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Article of Obstetr
Article of Obstetr
CORD PROLAPSE
Umbilical cord prolapse is where the umbilical cord descends through the
cervix, with (or before) the presenting part of the fetus. It affects 0.1 – 0.6% of
births.
Occult (incomplete) cord prolapse – the umbilical cord descends alongside the
presenting part, but not beyond it.
Overt (complete) cord prolapse – the umbilical cord descends past the
presenting part and is lower than the presenting part in the pelvis.
Cord presentation – the presence of the umbilical cord between the presenting
part and the cervix. This can occur with or without intact membranes.
Although the incidence is relatively low, the mortality rate for such babies is high
(~91 per 1000). This is largely because cord prolapse occurs more frequently
in preterm babies, who are often breech, and who may also have
other congenital defects.
In this article, we shall look at the risk factors, clinical features and management
of cord prolapse.
Pathophysiology
Umbilical cord prolapse is where the umbilical cord descends through the
cervix, with (or before) the presenting part of the fetus. Subsequently, fetal
hypoxia occurs via two main mechanisms:
Occlusion – the presenting part of the fetus presses onto the umbilical cord,
occluding blood flow to the fetus.
Arterial vasospasm – the exposure of the umbilical cord to the cold atmosphere
results in umbilical arterial vasospasm, reducing blood flow to the fetus.
Risk Factors
The main risk factors for cord prolapse include:
Breech presentation – in a footling breech, the cord can easily slip between and
past the fetal feet and into the pelvis.
Unstable lie – this is where the presentation of the fetus changes between
transverse/oblique/breech and back.
o If >37 weeks gestation, consider inpatient admission until delivery due to risk of
cord prolapse
Artificial rupture of membranes – particularly when the presenting part of the
fetus is high in the pelvis.
Polyhydramnios – excessive amniotic fluid around the fetus
Prematurity
The fetal heart rate patterns can vary from subtle changes, such as
decelerations with some of the contractions, to more obvious signs of fetal
distress, such as a fetal bradycardia. The latter is strongly associated with
cord prolapse; relating to the mechanism of occlusion of the cord by the
presenting part.
PLACENTA PREVIA
Placenta Previa: Symptoms, Causes, and Treatment
Placenta Previa is a condition where the placenta lies low in the
uterus and partially or completely covers the cervix. The placenta
may separate from the uterine wall as the cervix begins to dilate
(open) during labor.
How Common Is Placenta Previa?
Placenta previa affects about 1 in 200 pregnant women in the third
trimester of pregnancy.
Placenta Previa is more common in women who have had one or
more of the following:
More than one child
A cesarean birth
Surgery on the uterus
Twins or triplets
What Are The Different Types Of Placenta Previa?
Complete Previa: the cervical opening is completely covered
Partial Previa: a portion of the cervix is covered by the placenta
Marginal Previa: extends just to the edge of the cervix
What Are The Symptoms Of Placenta Previa?
Signs and symptoms of placenta previa vary, but the most common
symptom is painless bleeding during the third trimester.
Other Reasons To Suspect Placenta Previa Would Be:
Premature contractions
Baby is breech, or in a transverse position
Uterus measures larger than it should according to gestational age
What Is The Treatment For Placenta Previa?
Once diagnosed, placenta previa will usually require bed rest for the
mother and frequent hospital visits. Depending on the gestational
age, steroid shots may be given to help mature the baby’s lungs. If the
mother experiences bleeding that cannot be controlled, immediate
cesarean delivery is usually done regardless of the length of the
pregnancy. Some marginal previas can be delivered vaginally,
although complete or partial previas would require a cesarean
delivery.
Most physicians recommend women who are experiencing Placenta
Previa to:
Avoid intercourse
Limit traveling
Avoid pelvic exams
What Causes Placenta Previa?
The exact cause of Placenta Previa is unknown.
However, the following can increase your risk:
If over the age of 35
Had more than four pregnancies
Have a history of uterine surgery (regardless of incision type)
How Do I Cope With Placenta Previa?
With all the excitement and anticipation of a healthy delivery,
receiving the diagnosis of placenta previa can be a very shocking and
frustrating experience. There are support groups for bed
rest mothers and even some for mothers with placenta previa. They
are available to help you through this difficult time. Your
doctor, midwife, or doula should be able to assist you in finding
support groups or other women who have also had placenta previa.
PREMATURE RUPTURE OF MEMBRANE
REFLECTION
CORD PROLAPSE
A delay in management of cord prolapse (where a loop of umbilical cord
is below the presenting part and the membranes are ruptured) is associated
with significant perinatal morbidity and mortality. It is acknowledged as
a serious obstetric emergency. The main aim of management is to relieve
pressure on the cord from the presenting part digitally and/or through the
technique of bladder filling.
Several risk factors are associated with cord prolapse : Unengaged or
poorly applied presenting part Obstetric interventions (eg. amniotomy,
vaginal manipulation of fetus, external cephalic version)
Malpresentations (breech/shoulder/transverse or oblique lie/compound
presentation) Prematurity and low birth weight Polyhydramnios
Second twin Fetal congenital abnormalities (eg. anencephaly)
Abnormal placentation Multiparity.
PLACENTA PREVIA
Placenta previa is a pregnancy problem in which
the placenta blocks the cervix. The placenta is a round, flat organ
that forms on the inside wall of the uterus soon after conception.
During pregnancy, it gives the baby food and oxygen from the
mother.
In a normal pregnancy, the placenta is attached high up in the
uterus, away from the cervix. In placenta previa, the placenta
forms low in the uterus and covers all or part of the cervix.
If placenta previa is present during labor and delivery, it can cause
problems for both mother and baby.
The mother may lose a lot of blood, which can be dangerous for
both her and her baby.
The placenta may separate too early from the wall of the uterus.
This is called placenta abruptio, and it can cause serious
bleeding, too.
The baby may be born too early (premature), at a low birth
weight, or with a birth defect.
PREMATURE RUPTURE OF MEMBRANE