Pathology of Umbilical cord

Question 1

normal length of UC:

Answer 1

55 cm

Question 2

Give examples:
Constitution:
Length:
Position:

Answer 2

agenesis of UA
in particular brevity (short)
The most dangerous: UC prolapse

Question 3

Freq of Absence of an ua is …. in twin pregnany

Answer 3

0.4 to 1 to 5

Question 4

Why is bigger UA or UV?

Answer 4

UV

Question 5

T or F
single UA is mainly associated with other abnormalities

Answer 5

F
mainly isolated

Question 6

single UA is ass with:

Answer 6

Premature births
Small foor GA
Fetal hypertrophies

Question 7

T or F
We should F/u in case of single UA depending on associated anomaly and no need for amniocentesis

Answer 7

T
if isolated no need for F/U except if small for GA

Question 8

Second Constitutional anomaly is:
Pseadocyst > or equal 5 cm may be associated with———or……

Answer 8

-cord tumors
-tri 13 or tri 18

Question 9

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…..

Answer 9

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

Question 10

Positional abnormalities:
1.
2.
3.
4.

Answer 10

Nodes of cord
Coils of UC
Lateral UC prolapse
UC prolapse

Question 11

Regarding nodes:
Formed at…….
Serious narrowing is……(common or rare)
Is it an indication for CS?
Mortality percentage and cause?

Answer 11

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

Question 12

Coils:
Can be around… but most common is … or….
Freq…..
Dx method and time?
Indication for Cs?
Complications?

Answer 12

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

Question 13

Whats Hon maneuver?

Answer 13

pressing the uterine fundus to produce bradycardia
(used in positional anomalies as early modifications of Heart sounds)

Question 14

Signs of fetal distress:
1.
2.
Solution?

Answer 14

Bradycardia by hon maneuver
After rupture of membranes meconial type AF
Termination of preg by vag or C

Question 15

Lateral UC prolapse:
Definition:
Can the cord be seen by vaginal exam?
Sign?
TX?

Answer 15

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

Question 16

Prolapse:
Definition:
Consequences:
Etiologies:

Answer 16

-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

Question 17

Management:

Answer 17

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

Question 18

TX

Answer 18

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

Question 19

T or F
In case of breech there is more compression but less prolapse

Answer 19

F
reversed and requires monitoring

Question 20

During preparation of extraction what we should do?

Answer 20

By vaginal exam we should push the presenting part and support the cord by fingers

Question 21

T or F
in procubitus the membranes are ruptured
whats the mangement in procubitus

Answer 21

F they are intact
Not a stat case as typical prolapse we should not rupture the membranes and do an urgent C sectio