length of the umbilical cord is not the main reason for the umbilical cord prolapse. However, when the fetal head is unable to connect, the umbilical cord is prone to prolapse when it is too long. According to statistics, there is 1 umbilical cord length in every 10 cases of umbilical cord prolapse. If the length of the umbilical cord exceeds 75 cm and the length of the umbilical cord exceeds 75 cm, the probability of prolapse is 10 times higher than that of the normal length of the umbilical cord (50 to 55 cm).
Premature or twin pregnancy (10%):
The latter is prone to occur before the second fetus is delivered, and may be too small with the fetus. The first exposure of the fetus cannot be closely linked to the entrance of the pelvis or the high incidence of abnormal fetal position.
Other (10%):
Such as early rupture of membrane, excessive amniotic fluid, the latter in the rupture of the membrane, because the intrauterine pressure is too high, amniotic fluid outflow is too urgent, the umbilical cord can be washed out by the amniotic fluid to form umbilical cord prolapse.
Pathogenesis
Before the birth, there is an influence of the first exposure, and there are more gaps between the first exposure of the fetus and the entrance of the pelvis, which can cause umbilical cord prolapse, such as breech position, transverse position, pelvic stenosis, disproportionate head basin and small fetus. There are also some contributing factors, such as premature rupture of the umbilical cord and excessive amniotic fluid. When the umbilical cord length exceeds 75cm, the chance of umbilical cord prolapse is 10 times that of normal. When the amniotic fluid is too much, the pressure in the amniotic cavity is high. The umbilical cord is easily rushed out.
Prevention
Umbilical cord prolapse prevention
1. Do a good job of prenatal examination, accurately estimate the ratio of the first exposure to the pelvis, and find and correct the abnormal fetal position in time.
2, strengthen the observation of labor and listen to the fetal heart sounds, usually equipped with equipment for rescue.
3, for the maternal fetal head floating and breech maternal, should rest in bed, not enema, check should be gentle, avoid early rupture of the membrane.
4, immediately after the rupture of the membrane to listen to fetal heart, if there is an abnormality and suspected umbilical cord prolapse may be, immediately do a vaginal examination, anal examination can not be a clear diagnosis, mild prolapse cases are often easy to miss diagnosis, and found umbilical cord prolapse No powerful processing can be done immediately.
5, strict control of artificial rupture of membrane induced labor indication: cervical mature, fully flattened, top exposed, fetal head connection, must be artificial rupture, should take high rupture of membrane to avoid umbilical cord with amniotic fluid out when the out.
6. If the fetal head is slightly floating and must be induced, the head basin should be excluded. After piercing the membrane, push the fetal head into the pelvic entrance, dress the abdomen, pay attention to the situation, and listen to the fetal heart sound.
Complication
Umbilical cord prolapse complications Complications, fetal distress, fetal death
The prolapsed umbilical cord is squeezed between the exposed part and the pelvis, and the blood circulation of the placenta is blocked, which can cause severe fetal distress, especially if the head is exposed first. When the umbilical cord is located behind the pubic symphysis, the pressure is very heavy, and the cord blood can be made. The flow is completely blocked, causing the fetus to die quickly, and can also cause fetal hypoxemia, hypoxia and the like.
Symptom
Symptoms of umbilical cord prolapse Common symptoms Fetal heart rate abnormal cord blood circulation disorder Fetus distressed fetal heart sound disappears (no... Fetal membrane rupture after umbilical cord detachment wound... Umbilical cord is too short or relatively short
The first exposure or prolapse of the umbilical cord has little effect on the mother. It only increases the surgical rate. It is very harmful to the fetus. The umbilical cord is exposed or prolapsed. The first exposed part of the fetus has not yet entered the basin. The membrane is not broken, but only in the palace. When the time is reduced, the first exposed part of the tire is forced to fall, and the umbilical cord may be abnormal due to temporary compression. If the exposed part of the fetus has been inserted into the basin, the membrane is broken, and the umbilical cord is pressed against the exposed part of the fetus and the pelvis. Between, causing fetal hypoxia, fetal heart rate must change, or even completely disappear, the head is the most exposed, the shoulder is the lightest, if the cord blood circulation is not more than 7 to 8 minutes, the fetus is dead.
Examine
Umbilical cord prolapse examination
According to the condition, blood, urine, routine, biochemical examination, electrocardiogram, B-ultrasound, Doppler and other tests are selected.
According to the relationship between rupture of membrane and fetal heart sound and vaginal examination, umbilical cord prolapse is not difficult to diagnose, but the key is to have an impression, especially pay attention to recessive prolapse. In addition, it is also required to judge fetal condition, fetal position and palace. The mouth is open to a large extent for rescue.
Diagnosis
Diagnosis of umbilical cord prolapse
diagnosis
1, fetal position is not correct, pelvic narrow or premature birth, etc., after the rupture of the fetal heart rate has changed, that should be considered the possibility of umbilical cord first exposed or umbilical cord prolapse, immediate vaginal examination, or without rupture, but fetal heart There is a change, do a vaginal examination, touch the cord in the anterior amniotic sac, and have a pulsation, the frequency of which is consistent with the fetal heart, then the umbilical cord can be diagnosed first, but should be distinguished from the umbilical cord-like attachment phase (the umbilical cord is active) Cable strip).
2, the membrane has been broken, the umbilical cord prolapse is easier to diagnose when the fetus survives, because the pulsating strip can be clearly touched in front of the first exposed part, the umbilical cord beat can disappear due to pressure, but can not be used Diagnose the fetus has died, should listen to the fetal heart sound at the same time, such as fetal heart sound disappeared to confirm the fetal death.
3, recessive umbilical cord prolapse, even if the vaginal examination is often unable to get a timely and clear diagnosis, it should be too short with the umbilical cord or the umbilical cord around the neck after the relatively short phase of the umbilical cord, the latter is too short umbilical cord often traction tire The head makes it difficult to fall, the labor process is prolonged, and the fetal head falls slowly. Generally, the clinical symptoms of fetal distress appear only after the exposed part of the late stage of labor is lowered into the pelvic cavity, and the recessive umbilical cord prolapse is mostly in the early stage of childbirth. That is, clinical symptoms appear.
4, after vaginal examination to confirm the umbilical cord prolapse, should also identify the opening of the cervix, the degree of fetal head decline, with or without the head basin, fetal position or abnormal fetal position, in order to determine the treatment plan.
If there is a cause of umbilical cord prolapse, you should be alert to the presence or absence of umbilical cord prolapse. If the membrane is not broken, the fetal heart rate will suddenly slow down after the contraction, change the position, push up and lift the hip and quickly recover. Should consider the possibility of umbilical cord recessive prolapse, fetal heart rate monitoring should be carried out after delivery, monitoring methods can be based on conditions, fetal monitors can be used at birth, ultrasound Doppler or stethoscope to monitor fetal heart rate and fetal organisms Physical monitoring to understand the condition of the fetus, and B-mode ultrasound can be used to help determine the position of the umbilical cord. It will be clearer with the vaginal probe. If the membrane has been ruptured, it should be vigilant. When the fetal heart rate is abnormal, the vagina should be used immediately. Check, pay attention to the presence or absence of umbilical cord prolapse and umbilical blood vessels with or without pulsation, can not force to touch, so as not to delay the treatment time and increase the pressure of the umbilical blood vessels, under the exposed side of the fetus or below the exposed part of the fetus and in the vagina touch the umbilical cord , or if the umbilical cord is removed from the vulva, the diagnosis is undoubted.
