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Umbilical Cord Prolapse

Prolapse of the Umbilical Cord


Presentation

  • 763.4 anteversion, cervix or uterus 654.4 atony, uterus 661.2 bicornis or bicornuate uterus 654.0 breech presentation (buttocks) (complete) (frank) 652.2 brow presentation 652.4 cephalopelvic disproportion (normally formed fetus) 653.4 chin presentation[icd9data.com]
  • The frequency of cord prolapse in vertex presentation was 0.24%; breech 3.5% and transverse 9.6% in a review by Barclay. 14 The majority of events occur in cephalic presentations due to the infrequency of nonvertex presentations.[doi.org]
  • CONCLUSIONS: Umbilical cord prolapse is more common in cases of preterm delivery, non-vertex fetal presentation, and spontaneous rupture of membranes.[ncbi.nlm.nih.gov]
  • The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%).[ncbi.nlm.nih.gov]
Hypoxemia
  • A fetal heart rate pattern (see Fetal Monitoring ) that suggests cord compression and progression to hypoxemia (eg, severe bradycardia, severe variable decelerations) may be the only clue.[msdmanuals.com]
  • MATERIAL AND METHODS: Among all 102 infants with CP who were preliminarily determined as caused by antenatal and/or intrapartum hypoxemia by the Japan Council for Quality Health Care until April 2012, all 56 infants who met all of the following criteria[ncbi.nlm.nih.gov]
  • Enhanced Umbilical Blood Flow During Acute Hypoxemia After Umbilical Cord Compression: A Role for Nitric Oxide. Retrieved from Hofmeyr (1997, October 19). Amnioinfusion for potential or suspected umbilical cord compression in labor (review).[americanpregnancy.org]
  • In abruptio placentae—as well as maternal hypotension, hypoxemia, or increased arterial resistance, as in uterine hyperstimulation—there is poor oxygen delivery to the placenta and fetus, giving rise to low pH in both umbilical arterial and venous gases[doi.org]
Hypotension
  • […] labor laceration 664.9 lateroversion, uterus or cervix 654.4 locked mates 660.5 low implantation of placenta - see Delivery, complicated, placenta, previa mal lie 652.9 malposition malpresentation 652.9 marginal sinus (bleeding) (rupture) 641.2 maternal hypotension[icd9data.com]
  • In abruptio placentae—as well as maternal hypotension, hypoxemia, or increased arterial resistance, as in uterine hyperstimulation—there is poor oxygen delivery to the placenta and fetus, giving rise to low pH in both umbilical arterial and venous gases[doi.org]
  • In addition, numerous causes of sudden fetal bradycardia such as maternal hypotension, placental abruption, uterine rupture should be carefully evaluated. Risk factors Several risk factors for UCP have been identified ( Table 1 ).[ncbi.nlm.nih.gov]
Fracture
  • […] excessive face presentation 652.4 failure, fetal head to enter pelvic brim 652.5 female genital mutilation 660.8 fetal fetopelvic disproportion 653.4 fever during labor 659.2 fibroid (tumor) (uterus) 654.1 fibromyomata 654.1 forelying umbilical cord 663.0 fracture[icd9data.com]
Metrorrhagia
  • […] previa mal lie 652.9 malposition malpresentation 652.9 marginal sinus (bleeding) (rupture) 641.2 maternal hypotension syndrome 669.2 meconium in liquor 656.8 membranes, retained - see Delivery, complicated, placenta, retained mentum presentation 652.4 metrorrhagia[icd9data.com]
Neonatal Seizures
  • Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention[ncbi.nlm.nih.gov]
  • UCP was associated with an increased risk of placental abruption, excessive bleeding, Caesarean sections, lower Apgar scores, requiring assisted ventilation, neonatal seizures, hyaline membrane disease, and fetal injuries.[ncbi.nlm.nih.gov]
  • seizures, neonatal encephalopathy (2%), and cerebral palsy (0.43%). 5 However, a recent study estimated a neonatal encephalopathy incidence of only 0.32%. 20 Neonatal encephalopathy was defined as either neonatal seizures or two of the following lasting[ncbi.nlm.nih.gov]

Workup

Polyps
  • […] prolapse of umbilical cord 663.0 oversize fetus 653.5 pathological retraction ring, uterus 661.4 pelvic penetration, pregnant uterus by instrument 665.1 perforation - see Delivery, complicated, laceration persistent placenta, placental polyhydramnios 657 polyp[icd9data.com]

Treatment

  • […] cord prolapse (UCP), describe the role of conservative treatment in the previable infant with a UCP, and list the various methods of treatment of UCP to optimize outcome for both mother and infant.[doi.org]
  • In eight cases, fetal distress continued after treatment, as compared with 33 cases before this type of treatment started (P less than .001); no difference was found in the outcome between neonates weighing less than or greater than 2500 g.[ncbi.nlm.nih.gov]
  • Treatment for umbilical cord prolapse Once a prolapse is diagnosed, it requires rapid delivery (1).[abclawcenters.com]

Prognosis

  • The objective of our study was to determine the frequency of cord prolapse, its aetiological factors and to evaluate fetal prognosis.[ncbi.nlm.nih.gov]
  • Treatment and prognosis A cord prolapse is an obstetric emergency that in a viable fetus necessitates an expeditious delivery 7,12.[radiopaedia.org]
  • Prognosis is usually dependent on the status of the fetus at the time of the prolapse, the degree of cord compression, and the time from occurrence to delivery. 6.[cancertherapyadvisor.com]
  • Frequency of cord prolapse: etiological factors and fetal prognosis in 47 cases in a health center. Mali Med. 2006;21(1):25-9. Hasegawa J, Sekizawa A, Ikeda T, Koresawa M, Ishiwata I, Kawabata M, et al.[ijrcog.org]
  • Prolapse of umbilical cord is an obstetric emergency with a well-documented grave fetal prognosis in poorly equipped obstetric centers.[nigeriamedj.com]

Etiology

  • An extensive review of the literature regarding the etiology, risk factors, and management options for umbilical cord prolapse in both viable and previable pregnancies accompanies this report.[ncbi.nlm.nih.gov]
  • […] slip pass the fetus and into the birth canal Umbilical cord can become markedly compressed when delivered with or before the fetus Umbilical cord vascular occlusion and decreased placental venous return can severely limit fetal oxygenation capacity Etiology[pathologyoutlines.com]

Epidemiology

  • Definition / general Cord prolapse occurs when the umbilical cord is expelled with or prior to the fetus during the fetal presentation process Epidemiology Approximately 0.4 - 0.5% of deliveries are complicated by cord prolapse Pathophysiology Lack of[pathologyoutlines.com]
  • Relatively large studies that have tried to quantify long-term effects of cord prolapse on children found that less than 1% (1 in 120 studied) suffered a major neurologic handicap, [7] and less than 1% (110 in 16,675) had diagnosed cerebral palsy. [15] Epidemiology[en.wikipedia.org]
  • In twin pregnancies, cord prolapses occur more frequently in the second twin to be delivered, with 9% in the first twin and 14% in the second twin. 1 in 300 deliveries EPIDEMIOLOGY 11. ANATOMY & PHYSIOLOGY 12. TYPES OF UMBILICAL CORD PROLAPSE 13. 1.[slideshare.net]
  • Epidemiology Incidence The overall incidence of overt prolapsed cord is between 1 and 6/1,000 deliveries. [ 1 ] The perinatal mortality rate from cord prolapse is 91 per 1,000.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Definition / general Cord prolapse occurs when the umbilical cord is expelled with or prior to the fetus during the fetal presentation process Epidemiology Approximately 0.4 - 0.5% of deliveries are complicated by cord prolapse Pathophysiology Lack of[pathologyoutlines.com]
  • It has been suggested that the pathophysiology of cord prolapse is almost an “all or none event”, either causing overwhelming neurological injury and death or causing little or no cerebral injury, and this is supported by the very low incidence of stillbirth[ncbi.nlm.nih.gov]

Prevention

  • Early amniotomy increases the variable decelerations and hence increases the rate of cesarean section because of fetal distress, but it may prevent pregnant women from umbilical cord prolapse, which has a high mortality rate.[ncbi.nlm.nih.gov]
  • […] baby’s injury was preventable.[birthinjurysafety.org]
  • Obstetric intervention is associated with nearly one in five cases of cord prolapse and represents a readily preventable cause of maternal and perinatal morbidity.[ncbi.nlm.nih.gov]
  • A significant number of deaths were diagnosed on presentation to hospital and were not deemed preventable.[ncbi.nlm.nih.gov]
  • The principal causes of asphyxia in this context are thought to be cord compression and umbilical arterial vasospasm preventing venous and arterial blood flow to and from the fetus.[rcog.org.uk]

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