This document discusses the structure, function and abnormalities of the umbilical cord. It begins by describing the normal anatomy of the umbilical cord, including that it contains a single umbilical vein and two umbilical arteries surrounded by Wharton's jelly. It then discusses various abnormalities such as abnormal cord length, coiling, number of vessels and cord insertions. Specific abnormalities like vasa previa and cord knots are explained in detail. The management of abnormalities like cord prolapse is also covered.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Abnormalities of placenta and cord obgjagan _jaggi
Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta) Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
USMLE GENERAL EMBRYOLOGY 016 Anomalies placenta and umbilical cord.pdfAHMED ASHOUR
Anomalies of the placenta and umbilical cord can have significant implications for the health and development of the fetus during pregnancy. These anomalies may affect blood flow, nutrient exchange, and overall fetal well- being.
Early detection and appropriate management of placental and umbilical cord anomalies are essential for optimizing outcomes for both the mother and the baby. Prenatal screening, ultrasound examinations, and close monitoring during pregnancy are crucial for identifying and addressing potential issues.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Abnormalities of placenta and cord obgjagan _jaggi
Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta) Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
USMLE GENERAL EMBRYOLOGY 016 Anomalies placenta and umbilical cord.pdfAHMED ASHOUR
Anomalies of the placenta and umbilical cord can have significant implications for the health and development of the fetus during pregnancy. These anomalies may affect blood flow, nutrient exchange, and overall fetal well- being.
Early detection and appropriate management of placental and umbilical cord anomalies are essential for optimizing outcomes for both the mother and the baby. Prenatal screening, ultrasound examinations, and close monitoring during pregnancy are crucial for identifying and addressing potential issues.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
UMBILICAL CORD ABNORMALITIES & ITS OBSTETRIC OUTCOME BY DR SHASHWAT JANI
1. Dr. Shashwat Jani.
M. S. ( Obs – Gyn )
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Structure and function
Umbilical cord is covered by amnion
and contains a single umbilical vein, and two
umbilical arteries supported in Wharton jelly.
Amnion covers the umbilical cord
except near the fetal insertion, where an
epithelial covering is substituted.
29-Jun-16 2
Dr Shashwat Jani.
9909944160.
3. The arteries wind around the umbilical
vein in a spiral fashion and, because the vessels are
longer the cord itself, there are a number of foldings
or tortuorties producing protusions or false knots
on the cord surface.
The Wharton jelly protects the vessels
from undue torsion and compression.
29-Jun-16
Dr Shashwat Jani.
9909944160.
3
4. Abnormalities…
Length
Cord Coiling
Single Umbilical Artery
Four-vessel cord
Abnormalities of cord insertion
Cord Abnormalities capable of impeding blood
flow
Torsion and Strictures
Hematoma
Cysts
29-Jun-16 4
Dr Shashwat Jani.
9909944160.
5. Abnormal Cord Length
• Normal cord length is 50-60cm,
averagely 55cm
• Short cord: < 35cm is defined as short
cord, may lead to fetal distress, placental
abruptio, prolonged labour.
• Long cord: > 80cm is defined as long
cord, higher occurrence of cord around neck,
cord around body, cord knot, cord prolapse
and cord compression.
29-Jun-16 5
Dr Shashwat Jani.
9909944160.
6. Umb. Cord Diameter
• Lean cords are associated with IUGR
• Large diameter cords are associated
with macrosomia
• Clinical utility of parameter – unclear
29-Jun-16 6
Dr Shashwat Jani.
9909944160.
7. Umb. Cord Coiling
Cord vessels spiral through the cord
UCI ( Umbilical Coiling Index ) - is the no.
of complete coils divided by the cord length in
cm
They grouped the UCI as follows:
< 10th percentile — hypocoiled;
10th – 90th percentile — normocoiled;
> 90th percentile — hypercoiled.
29-Jun-16 7
Dr Shashwat Jani.
9909944160.
9. • Antenatal UCI has the lower
sensitivity than the
measurement postpartum.
• Hyper coiling is linked with
fetal demise, IUGR &
intrapartum hypoxia.
• Abnormal UCI has been
related to trisomies & single
umbilical artery
29-Jun-16 9
Dr Shashwat Jani.
9909944160.
10. Abnormalities of U. Cord Insertion
• Usually the cord is inserted at or near the
center of the fetal surface of placenta.
• Various cord insertion variations are:
Marginal Insertion ( Battledore Placenta )
Furcate insertion
Velamentous insertion
Vasa praevia
29-Jun-16 10
Dr Shashwat Jani.
9909944160.
11. www.realpt.co.kr
Abnomalities Definition Incidence Significance
Furcate insertion Umbilical vessels separate from
the cord substance before their
insertion into the placenta
Rare
Margnial Inserion Battledore placenta
: cord insertion at the
placental margin
7% at
term
Cord being pulled off
during delivery of the
placenta
Velamentous
Insertion
Umbilical vessels separate
in the membranes at a
distance from the placental
margin
Reach surrounded only by
a fold of amnion
1.1% more frequently
with twins
28% of triplets
13. Vasa Previa
Associated with velamentous insertion when
some of the fetal vessels in the membranes cross
the region of the cervical os below the presenting
fetal part.
Incidence : 1 / 5200 pregnancies
- ½ : associated with velamentous inserion
- ½ : marginal cord insertions and bilobedor,
succenturiate – lobed placentas.
29-Jun-16 13
Dr Shashwat Jani.
9909944160.
14. Risk factors :
- bilobed , succenturiate or low-lying placenta
- Multifetal pregnancy
- Pregnancy resulting from in vitro fertilization
Diagnosis :
• Color Doppler examination (low sensitivity with
ultrasound)
- Perinatal diagnosis : associated with increased
survival (97:44)
- Antenatal diagnosis : associated with decreased
fetal mortality compared with discovery at delivery
29-Jun-16
Dr Shashwat Jani.
9909944160.
14
15. Hemorrhage antepartum or intrapartum :
vasa previa and a ruptured fetal vessel
exists
Detecting fetal blood
- Apt test
- Wright stain : to smear the blood on glass
slides stain the smears with Wright stain and
examine for nucleated RBC
- Normally : are present in cord blood but
not maternal blood
Risk of low lying placenta : 80%
29-Jun-16 15
Dr Shashwat Jani.
9909944160.
16. Doppler scan to detect Vasa Previa
29-Jun-16
Dr Shashwat Jani.
9909944160.
16
17. Management of Vasa Previa
•If diagnosed prenatally
–Planned cesarean section (early enough to
avoid emergency, but late enough to avoid
prematurity)
–Baby requires aggressive resuscitation +
blood transfusion
29-Jun-16 17
Dr Shashwat Jani.
9909944160.
18. • If intra partum vaginal bleeding :
Speculum
Apt test - fetal hemoglobin is alkali
resistant.
If fetal bleeding confirmed, immediate
cesarean section
29-Jun-16 18
Dr Shashwat Jani.
9909944160.
19. Abnormalities Of Vessels Number :
• Single umbilical artery :
Results due to atrophy of the previously
existing umbilical artery.
• 4 vessel cord :
- Quiet uncomman
- May be a venous remnant
- Association with CMF is not clear
29-Jun-16 19
Dr Shashwat Jani.
9909944160.
20. Single Umbilical Artery
• Absence of one umbilical artery
INCIDENCE :
- 0.63 % in live births
- 1.92 % in perinatal deaths
- 3 % in twins
Incidence is increased in women with :
Diabetes
Epilepsy
PET
APH
Oligohydramnios
Hydramnios
Chromosomal abnormalities
29-Jun-16 20
Dr Shashwat Jani.
9909944160.
22. Single Umb. Art. & CMF
About 30% of all infants with only one umbilical
artery have congenital anomalies .
– Associated CMF :
Aneuploidies
Tracheo-oesophagial fistula
Renal agenesis
Imperforate anus
Vertebral defects
– 34% are growth restricted
– 17% deliver preterm
29-Jun-16 22
Dr Shashwat Jani.
9909944160.
23. Fused umbilical artery
Rarely umbilical artery may fail to split
Shared ,fused lumen
May involve the entire length or may
be partial (towards the placental
insertion site)
29-Jun-16 23
Dr Shashwat Jani.
9909944160.
24. Hyrtl Anastomosis :
Anastomosis b/w the two umb.
Arteries with in 3 cm of placental
insertion site
Acts as a pressure equalising system
b/w the two umbilical Aa.
Improves placental perfusion during
uterine contractions /during compression
of one of the umbilical arteries.
29-Jun-16 24
Dr Shashwat Jani.
9909944160.
25. Knots
False knots :
• Result from kinking of the vessels to
accommodate length of cord and are due to
redundancies of Umbilical vessels / Wharton’s
jelly.
29-Jun-16 25
Dr Shashwat Jani.
9909944160.
26. True Knots
• Incidence 1 – 2 %
• More common in monoamniotic twins
• Active fetal movements create true knots
• Risk of still births is increased 5 to 10 folds in
those with true knots.
• FHR abnormalities are common during labor
but cord blood PH values are normal .
29-Jun-16 26
Dr Shashwat Jani.
9909944160.
27. Umb. Cord Loops
The cord is frequently coiled around the fetus
More likely with longer cords
Loops around fetal neck are termed a nuchal cord
(uncommon cause of adverse PN outcome)
Contractions may compress the nuchal cord and cause FHR
decelerations and low umbilical artery
Incidence :
1 loop of Nuchal cord 20-34%
2 loops of nuchal cord 2.5-5%
3 loops of nuchal cord 0.2-0.5%
29-Jun-16 27
Dr Shashwat Jani.
9909944160.
28. Single is safer than multiple
umbilical cord loops around
the fetal neck.
Two types of cord loops
around the fetal neck :
Type A umbilical nuchal cord
encircles the fetal neck in a
sliding manner (less
dangerous)
Type B nuchal cord encircles
the neck in a locking manner
(very dangerous).
29-Jun-16 28
Dr Shashwat Jani.
9909944160.
29. Management
At the time of birth: -
• Look for cord around the neck
If it is loose enough for the cord to be
slipped over the babies head.
If the cord is wrapped multiple times it may
take a while.
29-Jun-16
Dr Shashwat Jani.
9909944160.
29
30. • At this time, if the
cord is too tight and
has to be cut before
the baby is born.
• This necessitates
babies birth rapidly,
since it is no longer
getting nutrients
from the mother via
placenta.
29-Jun-16
Dr Shashwat Jani.
9909944160.
30
31. Torsion & Stricture
Torsion :
Incidence : rare
Result from fetal movements during which the cord normally
becomes twisted
fetal circulation is compromised.
Stricture :
More serious
Most infants with this finding are stillborn
Associated with an extreme focal deficiency in Wharton jelly.
In mono amnionic twins, a significant fraction of the high
perinatal mortality rate is attributed to entwining of the
umbilical cords before labor.
29-Jun-16 31
Dr Shashwat Jani.
9909944160.
32. Hematoma
Accumulations of blood are associated with
short cords, trauma and entanglement
Result from the rupture of a varix, usually of
the umbilical vein with effusion of blood into
the cord
Caused by umbilical vessel venipuncture
29-Jun-16 32
Dr Shashwat Jani.
9909944160.
33. Umb. Cord Cysts
May be found along the course of the cord
True cysts:
› Epithelium lined
› Remnants of the allantois
› Coexist with patent urachus
False Cysts:
Due to degeneration of wharton’s jelly.
Single cyst may resolve completely
Multiple cysts may be associated with miscarriage /aneuploidy.
29-Jun-16 33
Dr Shashwat Jani.
9909944160.
36. Definition
• Ruptured membranes
– occult cord prolapse (descent of the umbilical
cord alongside)
– overt cord prolapse (umbilical cord past the
presenting part).
29-Jun-16 36
Dr Shashwat Jani.
9909944160.
37. NO ruptured membranes
Funic presentation = cord presentation =
procubitus →
one or more loops of umbilical cord
between the fetal presenting part and
the cervix,.
• If the cervix is opened the cord can be
easily palpated through the membranes.
29-Jun-16 37
Dr Shashwat Jani.
9909944160.
38. Etiology
Any obstetric condition that
predisposes to poor application of
the fetal presenting part to the
cervix may result in prolapse of the
umbilical cord.
29-Jun-16 38
Dr Shashwat Jani.
9909944160.
39. Predisposing Factors
Prematurity
Abnormal presentations (breech, brow, face,
transverse)
Multiple gestation
Placenta praevia
Polyhydramnios
Premature rupture of the membranes
Excessive length of the cord
29-Jun-16 39
Dr Shashwat Jani.
9909944160.
40. Maternal factors
• Multiparity
• Pelvic tumors
• Abnormal birth canal
Iatrogenic factor
• Artificial rupture of membranes
with an unengaged presentation
29-Jun-16 40
Dr Shashwat Jani.
9909944160.
41. Clinical diagnosis
• Overt cord prolapse visualizing the cord
protruding from the introitus (second or third
degree of prolapse), by speculum ex. or by
palpating loops of cord in the vaginal canal (first
degree prolapse).
• Funic presentation speculum and bimanual
ex.
• Occult prolapse Suspected if fetal heart rate
changes (variable decelerations) due to
intermittent compression of the cord are
detected during monitoring.
29-Jun-16 41
Dr Shashwat Jani.
9909944160.
42. If compression is complete and prolonged
it induces asphyxia, metabolic acidosis and death.
Asphyxia → hypoxic-ischaemic encephalopathy
and cerebral palsy.
• The causes of asphyxia:
Cord compression preventing venous return to the fetus
Umbilical arterial vasospasm secondary to exposure to
vaginal fluids and/or air.
29-Jun-16 42
Dr Shashwat Jani.
9909944160.
43. Prevention
High-risk patients :
Malpresentations + poorly applied cephalic
presentations → US at the onset of labor
during labor patients at risk for → continuosly
monitored for abnormalities of FHR
avoid amniotomy until the presenting part is
well applied to the cervix.
at time of spontaneous membrane rupture a
prompt, careful pelvic examination.
29-Jun-16 43
Dr Shashwat Jani.
9909944160.
44. MANAGEMENT
Venous access
Consent
Immediate CS.
The manual replacement is NOT recommended.
To prevent vasospasm - minimal handling of
loops of cord lying outside the vagina and cover
them in surgical packs soaked in warm saline.
29-Jun-16 44
Dr Shashwat Jani.
9909944160.