Almost always is a Umbilical cord prolapse a medical emergency. Delayed intervention can harm the fetus.
What is an umbilical cord incident?
© Andrei - stock.adobe.com
A Umbilical cord prolapse According to the medical definition, the umbilical cord shifts so that it lies between the birth canal and the unborn child during the birth process or in the context of a premature rupture of the bladder (tearing of the amniotic sac).
Since the pressure on the umbilical cord can lead to a lack of oxygen in the fetus, the umbilical cord incident is usually treated with emergency medicine. Within Germany, an umbilical cord incident occurs in around 0.3% of pregnancies.
This mainly affects fetuses with a different child position; Such a deviating child position can, for example, take the form of the oblique, foot or transverse position. The umbilical cord prolapse is also more common in multiple births.
causes
As a possible cause of one Umbilical cord incident In medicine, a birth canal is not adequately sealed by the fetus. For example, premature births or fetuses with above-average size increase the risk of an umbilical cord prolapse.
Other factors that can promote a prolapse of the umbilical cord include a very deep placenta (placenta) and / or a so-called hydramnios - 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 fact that the fetus is drawn into the expectant mother's pelvis by the sudden suction of the amniotic fluid; if the umbilical cord is below the fetus at this point, the unborn child's body can put pressure on the umbilical cord and an umbilical cord prolapse occurs.
Symptoms, ailments & signs
An umbilical cord prolapse can be identified by a number of signs. Usually the doctor first notices a drop in the heart rate of the embryo. This slows down the child's pulse and activity. During the physical examination, the pulsating umbilical cord can be felt in front of the embryo, often by this time it has already caught on the limbs, torso or neck of the child.
If the umbilical cord is not loosened immediately, there is an acute danger to life. As a result of the lack of oxygen and blood supply, brain cells die after just 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, fractures and, as a result, malformations can occur.
In the case of an umbilical cord incident, a caesarean section must always take place. If this happens in time and the child is still adequately supplied with oxygen, there will be no long-term effects. However, development delays can occur in individual cases. In addition, an umbilical cord prolapse usually results in premature birth, which is always associated with certain risks. An umbilical cord prolapse cannot be seen externally. However, mothers often notice that the child stops moving or suddenly moves in panic.
Diagnosis & course
To one Umbilical cord prolapse To diagnose, a so-called cardiotocography is often performed first; this is a procedure that makes it possible, for example, to check the heartbeat of an unborn child. Signs of an umbilical cord prolapse include a slow heartbeat in the fetus.
If the diagnosis is suspected, the attending gynecologist often scans the birth canal of the expectant mother in the next step in order to determine the position of a possibly prolapsed umbilical cord. If this examination step has not yet been able to adequately confirm a diagnosis, an amniotic fluid reflection is also possible if the cervix is already sufficiently open.
The course of an umbilical cord incident is positively influenced primarily by early medical intervention. If medical intervention is delayed, an umbilical cord prolapse can lead to damage to the fetus. In severe cases, an umbilical cord prolapse can result in the death of the embryo.
Complications
The umbilical cord prolapse is one of the most dangerous complications that can occur during childbirth. If the incident is not recognized in advance by the cardiotocography, the omitted or late medical treatment can, in the worst case, lead to serious damage or death to the child. A premature rupture of your bladder may be a sign.
In this case, the expectant mother should be brought to the hospital in a lying position as soon as possible. Due to the rupture of the bubbles, the amniotic fluid suction pulls the fetus towards the mother's pelvis. If the umbilical cord happened to be below the child at the moment, the fetus itself presses on the prolapsed umbilical cord. The mother can at least reduce the pressure in the lying position.
With every umbilical cord incident, the oxygen and blood supply to the fetus is interrupted. The child can either become severely disabled or even die, so an emergency caesarean section is necessary. If, in the worst case, the child has not received oxygen for too long and dies, it has to be reanimated inside the womb.
This works with bronchodilator drugs, for example. A caesarean section is inevitable in the umbilical cord prolapse, as the umbilical cord makes natural birth 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 will die during or immediately after delivery. Since the expectant mother is normally in the hands of medically trained staff, the irregularity is noticed and treated by the staff.
If the pregnant woman notices any peculiarities or abnormalities during the birth process, she should immediately inform the nurses, midwives or doctors present. Although the health of mother and child is constantly monitored during the birth process, warning signals or changes reported by the mother can be clarified and investigated more quickly.
In the case of a birth in an inpatient area, in a birthing center or in the case of a planned delivery in the home area, obstetricians are present in sufficient numbers. In the event of a spontaneous birth without the presence of trained personnel, an ambulance service must be alerted.
Until his arrival, the instructions of the emergency doctor should be obeyed, since in severe cases there is a mortal danger to mother and child. For anatomical reasons, an umbilical cord prolapse cannot be treated by the person concerned. The mother-to-be depends on the help of other people and can only give them feedback about changes in health, abnormalities or irregularities.
Treatment & Therapy
In most cases one requires Umbilical cord prolapse the quick performance of a caesarean section. If the mother-to-be has to be transported to hospital in the event of an incident umbilical cord (which can be the case, for example, in the event of an unexpected rupture of the bladder), it is often important to transport the patient in a prone position; in this position, the pressure of the fetus on the prolapsed umbilical cord can be reduced.
The emergency medical measure of relocating the head of the fetus that has protruded into the birth canal back into the uterus also helps to relieve the prolapsed umbilical cord in the event of an umbilical cord prolapse. In addition, the expectant mother's pelvis is often elevated until the caesarean section is performed.
A supplementary dose of active substances that suppress labor in the expectant mother (in medicine these active substances are also known as tocolytics) can prevent the fetus' head from pushing itself out of the uterus again.
If a fetus has already suffered severe oxygen deficiency as a result of an umbilical cord incident, resuscitation (resuscitation) of the unborn child within the uterus may be necessary in some cases; A corresponding resuscitation can take place, for example, with the help of drugs that cause the bronchi to widen.
Outlook & forecast
An umbilical cord incident can often be remedied by elevating the pelvis or lying on the side of the pregnant woman. The birth can take place vaginally with supervision of the child and is mostly successful. If there are complications during or after the umbilical cord prolapse, a caesarean section is performed. If necessary, drugs such as Fenoteral must be prescribed.
The prognosis for an umbilical cord incident is very good these days. In most cases, lying up or on the side is sufficient to enable natural birth. Nevertheless, an umbilical cord incident poses a mortal danger to the child and possibly also to the mother. The sooner the umbilical cord incident is recognized and resolved, the better the chances of a natural birth with a healthy baby. If the outcome is positive, the child and mother do not have to expect any long-term effects. However, a difficult birth can mean trauma for the mother, which has to be dealt with with therapeutic support.
Basically, the prospect of recovery is given, provided that the birth can be initiated as planned and no further incidents occur. If the bladder ruptures prematurely, there is a risk that the fetus will die in the womb.
prevention
If a premature rupture of the bladder occurs during a stage of pregnancy in which the head of the embryo has not yet positioned itself in the pelvis, transportation to a hospital on a prone basis can help to recover Umbilical cord prolapse to prevent in advance. Regular checkups during pregnancy can diagnose any fetal position abnormalities that may increase the risk of an umbilical cord prolapse.
Aftercare
In most cases, the measures and the options for direct follow-up care in the event of an umbilical cord incident are significantly limited or, in many cases, are not even available to the patient. For this reason, a doctor must be consulted as early as possible with this disease in order to prevent further harm to the child. In the worst case, this can lead to the death of the child and thus to a stillbirth.
The earlier the umbilical cord incident is recognized and treated, the better the further course of this disease will usually be. The symptoms themselves are usually relieved by a caesarean section. After such an operation, the mother should definitely rest and take it easy.
Exertion or stressful and physical activities should be avoided in order not to unnecessarily burden the body. Regular checks and examinations are also very important after the birth of the child in order to identify other complaints and damage early on and then treat them. In the event of an umbilical cord incident, the parents themselves have to rely on the help of their own family, which in particular can prevent depression and other psychological upsets.
You can do that yourself
The occurrence of an umbilical cord incident can hardly be prevented by the woman in advance and even if this complication occurs, it is the professional medical help that the pregnant woman and especially the child need. However, there are a few things the woman can consider about the umbilical cord incident.
First and foremost, that means keeping regular check-ups. Gynecologists can use the ultrasound images to assess the fit of the child's head and placenta and thus the risk of an umbilical cord prolapse. Otherwise, it makes sense for a pregnant woman to always contact a doctor or midwife if her complaints are unclear. This is especially true for twin pregnancies. The woman can also have the doctor or midwife show her how to feel the pulsation of the umbilical cord and, if in doubt, check this.
If the bladder ruptures prematurely, the risk of an umbilical cord prolapse increases rapidly. The pregnant woman can help herself and her child in these cases by getting into a lying position and elevating the pelvis. The wrong reaction is to get to the clinic quickly by car in a sitting position, supposedly to save time. Self-help with an umbilical cord incident is the lying position. In the ambulance, the pregnant woman is then taken to the hospital in a prone transport.
