Pathology of Umbilical cord Flashcards
normal length of UC:
55 cm
Give examples:
Constitution:
Length:
Position:
agenesis of UA
in particular brevity (short)
The most dangerous: UC prolapse
Freq of Absence of an ua is …. in twin pregnany
0.4 to 1 to 5
Why is bigger UA or UV?
UV
T or F
single UA is mainly associated with other abnormalities
F
mainly isolated
single UA is ass with:
Premature births
Small foor GA
Fetal hypertrophies
T or F
We should F/u in case of single UA depending on associated anomaly and no need for amniocentesis
T
if isolated no need for F/U except if small for GA
Second Constitutional anomaly is:
Pseadocyst > or equal 5 cm may be associated with———or……
-cord tumors
-tri 13 or tri 18
length anomalies:
short UC if :………
Can be secondary to…..around …. or…..
Can interfere in ….. especially in ….or……
A characteristic sign of short UC:
Long UC if:…. facilitates…..
less than 35 cm
coils around body or neck
delivery , engagement or descent
The head goes up after every contrx
> 1.50 m
mvts and predispose to UC coiling or loops
Positional abnormalities:
1.
2.
3.
4.
Nodes of cord
Coils of UC
Lateral UC prolapse
UC prolapse
Regarding nodes:
Formed at…….
Serious narrowing is……(common or rare)
Is it an indication for CS?
Mortality percentage and cause?
4th mo
Rare because of elasticity of cord
not indication of C but needs FU
6% - Death in utero from IUFD or acute fetal distress during labor or expulsion
Coils:
Can be around… but most common is … or….
Freq…..
Dx method and time?
Indication for Cs?
Complications?
trunk
neck or body
US at end of preg
21 to 33
not indication for Cs but we should FU for Fetal heart
Comp:
1.Accidental shortening of cord
2.Compression of vessels of neck which causes strangulation
3.UC compression
Whats Hon maneuver?
pressing the uterine fundus to produce bradycardia
(used in positional anomalies as early modifications of Heart sounds)
Signs of fetal distress:
1.
2.
Solution?
Bradycardia by hon maneuver
After rupture of membranes meconial type AF
Termination of preg by vag or C
Lateral UC prolapse:
Definition:
Can the cord be seen by vaginal exam?
Sign?
TX?
the UC is present between the presenting part of fetus and uterine walll
nooo its not like the classical where the cord is infront of presenting part
Bradycardia by compressing the uterin fundus or by compressing the cord against the pelvic wall by lateral displacement of head
Continous monitoring
Prolapse:
Definition:
Consequences:
Etiologies:
-Infront of presenting part at moment of rupture of membranes
Emergencyy and urgent delivery
Compression of cord and severe distress
1-poor acomodation of presentation
2-excess of fluid causes pressure gradient
3-placennta previa with oblique insertion of cord
4-a drop in pressure in arteries secondary to bradycardia
Management:
Vaginal exam (if we induce rupture we must recheck if there is prolapse even without symptoms)
can be visible in vulva (check for UC pulsation)
Can emain in vagina
Can also get stuck high where only signs of fetal distress occur
TX
STAT CASE
Delivery vaginally if full dilation and only if full dilation (10cm),forceps or vaccum can be used (accustomed to)
C section if not full dilation, must be done in the coming 15 min
T or F
In case of breech there is more compression but less prolapse
F
reversed and requires monitoring
During preparation of extraction what we should do?
By vaginal exam we should push the presenting part and support the cord by fingers
T or F
in procubitus the membranes are ruptured
whats the mangement in procubitus
F they are intact
Not a stat case as typical prolapse we should not rupture the membranes and do an urgent C sectio
