Umbilical cord anomalies are a group of conditions in which there is an incorrect structure or location of this structure, there are nodes, entanglement, tumors, cysts. At the same time, obvious signs of acute or chronic fetal hypoxia are noticeable: impaired motor activity, increased or slower heartbeat. Ultrasound, cardiotocography, dopplerometry, and postnatal placenta examination are used to detect umbilical cord abnormalities. Treatment depends on the type of umbilical cord anomaly, consists in hospitalization of the pregnant woman and monitoring the condition of the woman and fetus, or involves emergency delivery by caesarean section.
P02.6 Fetal and newborn lesions caused by other and unspecified umbilical cord conditions
Umbilical cord abnormalities are a complex of obstetric pathologies, which includes abnormal vascular development, the presence of blood clots in them, a change in the length of this structure, the identification of nodes, prolapse, cysts, neoplasms, atypical attachment. In the presence of such conditions, pregnancy is pathological. Early diagnosis of umbilical cord abnormalities is extremely important, since timely medical care allows you to preserve the health of a woman and the life of the fetus. It is possible to suspect violations during routine ultrasound, based on the data of auscultation and palpation of the fetus. Sometimes specialists diagnose umbilical cord abnormalities after the birth of a child, which is due to the frequent absence of deterioration of the condition of the pregnant woman and the fetus with such pathologies.
It has not yet been possible to determine exactly why umbilical cord abnormalities develop. However, there are suggestions that such pathological conditions may indirectly indicate the presence of congenital malformations, chromosomal aberrations in the fetus. Sometimes such defects do not have clear signs, additional studies will be required to identify them: cordocentesis, consultation of a geneticist, karyotype determination. Some obstetricians and gynecologists associate umbilical cord abnormalities with the negative impact of various factors on the pregnant woman’s body. In particular, harmful habits, harmful working conditions, and the use of certain medications can provoke a pathological condition.
In modern obstetrics, umbilical cord abnormalities are classified depending on the type of disorders. Given the length of the anatomical structure, it is worth canceling pathologies such as long and short umbilical cords. In the first case, the length of the structure is more than 70 cm, in the second – less than 40 cm. One of the most common anomalies of the umbilical cord is entanglement, in which the loops of the anatomical structure are located around various parts of the fetal body. At the same time, the occurrence of pathology does not depend on the size of the umbilical cord. Anomalies are possible both with a normal or long umbilical cord, and with a short one. The following forms of the pathological condition are distinguished:
- Isolated – involves the location of a loop only around one part of the body, for example, a leg or handle.
- Combined – there is entanglement of several anatomical areas at once.
- Non–acute is the most favorable option for the fetus, since there is no pressure on the entwined parts of the body, problems may arise in the second period of labor due to tension or not at all.
- Tight – promotes compression of blood vessels, which leads to fetal hypoxia.
The anomalies of the umbilical cord include the presence of nodes. There are two forms of this pathological condition:
- False nodes are formed due to varicose veins of the umbilical cord or against the background of accumulation of jelly–like substance. The prognosis is favorable, there is no threat to the condition of the fetus or mother.
- True ones are an unfavorable variant of pathology, nodes are formed in the early stages of pregnancy, when the embryo is small and can easily slip into the loop formed by the umbilical cord. Strong tension contributes to disruption of blood flow, followed by fetal hypoxia, and immediate delivery is required.
Anomalies of the umbilical cord may also consist in its incorrect attachment. Normally, the umbilical cord is localized in the center of the placenta. The following forms of disorders are possible:
- Marginal attachment – the umbilical cord is placed on the periphery of the placenta.
- Shell attachment – the anatomical structure is attached to the fetal membranes, in childbirth this condition can cause rupture of the umbilical cord with subsequent fetal hypoxia.
Umbilical cord abnormalities often have no pathological signs. The clinical picture depends on the type of disorder. With pathological attachment of the structure, bleeding may develop during labor. Sometimes umbilical cord abnormalities contribute to an increase in the duration of labor, the duration of which can be 20 hours or more. With tight fetal entanglement and true nodes, signs of fetal hypoxia are observed. With an acute lack of oxygen, there is an increase in the number of fetal movements, accelerated heartbeat. With chronic hypoxia, the manifestations of pathology will be opposite – there is a decrease in movements, bradycardia. With such anomalies of the umbilical cord as non-tight entanglement and false nodes, violations on the part of the mother or fetus are not detected.
To identify umbilical cord abnormalities, anamnesis is collected: they find out the living and working conditions of a woman, specify what diseases the patient suffered, whether there were pregnancies and childbirth, how they ended. An objective examination involves auscultation of the fetal heartbeat. To determine the signs of umbilical cord abnormalities, instrumental diagnostic methods are used. Ultrasound shows the level of blood flow in the vessels, their diameter, the localization of the placenta and the attachment of the umbilical cord to it, the fetal heart rate, its motor activity. With abnormalities of the umbilical cord, it is possible to slow down or increase the heart rate, insufficient oxygen supply to the fetus. Also, during ultrasound scanning, it is possible to detect entanglement, knots. Cardiotocography, dopplerometry may be prescribed for the diagnosis of umbilical cord abnormalities.
Treatment of umbilical cord abnormalities depends on the type of pathology present. When this pathological condition is detected, a woman is hospitalized in a gynecological hospital. Pregnancy management under the supervision of doctors is indicated with a non-tight cord entanglement, the presence of false nodes. At the same time, a prerequisite should be the well-being of the woman and the fetus. Emergency delivery by caesarean section is indicated if umbilical cord abnormalities contribute to fetal hypoxia (in particular, with tight entanglement, in the presence of true nodes).
Prognosis and prevention
The prognosis for umbilical cord abnormalities is favorable in most cases. Even in the presence of acute hypoxia and emergency delivery, timely medical care can save the child’s life. Sometimes oxygen starvation of the fetus leads to a delay in intrauterine development, the formation of fistulas, Meckel diverticula, cystic formations in the bile ducts. Fetal death due to umbilical cord abnormalities is rarely observed. On the mother’s side, complications such as labor and postpartum bleeding are possible. Prevention of umbilical cord abnormalities consists in planning pregnancy, abandoning bad habits during gestation, timely delivery of the necessary tests and routine examinations by an obstetrician-gynecologist. It is also necessary to eliminate stress, adhere to a balanced diet and provide a pregnant woman with a full night’s rest.