Almost always an umbilical cord is a medical emergency. Delayed intervention can damage the fetus.

What is an umbilical cord incident?

An umbilical cord prolapse, as defined by the medical profession, occurs when the umbilical cord shifts between the birth canal and the unborn child during labor or premature rupture of the membranes (rupture of the amniotic sac).

Since the pressure on the umbilical cord in the fetus can lead to lack of oxygen, the umbilical cord incident is usually treated emergency medical. Within Germany, an umbilical cord episode occurs in about 0.3% of pregnancies.

In particular, fetuses with abnormal childhood status are affected; such a different child situation may take the form of the oblique, foot or transverse position, for example. Even with multiple births the umbilical cord prolapse occurs more.

causes

A possible cause of an umbilical cord injury in medicine is a birth canal that is not adequately sealed by the fetus. For example, in premature births or above-average fetuses, the risk of an umbilical cord prolapse increases.

Other factors that may favor an umbilical cord event include a very deep placenta and / or a so-called hydramnion - the presence of an increased amount of amniotic fluid in the uterus.

If an umbilical cord prolapse occurs as part of a premature rupture of the bladder, the incident may be due to the fetus being pulled into the pelvis of the expectant mother by the sudden suction of the amniotic fluid; If at this time the umbilical cord is below the fetus, the body of the unborn child may exert pressure on the umbilical cord and an umbilical cord prolapse occurs.

Symptoms, complaints & signs

An umbilical cord prolapse can be determined by various signs. Most often, the doctor first noticed a drop in the heart rate of the embryo. This slows the pulse and activity of the child. During physical examination, the pulsating umbilical cord can be felt in front of the embryo, often at that time it has already caught on the limbs, on the torso or on the neck of the child.

If the umbilical cord is not released immediately, there is an acute danger to life. As a result of the lack of oxygen and blood supply, brain cells die within a few minutes. This often results in severe disability or even death of the child. If the umbilical cord wraps around the fingers or toes, it can lead to fractures and as a result to malformations.

In the case of an umbilical cord incident, a caesarean section must always take place. If this happens on time and the child is still sufficiently supplied with oxygen, no long-term consequences occur. However, there may be developmental delays in individual cases. In addition, an umbilical cord prolapse usually results in a premature birth, which is always associated with certain risks. Externally, an umbilical cord incident is not apparent. However, mothers often notice that the child no longer or suddenly panic moves.

Diagnosis & History

To diagnose an umbilical cord incident, a so-called cardiotocography is often performed first; this is a procedure that, for example, makes it possible to check the heartbeat of an unborn child. The evidence of an umbilical cord event includes a slowed heartbeat of the fetus.

In a presumptive diagnosis, a treating gynecologist in a next step often scans the birth canal of the expectant mother to determine the position of a potentially prolapsed umbilical cord. Even if this examination step could not adequately ensure a diagnosis, it is also possible, for example, to have an amniotic fluid reflection when the cervix is ​​already sufficiently open.

The course of an umbilical cord event is positively influenced, above all, by early, medical intervention. If a medical intervention is delayed, an umbilical cord prolapse may result in damage to the fetus. In severe cases, an umbilical cord prolapse may result in the death of the embryo.

complications

The umbilical cord prolapse is one of the most dangerous complications that can occur at birth. If the incident is not detected in advance in cardiotocography, failure or late medical treatment will in the worst case result in serious injury or death to the child. An indication can be a premature rupture of the membranes.

In this case, the expectant mother should be hospitalized as soon as possible in a lying position. Due to the rupture of membranes, the amniotic fluid suction pulls the fetus towards the mother's pelvis. If the umbilical cord happens to be below the child at the moment, the fetus itself presses on the protruding umbilical cord. The mother can at least reduce the pressure in a lying position.

Each umbilical cord episode breaks the oxygen and blood supply to the fetus. The child may either be severely disabled or even die, so an emergency caesarean section is necessary. If, in the worst case, the child has not had oxygen for too long and dies, it must be resuscitated within the womb mother.

This works, for example, with bronchodilator drugs. A caesarean section is unavoidable in the case of umbilical cord prolapse because the umbilical cord makes a natural delivery through the vagina impossible.

When should you go to the doctor?

Since an umbilical cord incident is an emergency, immediate action must be taken if it occurs. Otherwise, the fetus dies during or immediately after delivery. Since normally the expectant mother is in the hands of a medically trained staff, the irregularity is noticed and treated by the employees.

If pregnant women notice any abnormalities or abnormalities during childbirth, they should immediately inform the nurses, midwives or doctors present. Although there is a permanent monitoring of maternal and child health during birthing, alerts or changes reported by the mother can be clarified and investigated more quickly.

Obstetricians are present to a sufficient extent in the case of an inpatient birth, a birth house or a planned childbirth in the home. In a spontaneous birth without the presence of trained personnel, an emergency service is to alert.

Until the patient arrives, the instructions of the emergency doctor should be followed, as in serious cases there is danger to life for both mother and child. An umbilical cord injury can not be treated by the affected person for anatomical reasons. The mother-to-be is dependent on the help of other people and can only provide feedback on health changes, abnormalities or irregularities.

Treatment & Therapy

In most cases, an umbilical cord prolapse requires rapid caesarean section. If the expectant mother has to be transported to the hospital for the present case of an umbilical cord (which may be the case, for example, in the case of an unexpected rupture of the bladder), it is often important to carry out a prone position; In this position, the pressure of the fetus on the prolapsed umbilical cord can be reduced.

Also, to relieve the prolapsed umbilical cord contributes to an umbilical cord incident, for example, the emergency medical measure to relocate the head of the fetus pushed into the birth canal back into the uterus. In addition, the expectant mother's pelvis is often stored up to the time of the caesarean section.

Supplementary administration of active substances that suppress the labor activity of the expectant mother (in medicine, these active substances are also referred to as tocolytics), can prevent the head of the fetus from pushing out of the uterus again.

If a fetus has already suffered from a severe lack of oxygen as a result of an umbilical cord injury, resuscitation of the unborn child within the uterus may be necessary in some cases; such a revival can be done, for example, using drugs that cause dilation of the bronchi.

Outlook & Forecast

An umbilical cord prolapse can often be corrected by pelvic elevation or lateral positioning of the pregnant woman. The birth can be vaginal under supervision of the child and is mostly successful. In case of complications during or after the umbilical cord episodic a caesarean section is made. If necessary, medications such as fenoteral must be prescribed.

The prognosis of an umbilical cord is very good nowadays. In most cases, a high or side bearing is sufficient to allow a natural birth. Nevertheless, an umbilical cord injury for the child and possibly also for the mother's life. The faster the umbilical cord is detected and repaired, the better the chances of a natural birth in which the baby is born healthy. In a positive course, child and mother have to expect no late effects. However, a difficult birth for the mother can mean a trauma, which must be worked up with therapeutic support.

Basically, there is the prospect of a recovery, insofar as the birth can be initiated as planned and no further incidents occur. An early rupture of the bladder is likely to cause the fetus to die in the womb.

prevention

If a premature rupture of the membranes occurs during pregnancy, when the head of the embryo is not yet positioned in the pelvis, prone to hospital transport can help prevent an umbilical cord prolapse. Regular check-ups during pregnancy can diagnose any possible fetal abnormalities of the position that may increase the risk of an umbilical cord.

aftercare

In most cases, the measures and the possibilities of direct follow-up for an umbilical cord are clearly limited or in many cases are not available to the patient. For this reason, a doctor must be consulted as early as possible in order to prevent further damage to the child. In the worst case, it can lead to the death of the child and thus to a stillbirth.

The earlier the umbilical cord incident is detected and treated, the better is usually the further course of this disease. The complaints themselves are usually alleviated by a caesarean section. After such a procedure, the mother should definitely rest and spare.

Efforts or stressful and physical activities are foreseen in order not to burden the body unnecessarily. Even after the birth of the child, regular checks and examinations are very important in order to detect other complaints and damage at an early stage and then to treat them. The parents themselves are dependent on the help of their own family in an umbilical cord incident, which can be prevented mainly depression and other mental upsets.

You can do that yourself

The occurrence of an umbilical cord incident can hardly be prevented by the woman in advance and even with the occurrence of this complication it is the professional medical help that the pregnant woman and above all the child need. However, there are some things that the woman around the umbilical cord can notice.

This is first and foremost the compliance with the regular check-ups. Gynecologists can use the ultrasound images to assess the location of the head and placenta and thus the risk of an umbilical cord. Otherwise, it is useful if a pregnant woman always turns to unclear complaints to doctor or midwife. This is especially true for twin pregnancies. The woman can also be shown by the doctor or midwife, as the pulsation of the umbilical cord is to feel and control this in doubt.

If premature rupture of the membranes has occurred, the risk of an umbilical cord prolapse increases rapidly. The pregnant woman can help herself and her child in these cases by moving to a lying position and lifting the pelvis. The wrong reaction is to save time, by car in a sitting position quickly to get to the clinic. Self-help with umbilical cord prolapse is the lying position. Also in the ambulance, the pregnant woman is subsequently transported to the hospital in a prone position.

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