Umbilical cord pathology - Abnormalities of the umbilical cord insertion

Insertion cord is normally in the center or near the center of the placenta. Eccentric insertion is quite common and can not be considered abnormal only in marginal cases and velamentoase insertion.
 Marginal cord insertion
 Marginal cord insertion is the insertion of the edge of the placenta and is observed in 2-15% of cases.
 Clinical bleeding can occur through small, which make differential diagnosis problem with placenta previa. Some authors have found that more frequent association with preterm birth abnormalities, but this view is not universally accepted. Another discussion is the pathological association with intrauterine growth retardation, explained by a decrease in uteroplacental flow.
 Ultrasound diagnosis is made during the course of pregnancy and by inspection of the placenta, postpartum.

 Velamentous insertion of umbilical cord
 Velamentous insertion is the insertion of the umbilical cord membrane, outside board villi, placental edge distance. Funicular vessels to travel the placenta without having any support, displayed between the villi and amniotic foil.
 This anomaly results from development of vasculature eccentric to the future of primary placental site, which explains the frequent association with some of placental abnormalities (placenta biloba, succenturiata, praevia).
 FrequentThis type of cord insertion is present in more than 1% of births to single fetus, twins more frequently (9%) and the loads are almost the rule triple.
 Vasa praeviaIf the cord insertion velamentoase sometimes funicular vessels are located between the membranes from the lower end of the hole and the internal cervix before the presentation. This situation is called Utensils and previa is a common abnormality in twin pregnancies.
 PathophysiologyIn both situations, and utensils velamentous insertion praevia is fetal distress during labor induced by these mechanisms:- Compression of the vessels, the progress of the delivery mechanism, causing fetal hypoxia;- Praevia vessel rupture, with rupture of membranes, causes hemorrhage and acute fetal anemia (syndrome Benckiser).This anomaly of the cord insertion is more frequently associated with intrauterine growth retardation, premature birth and cord prolapsing.
 DiagnosisDuring pregnancy, the clinical diagnosis is practically impossible.At birth, clinically speaking, vaginal bleeding and sometimes is found when the membranes are intact umbilical vessels may feel that protrudes through the membranes located above presentations. Fetal monitoring showed concomitant alteration BCF rate when these vessels are compressed between the fingers that examines and presenter.Vessels can be viewed directly when the cervix is ​​dilated, the amnioscopie or ultrasound.The differential diagnosis is placenta previa, bleeding or rupture of the marginal sinus of placenta. Unlike placenta previa, rupture of membranes does not improve bleeding.
 For the diagnosis of fetal origin is required to confirm bleeding, may be used for this purpose two laboratory methods:- Fit test based on fetal hemoglobin resistance in alkaline environments;- Kleihauer-Betke test, which identified by staining with fetal hemetiile Erythrosine in eluting acid.Of these, the first is more beneficial because it can be done in minutes, in any laboratory.
 Breast prognosis is good, but the fetal prognosis is reserved, due to fetal mortality and morbidity 60% fetal posthemoragica dominated by severe anemia.
 ConductOnce the diagnosis is indicated by cesarean birth, the fetal interest. Rarely, when there was no travalilui during practice conditions Caesarean section, it must quickly end in vaginal delivery by forceps or small mining application.