Umbilical cord prolapsing

Umbilical cord prolapsing
Is this belt loops at the lower end of the uterus, together with the anchor.

 
Classification It is based on location and situation membranes prolapsing loop in the following forms: - Laterocidenta or occult cord prolapsing result from lowering the belt loop next presentation, but not exceeding the internal orifice of cervix; - Prolapsing actual rupture of membranes occurs at the location of the belt loop in front of the presenter and can be of three grades: Grade I, in which the cord is in place, Grade II in the cord reaches the vulva and grade III in cord exceeds the vulvar opening, exteriorizandu away; - Procubitus, the membranes were intact, before the presentation was prolapsing loop and can be easily palpable through membranes, if there is a degree of dilatation of the cervix; - Prolapsing complicated the cord prolapsing prolapsing is associated with a member of the fetus.

 
Frequent Cord prolapsing occurs in 2-5 cases per 1000 births.

 
Etiology. Items in obstetrical pathology that prevents proper application of the presentation at the lower end of the uterus and employment are factors favoring the superior strait of the cord prolapsing. They are:

1. ovulari factors - Multiple pregnancy - Prematurity; - Pathological presentations (breech, frontal, facial, transverse) - Placenta praevia; - Polihidramniosul; - Spontaneous premature rupture of membranes, before engaging presentations; - Long or velamentous insertion cord.

2. maternal factors - Multiparity; - Pelvic tumors praevia; - Rough channel dystocia.

3. iatrogenic factors - unexpected amniotomy (when not engaged or presentational during obstetric maneuvers).

 
Pathophysiology This loops the cord at the same level presentational cause intermittent compression, rhythmic contractions, the umbilical and superior strait, cervix, vagina. In the intervals of cord compression, fetal circulation is compromised in terms of duration and intensity, is installed with fetal hypoxia and brain damage exitus.
In addition, actual prolapsing, cord contact with the external environment (air) produces irritation to cooling and drying, causing spasm of umbilical vessels and emphasizing the damage the fetus.

 
Diagnosis
In prolapsing itself, depending on the degree and major complications, and examined by simple inspection reveals valves Prolab chance that outwardly through the cervix. Digital vaginal examination confirmed this loop cord.

 
Procubitusului diagnosis is possible by observing that the vaginal examination with valves cord through transparent membranes and digital vaginal examination, which identifies this structure as an elastic cord, soft, running and feel the pulses of which the umbilical vessels.

 
Laterocidenta is a possibility that can rarely be diagnosed by digital vaginal examination. This diagnosis should be suspected when monitoring indicates fetal bradycardia promptly and variables that appear concurrently with uterine contractions, without pre-existing motivation and disappear after cessation cintractiilor. BCF These changes indicate the presence of fetal distress, which in the case of total compression and prolonged hypoxia and acidosis cause and fetal exitusului final.

 
Fetal prognosis is reserved, and perinatal mortality varies between 20% and 60%. Factors that influence prognosis are: 1. prompt extraction of the fetus, looking directly related to the degree and duration of cord compression, if the interval between the appearance of prolapsing and extracting the fetus, followed by resuscitation to no more than five minutes, the prognosis is good, otherwise serious damage or fetal death are inevitable; 2. how to resolve delivery, caesarean section is the optimal solution; 3. type presentations, presentational skull, although it is associated with a lower incidence of prolapsing is the most unfavorable; 4. associated pathology: prematurity, fetal distress preexisting.

 
Breast prognosis is burdened by risks associated pathology, especially traumatic obstetric maneuvers.

 
Prophylactic Conduct addresses all pregnancies there prolapsing conditions favored production of cord and consists of the following: - Artificial rupture of membranes, is well practiced only when applied to cervical preyentatia (employed or at least fixed); - Spontaneous rupture of membranes will be followed promptly by a careful vaginal examination to eliminate the possibility of a prolapsing of the weld; - Pregnant women or those with pathological presentations insufficiently cranial presentation will benefit from an ultrasound exam to determine the exact position of the fetus and umbilical cord; - Because most procidentelor occur during labor, as cervical dilatation progresses, pregnant women will be constantly monitored to detect early occurrence rate alterations BCF.

 
Therapeutic attitude will be adopted according to: - Clinical form; - The degree of dilatation of the cervix; - Fetal status (viability, maturity, presentation).

 
In prolapsing itself, immediately after diagnosis, genital exam is done to specify the dilation of cervix, presentation and delivery mechanism, whether umbilical pulsation vessels, possible prolapsing a member (prolapsing complicated), to listen to BCF.
If the fetus is alive, and performing cesarean birth conditions are met, the intervention is compulsory and is an obstetrical emergency. After extraction, the fetus will be immediately taken to intensive care in neonatology for the application required.
If the fetus is compromised, assist in presentations longitudinal natural birth, in presentational Transverse Cesarean afectueaza embriotomie or interest in breast and uterine retraction if there was no imminent uterine rupture.
If the fetus is viable, cervical dilation is complete and presenter, skull or pelvis, is engaged, proceed to the rapid completion of vaginal birth by forceps application or big draw.

 
Current concepts on the treatment methods do not allow the cord prolapsing attempts to reduce prolapsing loop digital.

 
Laterocidenta (prolapsing occult cord), suggested the appearance cardiotocografic variables characterized by bradycardia during labor, genital exam requires immediate action to remove the possibility of a prolapsing itself. Pregnant is then placed in lateral decubitus (Sims position) or Trendelenburg position to relieve cord compression and fetal oxygen saturation monitors.
If the activity is restored and normal fetal pilfer the conditions for the birth the natural way obstetrics, it will be allowed to proceed normally under supervision.
If signs persist or recur compresiuneasupra cord, threatening the life of the fetus, caesarean section is performed.

 
In procubitus, in women with pregnancy at term, indicating the birth by caesarean section before rupture of membranes practiced. If your baby is premature, pregnant women will benefit from hospitalization and bed rest, prolonged, with the intention of getting back into normal position cord. During this period, repeated ultrasound examinations to be charged, to establish the cordon location, presenter and gestational age.

 
In conclusion, cord prolapsing is an obstetrical emergency, that is preferable, most often by cesarean birth, natural birth is reserved especially for fetuses and premature deaths.