Comparison and contrast of Umbilical and Nuchal cord
Introduction
Prolapse in umbilical cord occurs in very rare circumstances. This condition is manifested by removal of umbilical cord from cervix before the delivery of the foetus. This cord serves as a food pipe to the baby for the transfer of nutrients from mother to foetus and also collects the digestive waste products from baby. During prolapse, the cord twins around the baby which complicates the delivery. This disease condition occurs only 1% of pregnancies. Due to the higher risk of foetal fatality, umbilical cord prolapse is considered as a medical emergency during labor pain (Critchlow et al., 1994). There are three types of prolapse which have been identified still now. They are overt, occult and Funnet.
Overt funiculus prolapse: descent of the funiculus past the presenting foetal half. During this case, the wire is thru the cervix and into or on the far side the canal. Overt funiculus prolapse needs rupture of membranes.
Occult point prolapse: descent of the funiculus aboard the presenting foetal segments however has not advanced past the presenting foetal half. Occult point prolapse will occur with each intact or burst membrane.
Funic (cord) presentation: presence of the funiculus between the presenting foetal segments and foetal membranes. During this case, the wire has not passed the gap of the cervix. In funic presentation, the membranes don't seem to be nevertheless burst.
Nuchal cord arises when the umbilical cord surrounds the neck of the foetus. The prevalence of the formation of Nuchal cord prolapse is becoming very common nowadays. There are two types of Nuchal cord prolapse (Critchlow et al., 1994). They are
Type A: wrapping of Nuchal cord around the neck for 360°C (Lin, 2006).
Type B: Initially it forms as a hitch and then forms as a true loop (Lin, 2006).
Aetiology and demographics
The identified causes for the prolapse in the umbilical cord are the early rupture of the membrane which has amniotic fluid. Few other reasons for the umbilical cord prolapse are
Untimely delivery of the baby (Altaras et al., 1974)
Multiple births per pregnancy (twins, triplets, etc.) (Altaras et al., 1974)
Excessive amniotic fluid (Altaras et al., 1974)
Breech delivery (baby is delivered upside down) (Altaras et al., 1974)
Lengthy umbilical cord which accounts for unusual twists and turns (Altaras et al., 1974)
Incidence of UCP is calculable to be between one.4 and 6.2 per one thousand pregnancies. Though this has not modified within the last decade, the consequences of perinatal for UCP have enhanced considerably. Traditionally, UCP has been related to poor babe outcomes, with perinatal mortality starting from thirty second to forty seventh within the early to middle twentieth century.2 Current rates of perinatal mortality in cases of UCP are calculable to be 100 percent or less.1-4 the foremost seemingly explanations for these immensely improved outcomes are the magnified handiness of caesarean delivery and advances in foetal revitalization (Quershi et al., 2004).
Risk factors
- Possessing foetus in a breech position
- Rupturing of membranes
- Multiple births like triplets or quadruplets in a single pregnancy
- Possessing a long umbilical cord
- Possessing a large quantity of amniotic fluid around the foetus
Symptoms
The initial symptoms of the prolapse of umbilical cord are reduction in the heart rate of the foetus. Upon physical examination, the cord can be seen and felt in vagina by the Obstetrician or Gynaecologist (Quershi et al., 2004).
Diagnosis
Monitoring the foetal heart rate regularly is one of the effective preliminary diagnostics for umbilical cord prolapse. Bradycardia is predominant during the delivery for foetus in which heart rate is decreased than 120 beats per min. Pelvic examination is another way to observe the prolapse, in which cord can be felt palpate or fingers. Sonographic studies such as Doppler will elucidate the chronicness of the prolapse which may aid to conclude with a medical decision.
UCP will be occult or overt. Occult prolapse happens once the wire passes through the cervix aboard the vertebrate presenting part; it's neither visible nor palpable. In overt prolapse, the wire presents prior to the foetal and is visible or palpable among the channel vault or perhaps past the labia.
Prolapse of the umbilical or Nuchal cord typically results in wire compression that, in turn, results in abnormal findings on foetal heart rate (FHR) tracings in forty first to sixty seven of cases. These changes could present as a severe, unforeseen swiftness, typically with prolonged arrhythmia, or perennial moderate-to-severe variable decelerations. The diagnosing of overt UCP is created on channel examination, which is able to reveal a palpable epithelial duct (usually a soft, rhythmic mass) among or visibly extruding from the epithelial duct. A confirmed diagnosing of occult UCP is rare using Doppler; as a result of it cannot be definitively diagnosed even once Doppler ultrasound imaging is used. Tries to spot occult prolapse with imaging may delay necessary treatment for this aborting condition. Occult UCP doubtless is that the reason behind some cases of pressing delivery for unexplained foetal arrhythmia. X-ray and other imaging studies also reveal the cord prolapse. CT and MRI scan assists in the visualisation of twinning of cord (Quershi et al., 2004).
Treatment
There are wide ranges of treatment options. They are given below:
Delivery by C-section—while the baby can't be rapidly delivered by vaginal birth.
Alleviating pressure from the cord— the doctor is also ready to move the baby aloof from the wire thus as to not stop element offer the foetus. Women might also be asked to manoeuvre into a grip whilst the umbilical or nuchal cord pressure has been alleviated totally which safeguards the foetus.
Fast delivery—while the women is prepared to deliver, the doctor could attempt to deliver the baby terribly quickly mistreatment extractor or a vacuum extractor (Quershi et al., 2004).
Prognosis
Although an oversized share of UCP cases area unit attributed to induced causes, there's no proof that information of risk factors will cut back the incidence of UCP. According to (Gabbay et al., 2014), at identical time, it's vital to remember of the risks once enterprise the interventions antecedently delineated. It is tend to advocate avoiding amniotomy unless the foetal head is occupied, additional controlled unharness of fluid. If the vertex isn't well applied to the cervix, gentle fundal pressure throughout placement of a foetal scalp electrode or intrauterine pressure tube might facilitate to reduce elevation of the vertex out of pelvis. Suppliers ought to exercise caution with any of those procedures and perform them solely in cases within which different ways are inadequate
UCP can't be prevented, however ensuing foetal complications are shown to typically be preventable, with vital decreases in foetal morbidity and mortality once the condition is promptly and suitably treated.
(Gabbay et al., 2014) has reported that cord prolapse ends up in foetal hypoxia, and if not quickly treated, will result in semipermanent incapacity or death. Prompt delivery has been shown to boost outcomes. This suggests that cases of UCP ought to be delivered as quickly as doable, that usually means that delivery. In rare cases, however, UCP will occur once delivery is close to. If the supplier believes that a duct delivery may be performed earlier than a delivery, it's definitely acceptable to proceed with duct delivery. Operative delivery ought to be thought-about if the FHR tracing shows regarding findings.
The mainstay of management for UCP is imperative delivery. From the time of designation till caesarean may be performed, the vertebrate presenting half ought to be elevated to alleviate pressure on the twine and arrangements ought to be created for imperative delivery. Specifics of management can vary reckoning on whether or not associate operative delivery may be accomplished at intervals half-hour (typically associate in-hospital event) or there'll be a delay of quite half-hour (an out-of-hospital event).
Effects on lifestyle and functionality
(Gabbay et al., 2014) has reported that prolapse in umbilical and nuchal cord is a very threatening emergency condition during pregnancy. It may lead to foetal hypoxia. Hypoxia may affect any organ systems of the baby which leads to organ failure. Coming to the lifestyle, polycystic kidney diseases, renal failure are more likely to develop with the women who had umbilical cord prolapse. Pelvic inflammatory disease is another serious disease which is more common among mothers who had prolapsed umbilical cord.
Similarities and differences
(Gabbay et al., 2014) has reported that the vast difference between Nuchal and umbilical cord is that Nuchal cord very rarely causes foetal death whereas umbilical prolapse definitely causes cord. Similarities between both are both the cases occur in 2-3% of pregnancies only. Long umbilical cord is the sole reason for the formation of nuchal cord.
Conclusion
Prolapsed umbilical and nuchal cord is the most life-threatening disease condition which occur 1 in 300 births in Australia. The percentage of incidence ranges from 1-1.6%. This condition accounts for foetal death usually. Diagnosis of prolapse and efficient management options are available which easily prevents the fatality of both mother and foetus.
References
Critchlow CW, Leet TL, Benedetti TJ, Daling JR. 1994. Risk factors and infant outcomes associated with umbilical cord prolapse: a population-based case-control study among births in Washington State. Am J Obstet Gynecol; 170(613): 34-44.
Qureshi NS, Taylor DJ, Tomlinson AJ. 2004. Umbilical cord prolapse. Int J Gynaecol Obstet; 86(29): 88-95.
Altaras M, Potashnik G, Ben-Adereth N, Leventhal H. 1974. The use of vacuum extraction in cases of cord prolapses during labor. Am J Obstet Gynecol, 118(824): 67-80.
Gabbay-Benziv R, Maman M, Wiznitzer A, et al. 2014. Umbilical cord prolapse during delivery - risk factors and pregnancy outcome: a single center experience. J Matern Fetal Neonatal Med, 27(14): 56-63.
Lin MG. 2006. Umbilical cord prolapse. Obstet Gynecol Surv, 61(269): 75-79.
