qí dài yì cháng 2 Introduction
During fetal development, the attachment position and length of the umbilical cord may be abnormal. Sometimes the umbilical cord can be twisted, knotted, or twisted. One of the umbilical arteries may be missing during development. Tumors can also grow on the umbilical cord. Therefore, the following abnormalities may occur in the umbilical cord. 3. Velamentous attachment of the umbilical cord
The attachment point of the umbilical cord is not on the placental membrane. The umbilical blood vessels begin to branch before they reach the fetal surface of the placenta, walk between the amnion and chorion, and become thinner before reaching the placenta. A part of the umbilical cord makes the structural relationship between the umbilical cord, fetal membranes, blood vessels and placenta look like a ship and a sail, so it is called the umbilical cord sail-like attachment. If the blood vessels in the fetal membranes are close to the cervix, natural or artificial rupture of the fetal membranes can damage the blood vessels and cause bleeding. If there is excessive bleeding, the fetus may die within a short period of time. When assisting in the delivery of the placenta during the third stage of labor, the umbilical cord is often pulled, causing the blood vessels in the fetal membranes to rupture, causing bleeding. Therefore, this disease should be considered when the childbirth process is normal but blood flows out with the amniotic fluid after membrane rupture, and the fetus appears in distress within a short period of time. Therefore, when performing artificial rupture of membranes, you should first determine whether there are vascular pulses on the fetal membranes. If so, try to avoid blood vessels or prevent early rupture of membranes as much as possible. If necessary, a cesarean section can be performed after the diagnosis is confirmed to avoid endangering the mother and baby. ?
Racket-shaped placenta Normally, the umbilical cord is attached to the center of the fetal surface of the placenta (75%) or in the central part (18%). If the umbilical cord is attached to the edge of the placenta and the umbilical blood vessels run normally on the fetal side of the placenta, it is called a racket-shaped placenta (7%). Of no clinical importance. 4 The umbilical cord is too short or too long
The average length of the umbilical cord is 55cm. According to literature reports, the shortest is 0.5cm and the longest can be 198cm. It has been reported that the umbilical cord is as short as the fetal surface of the placenta and is complicated by congenital umbilical hernia. If the umbilical cord is attached to the upper edge of the placenta and is shorter than 30cm or attached to the lower edge and is shorter than 20cm, it is called the umbilical cord is absolutely too short. If the umbilical cord wraps around the neck or limbs and the remaining umbilical cord is too short, it is called a relatively short umbilical cord. If the umbilical cord is longer than 70cm, it is called excessive umbilical cord. During delivery, an umbilical cord that is too short can cause umbilical cord rupture, early placental detachment and even uterine inversion, as well as obstruction of the descent of the presentation and a significant slowdown in fetal heart rate, especially the latter. When it is found during labor that the presentation decreases during uterine contractions, but returns to the original level when contractions stop, and the fetal heart rate slows down significantly during contractions, it should be thought that the umbilical cord is too short, and efforts must be made to end the labor in time. , to avoid causing intrauterine fetal death. An umbilical cord that is too long can easily become knotted or entangled (around the neck or body), or even prolapse. 5 Umbilical cord entanglement
Umbilical cord entanglement mostly occurs in the fetal neck, with an incidence rate of about 20%, and less frequently around the trunk and limbs. Among 1,000 births, Kan and Eastman found that 20.6% of cases had one loop of umbilical cord around the neck, 2.5% had two loops, and 0.2% had three loops. During delivery, the umbilical cord is compressed on the presenting side and the fetal blood circulation is blocked, which may lead to intrauterine distress or death. If you find sporadic fetal heart rate decelerations during delivery, you should think of umbilical cord entanglement. When the umbilical cord is wrapped around the neck, an umbilical cord murmur can be heard at the fetal neck. When the fetal head is pushed downward with hands, the fetal heart rate may slow down. After the fetal head is delivered, the umbilical cord around the neck should be clamped and cut immediately to avoid further obstruction of blood supply. When the umbilical cord wraps more than two times around the neck, the umbilical cord is generally tight around the neck. At this time, all the umbilical cords around the neck should be cut and the fetus should be delivered quickly. This will improve the blood supply to the fetus and avoid excessive Pulling on the placenta causes bleeding. When the umbilical cord wraps around the neck too many times or is too tight and the umbilical cord is relatively short, it should be treated as too short. If necessary, cesarean section can be performed to save the fetus.
6 Umbilical cord knotting
Umbilical cord knotting can be divided into true knots and false knots. The true knot of the umbilical cord is formed when the fetus' body passes through the surrounding umbilical cord circle. If the knot is too tight, it can affect the blood circulation and cause intrauterine distress or even death of the fetus. There are two types of umbilical cord pseudoknot. One is caused by the excessive accumulation of Walton's glue in the umbilical cord, or the twisting and kinking of veins in the umbilical cord, which is called varicose veins. The other type is that the umbilical artery twists and turns into a group, which is an arterial nodule. 7 Umbilical cord torsion
The umbilical cord is twisted in one direction into a rope shape, which is called umbilical cord torsion. It may be caused by the excessively long umbilical cord and excessive fetal movement. Torsion of the umbilical cord has no clinical significance if it does not affect the blood supply to the fetus. Excessive torsion of the umbilical cord can cause fetal death. 8 Umbilical cord rupture
It is a serious birth accident that often occurs in those whose umbilical cord is too short. Due to excessive pulling on the umbilical cord, the umbilical blood vessels may rupture, and severe bleeding may affect the fetus or even cause death. 9 Single umbilical artery
The normal umbilical cord contains two umbilical arteries and one umbilical vein. The umbilical cord lacks one umbilical artery during development and is called a single umbilical artery. It is extremely rare, occurring in approximately 1 in 12,000 births. Half and half are men and women.
About 1/3 of babies with a single umbilical artery have malformations, and the malformations are often multiple and severe. Esophageal atresia or congenital anatomy is the most common, and is more common in male infants. 10 Umbilical cord tumors
Umbilical cord tumors are relatively rare, and umbilical cord myxomas, sarcomas, and cystic teratomas have been reported. Umbilical cord cysts often contain remnants of the umbilical mesenteric duct or allantois and are formed by liquefaction of Walton's jelly in the umbilical cord.
11 Cord hematoma