Marginal attachment of the umbilical cord to the placenta: causes, dangers, how pregnancy proceeds. Shell attachment of the umbilical cord Umbilical cord from the upper edge 25mm
The normal course and development of pregnancy cannot be imagined without two extremely important organs - the placenta and the umbilical cord. They are directly related to each other during intrauterine development of the fetus. This article will tell you about the types of attachment of the umbilical cord to the placenta, as well as the norm and danger of deviations.
Norm
The umbilical cord, or, as it may also be called, the umbilical cord, is an elongated flagellum, inside which blood vessels pass. They are necessary to ensure that the fetus, during its intrauterine life, receives all the necessary nutrients for growth and development. The normal umbilical cord appears as a gray-blue cord that is attached to the placenta. Normally, it is formed in the very early stages of pregnancy and continues to develop along with the growing baby.
The umbilical cord can be easily visualized already in the 2nd trimester of pregnancy. It is well determined during an ultrasound examination. Also, through ultrasound, the doctor can assess the condition of the actively developing placental tissue. During the examination, the doctor must also evaluate how the umbilical cord is attached to the placenta.
The umbilical cord is finally formed only by 2 months from the moment of conception. As the umbilical cord grows, its length also increases. At first, the umbilical cord is only a few centimeters long. It gradually increases and reaches, on average, 40-60 cm. The length of the umbilical cord can be definitively determined only after childbirth. While the baby is in the mother's womb, the umbilical cord may curl somewhat.
Normally, the umbilical cord is attached to the center of the placenta. Doctors call this location central. In this case, intrauterine development proceeds physiologically. The blood vessels that are located in the umbilical cord reach the placenta and ensure sufficient blood flow.
With eccentric attachment of the umbilical cord, it is attached not to the central part of the placental tissue, but closer to its edge. Usually in this case the umbilical cord does not reach the edge of the placenta by a couple of centimeters. Eccentric attachment of the umbilical cord is usually not accompanied by the development of any adverse functional disorders. However, the paracentral attachment of the umbilical cord to the placental tissue requires doctors to be quite attentive to the development of pregnancy.
The easiest way to determine the type of attachment of the umbilical cord to the placenta is if the placental tissue is located along the anterior or lateral wall of the uterus.
If for some reason the placenta is located on the posterior wall, then determining the type of attachment becomes much more difficult. In this case, it is better to conduct examinations using expert-level devices. This allows you to get more informative and accurate results.
Central attachment
However, the central attachment of the umbilical cord to the placental tissue is not always formed during pregnancy. Abnormal attachment options in this case can lead to the development of various functional disorders.
Pathologies
Doctors identify several abnormal variants of attachment of the umbilical cord to the placenta. Thus, the umbilical cord can be directly attached to the edge of the placenta. Experts call this attachment marginal. This condition is characterized by the fact that the blood vessels located in the umbilical cord are located quite close to the edge of the placenta.
Lateral attachment of the umbilical cord to the placenta is not always the reason leading to the development of dangerous complications during pregnancy. Obstetricians-gynecologists especially highlight the condition in which the umbilical cord is located at a distance of less than 0.5 radius of the placenta from the edge. In this case, the risk of developing various complications is quite high.
Another clinical option for attaching the umbilical cord to the placenta is tunical. This condition is also called spiny. In this case, the blood vessels that are located in the umbilical cord are attached to the amniochorial membrane.
Normally, the arterial vessels that are located in the umbilical cord are covered with Wharton's jelly. This gelatinous substance protects the arteries and veins that are present in the umbilical cord from various damages. When the umbilical cord is attached to the placenta, the blood vessels are not covered with Wharton's jelly along their entire length. This contributes to the fact that the risk of developing various traumatic injuries to arteries and veins is quite high.
According to statistics, sheathed umbilical cord attachment occurs during pregnancy with one baby in approximately 1.2% of cases. If the expectant mother is expecting twins, then in such a situation the risk of developing this pathology increases and is already almost 8.8%.
In obstetric practice, there are cases when the umbilical cord can change its attachment to the placenta. The reasons for this may be different. This may be due to inaccuracies in determining the initial site of attachment of the umbilical cord to the placenta (the notorious human factor), as well as due to the migration of placental tissue during pregnancy. Note that changes in the location of the umbilical cord still occur infrequently.
Possible consequences
Abnormal attachment of the umbilical cord to the placenta threatens the development of a number of complications that can appear at different stages of pregnancy. In order to identify them in a timely manner, doctors resort to various diagnostic methods, the main of which is ultrasound examination. In this case, ultrasound is prescribed several times. This is necessary so that doctors can assess the dynamics of the development of pathology and promptly correct emerging disorders.
Since blood vessels pass through the umbilical cord, to assess the intensity of blood flow, doctors resort to prescribing another diagnostic method - Dopplerography. This examination allows you to assess whether there are any defects in the blood supply to the placenta and the fetus. Possible complications largely depend on how the umbilical cord is attached to the placenta.
When the umbilical cord is attached to the placenta, the risk of developing various traumatic injuries is quite high. Also, with this attachment option, there is a fairly high risk of developing dangerous bleeding, which can develop during childbirth. Some researchers believe that with this type of attachment of the umbilical cord to the placenta, the risk of developing intrauterine growth retardation is quite high.
In some cases, the membrane attachment of the umbilical cord to the placenta is accompanied by the development of combined pathologies. Thus, with this condition, anomalies and malformations of the internal organs of the fetus can also develop (including heart and vascular defects, defects in the structure of the musculoskeletal system, esophageal atresia), vascular pathologies, the appearance of additional lobules in the placental tissue and other disorders.
Another possible complication that can develop when the umbilical cord is attached to the placenta is the development of intrauterine fetal hypoxia. In this case, the child’s body does not receive enough oxygen necessary for “tissue” respiration. The resulting oxygen deficiency contributes to the disruption of the functioning of the internal organs of the fetus. This situation is fraught with the development of dangerous pathologies that can appear even after the child is born.
When the umbilical cord is attached to the placenta, the method of delivery is often a cesarean section. In some cases, natural childbirth can be dangerous due to the development of dangerous birth injuries and injuries. In order to avoid them, doctors prescribe a caesarean section.
Note that the choice of method of obstetric care is chosen individually, taking into account the various features of the course of a particular pregnancy.
For information on low placentation during pregnancy and the location of the placenta, see the following video.
Umbilical cord abnormalities– a group of conditions in which there is an abnormal structure or location of a given structure, nodes, entanglements, tumors, cysts are present. In this case, clear signs of acute or chronic fetal hypoxia are noticeable: impaired motor activity, increased or slowed heartbeat.
Ultrasound, cardiotocography, Doppler, and postnatal examination of the placenta are used to identify umbilical cord abnormalities.
Treatment depends on the type of umbilical cord anomaly and involves hospitalization of the pregnant woman and monitoring the condition of the woman and fetus, or involves emergency delivery by cesarean section.
Umbilical cord anomalies are a complex of obstetric pathologies that include abnormal development of blood vessels, the presence of blood clots in them, changes in the length of this structure, identification of nodes, prolapse, cysts, neoplasms, and atypical attachment. In the presence of such conditions, pregnancy is pathological.
Early diagnosis of umbilical cord abnormalities is extremely important, since timely medical care can preserve the health of the woman and the life of the fetus. Abnormalities can be suspected during a routine ultrasound, based on data from auscultation and palpation of the fetus.
Sometimes specialists diagnose umbilical cord abnormalities after the birth of a child, which is associated with the frequent absence of deterioration in the condition of the pregnant woman and the fetus with such pathologies.
Causes of umbilical cord abnormalities
It has not yet been possible to establish exactly why umbilical cord anomalies develop. However, there are suggestions that such pathological conditions may indirectly indicate the presence of congenital defects and chromosomal aberrations in the fetus.
Sometimes such defects do not have clear signs; additional studies will be required to identify them: cordocentesis, genetic consultation, karyotype determination. Some obstetricians and gynecologists associate umbilical cord abnormalities with the negative impact of various factors on the pregnant woman’s body.
In particular, bad habits, harmful working conditions, and the use of certain medications can provoke a pathological condition.
Classification and symptoms of umbilical cord abnormalities
In obstetrics, umbilical cord abnormalities are classified depending on the type of abnormality. Considering the length of the anatomical structure, it is worth abolishing pathologies such as long and short umbilical cord. In the first case, the length of the structure is more than 70 cm, in the second - less than 40 cm.
One of the most common anomalies of the umbilical cord is entanglement, in which loops of the anatomical structure are located around various parts of the fetal body. In this case, the occurrence of pathology does not depend on the size of the umbilical cord. Anomalies are possible both with a normal or long umbilical cord and with a short one.
The following forms of pathological condition are distinguished:
- Isolated– involves placing the loop around only one part of the body, for example, a leg or arm.
- Combined– there is entanglement of several anatomical areas at once.
- Not tight– the most favorable option for the fetus, since there is no pressure on the entwined parts of the body; problems may arise in the second stage of labor due to tension or be completely absent.
- Tight– promotes compression of blood vessels, which leads to fetal hypoxia.
Umbilical cord anomalies also include the presence of nodes. There are two forms of this pathological condition:
- False knots– are formed due to varicose veins of the umbilical cord or against the background of accumulation of a gelatinous substance. The prognosis is favorable, there is no threat to the condition of the fetus or mother.
- True– an unfavorable variant of the pathology, the nodes form in the early stages of pregnancy, when the embryo is small in size and can easily slip into the umbilical cord loop. Strong tension contributes to impaired blood flow with subsequent fetal hypoxia, which requires immediate delivery.
Anomalies of the umbilical cord may also consist in its improper attachment. Normally, the umbilical cord is located in the center of the placenta. The following forms of violations are possible:
- Edge attachment– the umbilical cord is located on the periphery of the placenta.
- Shell attachment– the anatomical structure is attached to the fetal membranes; during childbirth, this condition can cause rupture of the umbilical cord with subsequent fetal hypoxia.
Umbilical cord abnormalities often have no pathological signs. The clinical picture depends on the type of disorder. With pathological attachment of the structure, bleeding may develop during labor. Sometimes umbilical cord abnormalities contribute to prolonged labor, which can last 20 hours or more.
With tight entanglement of the fetus and true nodes, signs of fetal hypoxia are observed. With an acute lack of oxygen, there is an increase in the number of fetal movements and an accelerated heartbeat. In chronic hypoxia, the manifestations of the pathology will be the opposite - there is a decrease in movements and bradycardia.
With such umbilical cord anomalies as loose entanglement and false knots, abnormalities on the part of the mother or fetus are not detected.
Diagnosis and treatment of umbilical cord abnormalities
To identify umbilical cord anomalies, anamnesis is collected: they find out the woman’s living and working conditions, clarify what diseases the patient suffered, whether there were pregnancies and births, and how they ended.
Physical examination involves auscultation of the fetal heartbeat. To determine signs of umbilical cord abnormalities, instrumental diagnostic methods are used.
Ultrasound shows the level of blood flow in the vessels, their diameter, the location of the placenta and the attachment of the umbilical cord to it, the fetal heart rate, and its motor activity.
If the umbilical cord is abnormal, the heart rate may slow down or increase, and there may be insufficient oxygen supply to the fetus. Also, when carrying out an ultrasound scan, it is possible to detect entanglements and nodes. To diagnose umbilical cord abnormalities, cardiotocography and Doppler ultrasound may be prescribed.
Treatment of umbilical cord abnormalities depends on the type of pathology present. If this pathological condition is detected, the woman is hospitalized in a gynecological hospital.
Pregnancy management under medical supervision is indicated in cases of loose umbilical cord entanglement and the presence of false nodes. In this case, a prerequisite must be the good health of the woman and the fetus.
Emergency delivery by cesarean section is indicated if umbilical cord abnormalities contribute to fetal hypoxia (in particular, with tight entanglement, in the presence of true nodes).
Forecast and prevention of umbilical cord anomalies
The prognosis for umbilical cord anomalies is favorable in most cases. Even in the presence of acute hypoxia and emergency delivery, timely medical care can save the life of the child.
Sometimes oxygen starvation of the fetus leads to intrauterine growth retardation, the formation of fistulas, Meckel's diverticula, and cystic formations in the bile ducts. Fetal death due to umbilical cord abnormalities is rare.
On the maternal side, complications such as labor and postpartum hemorrhage are possible.
Prevention of umbilical cord anomalies consists of planning pregnancy, giving up bad habits during pregnancy, timely passing the necessary tests and conducting routine examinations with an obstetrician-gynecologist. You should also avoid stress, adhere to a balanced diet, and provide the pregnant woman with a good night's rest.
Source: http://MyMedNews.ru/anomalii-pypoviny/
The umbilical cord is the road of life
First of all, let’s get acquainted (in absentia, of course) with its structure, which consists of two arteries (oddly enough, everything is mixed up in the umbilical cord: venous blood flows through the arteries, saturated with waste products and moving from the child to the mother’s body) and one vein (and This is already a blood vessel going from mother to baby and, accordingly, carrying arterial blood rich in oxygen and nutrients).
Nerve fibers run along them, and on the outside all these “wires” are surrounded by a special gelatinous substance that plays a protective role against compression.
The uppermost membrane of the umbilical cord is the amnion, or, otherwise, the amniotic membrane.
The umbilical cord usually has a bluish color, a shiny surface and is spirally twisted (the norm is a left-hand twist vector - by the way, in nature, in general, many structures gravitate towards the left side).
One end of the umbilical cord is attached to the baby’s tummy, and the other to the placenta, and there may be options: most often this occurs in the central part of the placenta (doctors say “central attachment” - this is normal), less often - on the side (lateral attachment) or even at its edge (marginal attachment).
The umbilical cord “receives” such a relatively simple structure already in the 2-3rd week of pregnancy - that’s when it begins to form and for some time grows and develops along with the baby. Unfortunately, even such a simple formation can receive certain errors and violations as a result of its formation. Let's list the main ones.
Umbilical cord: pathologies
As a rule, almost all umbilical cord pathologies are fraught with the same thing - impaired blood supply to the child. First of all, this affects the supply of oxygen to the baby’s tissues and organs, and the most sensitive to the lack of the main vital gas is the nervous tissue - the brain cells.
Umbilical cord: insufficient umbilical cord length
Doctors can diagnose “absolutely short” (when shortening actually occurs, then the dimensions are less than 40 cm) or “relatively short” (also called “false shortening” - in this case, the physical length of the cord remains normal, but due to entanglement the relative size of its free end decreases, or is it due to the presence of true nodes -
see points 3 and 4). By the way, in the second case, the total length of the umbilical cord, on the contrary, may be too long (more than 70 cm), which is why the baby becomes entangled in its excessive length. The second reason for false shortening is fetal hypoxia, which leads to its excessive motor activity and, as a consequence, to entanglement in the umbilical cord rings.
The complications of a short umbilical cord are obvious: due to its too short length, the movement of the child along the birth canal is difficult and is associated with the danger of separation (detachment) of the placenta and rupture of the umbilical cord itself.
Umbilical cord: excessive length
As we have already found out, it is also undesirable, since it is fraught, for example, with entanglement, the formation of true nodes and loss of loops when amniotic fluid is released.
Umbilical cord: entanglement
Sometimes this pathology may not be related to the length of the umbilical cord (it also occurs with normal sizes, and also, as we now know, with its shortening or lengthening).
In some cases, if the loops lie freely and are not compressed, this fact does not affect the condition of the fetus in any way until birth.
And only a tight entanglement can be truly dangerous when the child suffers from severe circulatory disorders and hypoxia.
The diagnosis may include the following definitions of entanglement: isolated (that is, the umbilical cord is wrapped around one part of the fetus’s body - for example, a hand), combined (several places are already involved here), tight (very undesirable, since in this case blood circulation may suffer ) and not tight (almost harmless for the baby; negative consequences may become felt only in the second stage of labor or not at all). Doctors can also note the frequency of entanglement (a medical record was recorded for a baby who managed to wrap the umbilical cord around himself as many as 9 times!).
One of the frequently noted types of entanglement is a single, loose entanglement around the child’s neck - the frequency of occurrence is 20-30% of all births and, as a rule, does not in any way affect the health and further development of the baby.
Also, sometimes after giving birth, mothers can find out that the baby was born with a belt-type or rein-type entanglement - in such allegorical language with a touch of military and cavalry romance, doctors designate certain categories of wrapping the umbilical cord around the baby’s body.
So, the first definition concerns the loops of the umbilical cord located on the thigh and opposite shoulder of the baby, and the second is given when it passes under the baby’s armpits. Agree, the names given are accurate and reflect the very essence!
Umbilical cord: the presence of true and false nodes
A knot can be tied on the umbilical cord, like on a string - they are different for reasons and completely different in consequences for the fetus and mother. False nodes are local thickenings of the umbilical cord due to varicose veins or accumulation of gelatinous substance.
They are not dangerous because they do not affect the development of the fetus and the birth process. Perhaps, of all the possible developmental disorders of the umbilical cord, they are the most “desirable”. But true umbilical cord knots form in the early stages of pregnancy, when the fetus is still so small that it can slip through the umbilical cord loop.
True umbilical cord knots can adversely affect the outcome of childbirth: when the umbilical cord is pulled, such a knot is tightened, normal blood circulation through the vessels is stopped, and the baby is actually left without oxygen supply before the due date.
In this case, acute fetal hypoxia occurs, requiring immediate intervention.
Umbilical cord: missing one artery
At the same time as this disorder, the umbilical cord is thin, short, and, as a rule, has no turns.
The prognosis for such a diagnosis is sometimes unfavorable - the fetus may experience various malformations or premature onset of labor.
If the ultrasound doctor finds, along with this pathology, other signs of congenital malformations of the fetus, the woman may be referred for a consultation with a geneticist to rule out chromosomal abnormalities.
Umbilical cord: improper attachment
These include marginal (pregnancy and childbirth proceed without complications) and membrane attachment (the umbilical cord in this case is attached not to the placenta itself, but to the fetal membranes at some distance from its edge).
The second type of attachment is dangerous because during childbirth, rupture of vessels that are not protected by a gelatinous substance can occur. This will lead to an acute lack of oxygen and pose a threat to the child's life.
In addition, when the umbilical cord is attached to a membrane, there is an increased risk of fetal growth retardation, as well as premature birth.
Hypo- (small number of umbilical cord turns) and hypertortuosity (on the contrary, the number of vessel turns exceeds the norm)
Both conditions are usually associated with various disorders of fetal development and the general course of pregnancy - for example, premature birth, delayed fetal development and other troubles.
Skinny umbilical cord - this is the designation for an underdeveloped umbilical cord, having an average thickness of less than 1.4 cm (or, otherwise, a specific gravity of less than 0.5 g/cm).
Of these, the most common disorders are an absolutely short umbilical cord and entanglement of the umbilical cord around the neck, torso and limbs of the fetus. As a rule, no special treatment methods for these changes have been developed. Only in case of acute fetal hypoxia can emergency delivery be prescribed.
Umbilical cord: causes of pathologies
As for the reasons for the occurrence of these violations, there are many of them.
These are chemical factors (including the presence of undesirable substances in our food, because
it is necessary to monitor nutrition with particular care), and the mother’s unhealthy lifestyle (this includes smoking and alcohol abuse; also, too intense, to the point of exhaustion, sports or extreme sports can provoke disorders such as umbilical cord entanglement due to the release of adrenaline into the mother’s blood ), its acute and chronic diseases (diabetes mellitus), genetic predisposition, exposure to radiation.
Umbilical cord: condition monitoring
The range of studies to monitor the condition of the umbilical cord is not as wide as we would like, and, as a rule, only allows us to assume the presence of any complications, but not to confirm their absolute presence.
The most accessible and common way to study the umbilical cord is ultrasound scanning, which allows one to identify such umbilical cord anomalies as abnormal development of blood vessels, the presence of true and false nodes, and entanglement of the fetus with the umbilical cord. Ultrasound also makes it possible to clearly identify its attachment.
But the length during pregnancy is almost impossible to determine, although, as we saw above, this parameter is of utmost importance for mother and child during natural childbirth.
Doctors may prescribe a more informative Doppler (Doppler) study, during which they can study the movement of blood through the vessels - including the umbilical cord. Directly during childbirth, the cardiotocography (CTG) method is used, which allows you to monitor the heart of the mother and baby.
But the most important thing happened - the baby was born, the umbilical cord continues to “work” for some time after this moment. After the baby is born, the umbilical cord is cut, and a staple or ligature is placed on the area closest to the future umbilical cord.
It is now generally known that in the interests of the newborn and his mother, it is necessary to wait until the end of the umbilical cord pulsation (about 3-5 minutes) - a sign that it has completed its function completely.
Premature cutting of the umbilical cord is fraught with
the fact that the baby does not receive the amount of blood he needs, which in the future can lead to iron deficiency anemia.
Olga Soboleva, Candidate of Biological Sciences
Source: https://lisa.ru/moy-rebenok/beremennost/17848-pupovina-doroga-zhizni/
Pathologies of the fetal umbilical cord
Anomalies of the fetal umbilical cord are not so rare, in 21–65% of cases. During pregnancy, umbilical cord pathology, as a rule, does not manifest itself in any way, but poses a danger during childbirth. Often, anomalies of the fetal umbilical cord are an indication for planned, and more often for emergency cesarean section.
What is the umbilical cord and why is it needed?
Causes and description of pathologies of the fetal umbilical cord The umbilical cord is a spirally twisted tube that connects the fetus to the placenta. Normally, the length of the umbilical cord is 45–60 cm, and its diameter is 1.5–2 cm. Three vessels pass through the umbilical cord: the umbilical vein and two arteries.
Through the vein, the fetus receives oxygen and nutrients from the mother (through the placenta), and the arteries are necessary for removing the child’s metabolic products into the woman’s blood, which are then excreted by the kidneys. The umbilical cord begins to form at 2–3 weeks of intrauterine development and continues to grow with the fetus until the 28th week.
The umbilical vessels are surrounded by a jelly-like substance (Wharton's jelly), which not only fixes them, but also protects them from injury and compression.
Causes of fetal umbilical cord pathologies
The exact causes leading to fetal umbilical cord abnormalities have not yet been established. One of the factors in the development of umbilical cord pathology is intrauterine fetal malformations and chromosomal aberrations.
On the other hand, umbilical cord abnormalities may indirectly indicate fetal malformations, which requires additional antenatal studies (genetic consultation, karyotype determination, cordocentesis, etc.).
A connection has also been identified between umbilical cord pathology and exposure to harmful factors in the first trimester of pregnancy (smoking, drinking alcohol, hazardous working conditions).
Umbilical cord length abnormalities
There are short and long umbilical cords. A short umbilical cord is said to be when its length is 40 cm or less. A short umbilical cord can be absolute or relative.
Relatively short umbilical cord
The relatively short umbilical cord is caused by entwining around the fetal neck, less often around the legs and arms during pregnancy when the child moves.
The entanglement of the umbilical cord around the fetal neck is quite common; as a rule, it is a single entanglement, less often two or three times. The literature describes 2 cases of nine-fold entanglement of the umbilical cord around the neck.
Repeated entanglement poses a threat to the baby in the second (pushing) stage of labor. This pathology can lead to hypoxia or even the death of the baby.
Absolutely short umbilical cord
An absolutely short umbilical cord can cause premature birth, premature placental abruption, rupture of the umbilical cord or its vessels, which also leads to fetal death. An absolutely short umbilical cord is often observed with intrauterine malformations of the fetus.
Excessively long umbilical cord
An excessively long umbilical cord also causes entanglement, and, in addition, leads to the formation of true knots and excessive tortuosity, which threatens fetal hypoxia during childbirth.
Loss of umbilical cord loop
Loss of the umbilical cord loop (prolapse) occurs during childbirth and is an extremely dangerous situation.
This pathology requires immediate delivery (caesarean section), and while preparing the woman for surgery, it is necessary to hold the presenting part of the fetus to prevent compression of the umbilical cord, through which the baby receives oxygen.
Loss of the umbilical cord inevitably leads to acute hypoxia of the fetus and often to its death. As a rule, umbilical cord prolapse occurs after the rupture of amniotic fluid.
Predisposing factors for umbilical cord prolapse include:
- breech or leg presentation;
- premature birth (the fetus is very small and is not able to hold the umbilical cord in the uterus);
- multiple pregnancy (after the birth of the first child);
- excessively long umbilical cord;
- polyhydramnios;
- amniotomy.
Umbilical cord knots
There are true and false umbilical cord nodes.
False knots
False nodes are an accumulation of Wharton's jelly or local thickening of the umbilical vein due to its varicose veins and have no practical significance (do not affect pregnancy and childbirth).
True nodes
True nodes form during pregnancy (in the early stages), when the embryo is still too small and “floats” freely in the amniotic fluid. In this case, it can slip through the loop of the umbilical cord, resulting in a knot.
As long as the knot is not tightened, this pathology does not affect the condition of the fetus, but when the umbilical cord is stretched, which most often occurs during childbirth, the knot is tightened, which leads to hypoxia and the death of the child.
If the knot tightens during pregnancy, it ends either in miscarriage or antenatal death of the fetus.
Abnormal umbilical cord attachment
There are marginal and shell attachments of the umbilical cord. Normally, the umbilical cord is located in the center of the placenta; if it is localized closer to the edge of the baby's place, they speak of a marginal umbilical cord attachment.
A dangerous pathology is the membrane attachment of the umbilical cord, when the latter departs not from the maternal part of the placenta, but from the fetal membranes, while the umbilical cord is not protected by Wharton’s jelly.
If the membranes rupture during childbirth, damage to the umbilical cord vessels may occur, which leads to bleeding, anemia and intrauterine hypoxia or sudden fetal death.
Thrombosis of umbilical cord vessels
Thrombosis of umbilical cord vessels is a fairly rare pathology. Venous thrombosis is more common, but arterial thrombosis has a more unfavorable prognosis.
Vascular thrombosis is a secondary complication that develops with true umbilical cord nodes, tunicated umbilical cord attachment, long or short umbilical cord, as well as with multiple pregnancies, maternal diabetes mellitus, abdominal trauma and premature birth. The risk of umbilical cord vascular thrombosis is high in high-risk pregnancies.
Umbilical cord cysts
Umbilical cord cysts can be true or false. True umbilical cord cysts are lined by epithelial cells, whereas false cysts represent Wharton's jelly. Small cysts have no practical significance, but large umbilical cord cysts can compress its vessels and are diagnosed by ultrasound.
Anna Sozinova
(5 , rating:
Source: http://www.webmedinfo.ru/patoloii-pupoviny-ploda.html
Features of pregnancy and childbirth with marginal umbilical cord attachment
The umbilical cord is an organ that connects the fetus to the baby's place. This is a kind of cord consisting of 1 vein and 2 arteries, fastened together and protected from damaging effects by Vartan jelly. The traction between mother and fetus is necessary to provide the baby with oxygenated blood, nutrients, and remove carbon dioxide.
How the umbilical cord attaches to the placenta
The normal option for fixation is the departure of the umbilical cord from the center of the child's place. Anomalies are called lateral, marginal, shell attachment of the “cord”.
It is best to examine them in the 2nd trimester using ultrasound diagnostics, when the placenta is on the anterior or anterolateral uterine wall. When it is localized on the posterior wall, it may be difficult to determine.
The use of color Dopplerography makes it possible to recognize the exact variant of the pathological exit of the cord to the child's place.
Let's consider several types of abnormal fixation of the umbilical “cord”:
- Central - in the middle of the inner surface of the placenta. Occurs in 9 out of 10 pregnancies and is considered a normal option.
- Lateral (eccentric) - not in the center, but on the side of the embryonic organ, closer to its edge.
- Marginal - from the edge of the placenta. The umbilical arteries and vein pass to the child's place close to its periphery.
- Tunicate (pleated) - attached to the membranes of the fetus without reaching the placenta. The vessels of the umbilical cord are located between the membranes.
What is the marginal attachment of the umbilical cord?
Marginal deviation means fixation is not in the central zone, but in the peripheral zone. The umbilical arteries and vein enter the child's place too close to the very edge. Such an anomaly usually does not threaten the normal course of pregnancy or childbirth, being considered a feature of a specific period of gestation.
Experts say that marginal discharge is not an indication for a cesarean section: natural delivery is carried out. This attachment does not increase the risk of complications for the mother or baby. However, when doctors try to isolate the placenta by pulling the umbilical cord, the latter may come off.
Possible reasons for this condition
Experts consider the main cause of pathological attachment to be a primary defect in the implantation of the umbilical cord, when it is not localized in the area of the trophoblast that forms the baby's place.
Risk factors for anomalies are:
- First pregnancy;
- Young age, not exceeding 25 years.
- Excessive physical activity combined with a forced vertical position of the body.
- Obstetric factors - oligohydramnios, polyhydramnios, weight, position or presentation.
Most often, abnormal fixation of the umbilical cord occurs simultaneously with several variants of cord pathology - true nodes, non-spiral arrangement of vessels.
The meningeal site of attachment of the cord between the mother and the fetus is fixed much more often when a woman is carrying twins or triplets, or during repeated births. Often such an anomaly accompanies malformations of the child and organs: congenital uropathy, esophageal atresia, heart defects, a single umbilical artery, trisomy 21 in a baby.
What is the danger of diagnosis?
The marginal variant of the exit of the umbilical cord is not considered a serious condition. Doctors pay attention to such localization of the “cord” attachment in the case when the umbilical cord is located at a distance not exceeding half the radius of the child’s seat from the edge. This situation causes the development of obstetric complications.
For example, the radius of the placenta is 11 cm. If the cord in this form does not exceed 5.5 cm from the edge, close monitoring of the child’s condition is necessary: there is a high risk of developing oxygen starvation in the womb. For this purpose, medical workers monitor the movements of the babies and conduct CTG at least 2 times a week throughout the entire gestation period.
The shell version poses a much greater threat. The disorder is more typical for multiple pregnancies. The vessels are located between the membranes, are not covered with Vartan jelly, and fibrous tissue is also less developed there. For this reason, they may not be protected from damage during childbirth.
When the arteries and veins are located in the lower segment of the fetal bladder, rupture of the membranes leads to bleeding. The baby's amniotic fluid compresses the blood vessels, leading to massive blood loss in the baby. Acute hypoxia develops, and if timely medical care is not provided, fetal death may occur.
When the area of the membranes passes over the internal os of the cervix, located at the bottom of the presenting part of the baby, a diagnosis of vasa previa is made. This is a variant of the weaving type of “cord” departure.
The pathology is accompanied by rupture of amniotic fluid with bleeding. An emergency delivery is required.
When a baby is born with moderate or severe anemia and hypoxia, blood products are transfused immediately after birth.
How is pregnancy progressing?
With marginal attachment, the gestation period and subsequent delivery are most often not accompanied by the development of any complications. With the membrane variant, intrauterine hypoxia occurs during pregnancy with the subsequent development of growth retardation. The risk of premature birth increases.
With sheath fixation of the umbilical cord, damage to the arteries and veins sometimes occurs during gestation. This is accompanied by bleeding from the genital tract in the expectant mother and such manifestations as oxygen deficiency in the baby, rapid heartbeat followed by a decrease, muffled heart sounds, and the passage of meconium during cephalic presentation.
If symptoms appear, seek medical attention immediately to avoid maternal and fetal complications.
Peculiarities of childbirth with velamentous umbilical cord attachment
Such an anomaly in the origin of the cord is accompanied by a high risk of damage to the umbilical vessels, followed by fetal bleeding and rapid death of the child. To prevent their rupture and death of the baby, timely recognition of the pathological variant of the “cord” exit is necessary.
Natural childbirth requires good specialist skills and constant monitoring of the baby’s condition due to the high risk of death of the mother and baby. Childbirth should be quick and gentle. Sometimes the doctor can feel the pulsating arteries. The doctor opens the amniotic sac in a place so that it is distant from the vascular zone.
If there is a rupture of the membranes with blood vessels, rotation on the stem and extraction of the fetus are applied. When the head is in the cavity or pelvic outlet, obstetric forceps are used. These benefits can only be applied when the child is alive. To avoid adverse consequences, specialists choose surgical intervention - caesarean section.
Is it possible to eliminate this feature?
On many forums, expectant mothers ask themselves the question: how to get rid of the pathological discharge of the umbilical cord.
During gestation, it is impossible to eliminate the anomaly: it cannot be treated either with medication or surgery. There are no exercises to correct the abnormal attachment of the cord between mother and baby.
The main goal of the specialist is to prevent the rupture of the membranes and the subsequent death of the baby at birth.
Conclusion
For some women, the period of bearing a baby is overshadowed by various pathologies of the placenta or umbilical cord. Many of them do not affect the course of pregnancy and childbirth, but in rare cases there is a real threat to the health and life of the mother and child. We are talking about abnormal fixation of the umbilical “cord”.
By undergoing routine ultrasound examinations, the doctor can detect pathology and, based on the data, choose the appropriate delivery. Don’t panic, trust a specialist: he will help you carry and give birth to a healthy child.
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Sofia asks:
What is the marginal attachment of the umbilical cord to the placenta?
The placenta is a flat, rounded cake, one side attached to the wall of the uterus, and the other facing the fetus. The umbilical cord extends from the placenta to the fetus. Normally, the umbilical cord is attached to the central part of the placenta, but anomalies occur in approximately 5–6% of pregnancies. One of these variants of abnormal attachment of the umbilical cord to the placenta is marginal.
The marginal attachment of the umbilical cord is its fixation not in the central part, but on the periphery of the placenta, or, in other words, on the edge. That is, the vessels of the umbilical cord pass into the placenta close to the very edge. This abnormal attachment of the umbilical cord to the placenta is simply a feature of this particular pregnancy. In most cases, pregnancy and childbirth with marginal attachment of the umbilical cord proceed normally. This feature is not an indication for cesarean section, and childbirth may well occur naturally. The marginal attachment of the umbilical cord does not increase the risk of developing various complications during childbirth.
Only cases where the umbilical cord is attached at a distance from the edge that is half the radius of the entire placenta require close attention. For example, the radius of the placenta is 10 cm. If the umbilical cord in this case is attached at a distance of less than 5 cm from the edge (10 cm/2 = 5), then this case requires careful monitoring of the condition of the fetus, since there is a high probability of developing hypoxia. That is, it is necessary to monitor fetal movements and do CTG at least twice a week throughout pregnancy. CTG is also often done during labor to monitor the condition of the fetus. If acute hypoxia occurs, an emergency caesarean section is performed. Most often, such marginal attachment of the umbilical cord is observed during multiple pregnancies (twins, triplets, etc.).
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Anomalies and pathologies of the umbilical cord include changes in its length, formation of nodes, cysts, hematomas, hemangiomas, abnormal development of blood vessels, and pathological attachment. One type of such pathological attachment is the marginal attachment of the umbilical cord.
Normally, the umbilical cord should be attached to the center of the placenta. However, the following incorrect attachments of the umbilical cord are observed: tunicate, split, central, marginal, vasa praevia. Pathological attachments of the umbilical cord include the shell and marginal ones.
Membranous attachment involves the attachment of the umbilical cord to the membranes located at a certain distance from the edge of the placenta, and not directly to the placenta. The reason for this attachment is the primary pathology of umbilical cord implantation. With membrane attachment, the risk of premature birth increases, and fetal growth is possible. Also, this type of umbilical cord attachment during childbirth often leads to an acute (pathological condition caused by a lack of oxygen).
The marginal attachment of the umbilical cord is expressed by its attachment to the periphery of the placenta, while the vessels of the umbilical cord pass into the placenta quite close to its edge. With this pathological type of attachment, pregnancy and childbirth usually proceed without complications. Clinical attention is required only in cases where the localization of the umbilical cord is concentrated at a distance of less than 1/2 of the radius of the placenta from its edge. This location of the umbilical cord usually creates a distinct possibility of obstetric complications. More often, such an anomaly occurs in multiple pregnancies.
Visualization of the umbilical cord during ultrasound does not cause any particular difficulties at different stages of pregnancy. Significant difficulties involve diagnosing pathological umbilical cord attachments when the placenta is on the posterior wall of the uterus. Already from the middle of the second trimester, with transverse and longitudinal scanning, the vessels of the umbilical cord are clearly identified. Careful scanning of the umbilical cord reveals its helical twisting, and the number of turns can vary from 10 to 25. The absence of helical twisting is regarded as an echographic sign of chromosomal abnormalities.
Ultrasound assessment of the umbilical cord includes the study of the places of attachment of the umbilical cord to the placenta, to the anterior abdominal wall of the fetus, the number of umbilical cord vessels, and pathological modifications of the umbilical cord. The presence of any of the umbilical cord anomalies increases the incidence of perinatal complications. Not all types of anomalies are a threat to the condition of the fetus, but are unique markers of other pathologies.
Prenatal diagnosis of many abnormal forms is possible with ultrasound, and prenatal diagnosis also makes it possible to make a prognosis of the course of labor.
The marginal attachment of the umbilical cord to the placenta is a relatively rare cause for concern for the expectant mother. However, such an anomaly in the fixation of the umbilical cord in some cases (especially if complicated by other problems) can cause heavy bleeding during childbirth and fetal death. To reduce the risks, a pregnant woman may be advised to deliver by caesarean section.
Pregnancy monitoring
The key to successful pregnancy is regular observation at the antenatal clinic. Within the required time frame, the doctor will refer the pregnant woman for tests and other diagnostic procedures, and will conduct additional studies if indicated or if pathology is suspected.
Among the many possible complications of gestation, abnormalities in the attachment of the umbilical cord to the placenta stand out. In the early stages, such pathologies are not detected, but in the later stages they can affect the management of labor or worsen the child’s condition.
Diagnosis of attachment anomalies is usually carried out in the second trimester of pregnancy, provided that the placenta is located on the anterior or lateral walls of the uterus, although the umbilical cord can be examined at an earlier stage. If the placenta is located on the posterior wall or the woman has oligohydramnios, then diagnosing abnormalities in the umbilical cord attachment is difficult. The main diagnostic procedure is ultrasound diagnostics. Ultrasound is performed as part of the first and second screenings, in the third trimester of pregnancy, and also if indicated.
What is pregnancy screening? This is a set of studies that are carried out to identify a group of pregnant women with possible fetal malformations. Screening includes a biochemical blood test and ultrasound. These are fairly proven and reliable diagnostic methods, however, the need for screening still causes a lot of controversy (mainly among expectant mothers themselves).
Attaching the umbilical cord
The umbilical cord, or umbilical cord, is a “cord” of three vessels: two arteries and one vein. The vein carries blood enriched with oxygen and nutrients to the fetus, and the arteries carry blood that carries carbon dioxide. After birth, the umbilical cord on the child’s side is clamped and cut, leaving a process and an umbilical wound in its place. The shoot disappears within four to five days, and the wound gradually heals.
How is the umbilical cord attached to the placenta on the mother's side? In nine out of ten pregnancies, the cord is attached to the middle of the placenta. This is considered the norm. The departure of the umbilical cord from the center of the child's place is considered as a feature of fixation. Anomalies of attachment include the tunical, lateral and marginal attachment of the umbilical cord to the placenta.
Attachment abnormalities
The membrane attachment is characterized by attachment not to the placental tissue, but to the membrane. In this case, the vessels in some area are not protected, which creates the risk of damage and bleeding when the membranes rupture. In addition to the danger of intense bleeding during childbirth, some doctors argue that such a pathology increases the risk of intrauterine growth retardation.
This complication occurs only in 1.1% of singleton pregnancies, and in twins and triplets it occurs more often - in 8.7% of cases. The anomaly can be accompanied by fetal malformations in 6-9% of cases, especially defects of the interatrial and interventricular septa of the heart, artresia of the esophagus, and congenital uropathy. It happens that there is only one artery in the umbilical cord or there are additional lobes of the placenta. Shell attachment has been described in fetal trisomy 21 (Down syndrome).
Doctors can suspect dangerous diagnoses during routine screening of the first and second trimesters, which are carried out respectively at 11-13 weeks, 18-21 weeks, as well as at an ultrasound scan of the third trimester (what screening during pregnancy is is described above).
In case of increased risk for a woman, additional methods for diagnosing pathologies are recommended: umbilical cord puncture (cordocentesis), electro- and phonocardiography of the fetus, fetal cardiotocography, Dopplerography, biophysical profile, amnioscopy (study of the state of amniotic fluid and the fetus), aminocentesis (puncture of amniotic fluid) and so on .
Marginal attachment of the umbilical cord
The umbilical cord can be attached to the placenta from the side, closer to the edge. Thus, fixation is noted not in the central zone, but in the peripheral one. The arteries and vein enter too close to the very edge. Typically, such an anomaly does not threaten the normal course of pregnancy and childbirth. Marginal attachment is considered a feature of a specific period of gestation.
If marginal attachment of the umbilical cord to the placenta is diagnosed, what to do? Gynecologists claim that such a pathology does not threaten the development of the fetus and the normal course of pregnancy, and is also not an indication for cesarean section, that is, natural delivery is carried out. The only important feature: when medical personnel attempts to separate the placenta in the third stage of labor by pulling on the umbilical cord, the umbilical cord may be torn off, which threatens bleeding and requires manual removal of the placenta from the uterine cavity.
Reasons for this condition
The marginal attachment of the umbilical cord in the placenta occurs as a result of a primary defect in the implantation of the umbilical cord, when it is localized in the area that forms the baby's place. Risk factors include:
- mother's age is under 25 years;
- excessive physical activity;
- first pregnancy;
- some obstetric factors (polyhydramnios or oligohydramnios, fetal position or presentation, weight).
Often abnormal attachment is accompanied by other variants of pathology - non-spiral arrangement of nodes, true nodes.
The danger of diagnosis
What are the consequences of marginal attachment of the umbilical cord to the placenta? Such an anomaly, in most cases, is not a serious condition. Doctors pay special attention to the location if the umbilical cord is too short or too long, because this creates an additional risk of developing various obstetric complications. It is also important how close to the edge the cord is attached. If too close, there is a risk of oxygen starvation. Usually, with this diagnosis, CTG is performed twice a week throughout the entire period of pregnancy in order to timely determine possible fetal malaise.
How is pregnancy progressing?
Marginal attachment of the umbilical cord to the placenta is rarely accompanied by complications. In a small number of cases, there is a risk of intrauterine fetal hypoxia, developmental delay, and premature birth. Shell attachment is much more dangerous. In this case, damage to the vessels of the umbilical cord during pregnancy is possible. This is accompanied by the release of blood from the mother’s genital tract, rapid fetal heartbeat with a subsequent decrease in frequency, muffled heart sounds and other manifestations of a lack of oxygen in the child.
Features of childbirth
With marginal attachment during childbirth, damage to blood vessels is possible, followed by bleeding, which poses a danger to the life of the child. To prevent complications during the delivery process, timely recognition of the exit of the umbilical cord is necessary. Childbirth should be gentle and quick, the fetal bladder should be opened in a place that is distant from the vascular zone. A doctor can give a woman a natural birth, but this requires good medical skills, as well as constant monitoring of the condition of the mother and child.
If a vascular rupture occurs during childbirth, the baby is turned onto his leg and removed. If the fetal head is already in the cavity or at the outlet of the pelvis, then obstetric forceps are used. These methods can be used if the child is alive.
Often (and especially if there are additional medical indications), doctors recommend a planned cesarean section for a woman with a marginal attachment of the umbilical cord to the placenta. The operation allows you to avoid negative consequences that may occur during natural childbirth.
Eliminating the feature
Expectant mothers are interested not only in what marginal umbilical cord attachment is, but in ways to eliminate this feature so that there are fewer risks during childbirth. But during pregnancy it is impossible to eliminate the anomaly. There is no medical or surgical treatment. No amount of physical exercise will correct the improper attachment of the cord between mother and fetus. The main goal of observation is to prevent rupture of the vascular membranes and subsequent death of the child during childbirth.
Short conclusion
A certain number of pregnancies are complicated by various pathologies of the umbilical cord or placenta, one of which includes attachment anomalies. Many of these anomalies do not in any way affect the gestation period and childbirth, but in some cases there is a serious threat to the health and life of the mother or child. The doctor can detect the pathology during a routine ultrasound examination. Based on the data obtained, the most suitable method of delivery is selected. The expectant mother needs to try to be less nervous. It is imperative to trust specialists who will help you bear and give birth to a child.