Umbilical cord is the link between fetus and mother and the bridge of fetal life. One end of the umbilical cord is connected with the umbilical wheel of the fetus and the other end is connected with the placenta. Umbilical cord consists of two umbilical arteries, one umbilical vein and a gelatinous tissue-Walton glue wrapped on their surfaces. Through the umbilical cord, the fetus obtains oxygen and various nutrients from the mother; Fetal metabolic waste is transported to placenta and mother through umbilical cord and excreted. Once the umbilical cord is abnormal, the blood flow will be blocked, resulting in fetal distress, intrauterine hypoxia, fetal growth retardation, neonatal asphyxia and other problems.
What are the main abnormalities of umbilical cord?
Umbilical cord missing: If the fetal umbilical cord wheel is closely connected with the placenta, or the umbilical cord is attached to the fetal membrane in a sail shape and bent in a cobweb shape, there is no obvious umbilical cord contour. Fetuses without umbilical cord are often accompanied by various malformations, such as anencephaly, visceral prolapse and umbilical hernia.
Single umbilical artery: There is only one umbilical artery in the umbilical cord, which is called "single umbilical artery". Single umbilical artery 1/4 fetuses are accompanied by cardiovascular malformations or other malformations, and the abortion, premature delivery and mortality rate are also significantly increased. Most pregnant women in single umbilical artery have a history of induced abortion and infertility, and a few have chromosomal abnormalities.
Umbilical cord is too short: the length of umbilical cord is shorter than 30 cm, which is called "umbilical cord is too short". Too short umbilical cord will cause umbilical cord vascular compression, spasm and hypoxia, affect fetal nutrition and excretion, cause dysplasia, even infarction and rupture, and endanger fetal life. Clinically, it is more common in pregnant women with a history of gynecological inflammation.
Umbilical cord is too long: the length of umbilical cord exceeds 70 cm, which is called "umbilical cord is too long". The umbilical cord is too long, which is easy for the fetus to wrap around the neck and limbs, and the umbilical cord is knotted, twisted and embolized, resulting in intrauterine hypoxia and developmental retardation; During delivery, the progress of labor is affected, and umbilical cord prolapse leads to stillbirth and stillbirth. Most of these pregnant women have a history of infertility or intrauterine surgery.
Too thick umbilical cord: pregnant women with too thick umbilical cord, also known as umbilical cord "swelling", often have accidents such as early placental abruption, premature rupture of membranes, fetal malformation, stillbirth and stillbirth. The reason is that pregnant women often suffer from diabetes or have a history of reproductive organ infection (endometritis).
Umbilical cord is too thin: the normal umbilical cord diameter is1~1.5cm, and it is often spirally wound. If the umbilical cord is obviously thinner than half of the normal diameter, it will hinder the nutrition and excretion of the fetus, leading to the birth of low birth weight infants and even the asphyxiation of the fetus. These situations mostly happen to pregnant women with a history of intrauterine surgery.
How can pregnant mothers find out whether the fetal baby has abnormal umbilical cord in time?
Pass the b-ultrasound examination.
What should I do if I find my baby's umbilical cord abnormal?
1. Conventional B-ultrasound examination is simple, rapid and economical, and it is a preliminary examination method for umbilical cord abnormality. On the B-ultrasound screen, the image of umbilical cord can be clearly displayed, and whether there is an "indentation" caused by umbilical cord winding in the neck can be seen. If the umbilical cord wraps around the neck, the number of turns of the umbilical cord around the neck can also be preliminarily judged.
2. When necessary, color Doppler examination, commonly known as color Doppler ultrasound, has high specificity and sensitivity in diagnosing various umbilical cord abnormalities. Regardless of amniotic fluid volume and fetal position, umbilical cord can be distinguished from neck-winding or neck-winding. More importantly, fetal hypoxia and distress can be found in time by detecting umbilical cord hemodynamics.
3. Fetal ECG monitoring before delivery. Fetal ECG monitoring is referred to as fetal heart monitoring. Umbilical cord entanglement can not be detected, but it can be used to detect fetal distress caused by abnormal umbilical cord before and during labor. For pregnant women with umbilical cord around the neck, we hope to receive fetal heart monitoring once a week after 37 weeks of pregnancy.
4. Family self-monitoring. All the above are the monitoring measures taken by the hospital after the umbilical cord was found around the neck. So how can expectant mothers further ensure the safety of their babies at home? Here we recommend a self-monitoring method for pregnant women-fetal movement count. Normal fetal movement is about 50 ~ 200 times/day, and its amplitude fluctuates greatly. Every pregnant woman has her own rules. If the umbilical cord around the neck has caused fetal distress, fetal movement will change significantly. Fetal hypoxia has excessive or frequent fetal movements in the early stage and decreased fetal movements in the late stage. Expectant mothers with umbilical cord around their neck should pay special attention to their fetal movement rules and changes, and see a doctor in time if they find any abnormality.
Once the umbilical cord prolapse is found and the fetal heart is not bad, it means that the fetus is alive and will give birth in a few minutes. If the cervix is completely opened and the fetal head has entered the basin, forceps or fetal head aspiration should be performed immediately; Hip traction should be performed in breech position, and fetal position and hip traction can be turned to assist delivery when shoulder is exposed. The latter two are easier for pregnant women to achieve; Have difficulty, especially primipara, to cesarean section. If the cervix is not completely open, they should have a caesarean section immediately. During the preparation period, the lying-in woman should keep her head down and her hips up, and if necessary, push the fetal exposure above the pelvic entrance by hand to reduce the umbilical cord pressure. The operator's hand is kept in the vagina, so that the exposed part of the fetus can't descend any more, so as to eliminate the pressure of the umbilical cord, and the umbilical cord should be disinfected before being put back into the vagina.
If the umbilical cord is exposed first, the fetal membrane is not broken, and the uterus contracts well, it can be delivered through the vagina. If it is breech defect or shoulder presentation, cesarean section is necessary.
If the cervix is not fully open, the fetal heart is good, and there is no condition for cesarean section, or the mother and her family do not agree to cesarean section, you can try to restore the umbilical cord to its original state. Because the success rate of umbilical cord replacement is not high, it should be explained to the parturient and their families that the fetal heart has disappeared for more than 10 minutes before operation. If it is confirmed that the fetus died in the uterus, the family should be informed of the situation and let it give birth naturally through the vagina. In order to avoid perineal laceration, craniotomy is feasible.