SINGLE UMBILICAL ARTERY/ TWO-VESSEL

CORD

1%= SINGLE TON

5%= MUTIPLE PREGNACIES (twins, triplets, etc)
Have an umbilical cord that contains only two
blood vessels, instead of the normal three.
In these cases, one artery is missing.

CAUSE= unknown
INCREASE RISK FOR BIRTH DEFECTS:
-

Heart, central nervous system and

urinary-tract defects and chromosomal
abnormalities.

MANAGEMENT:
-

Inspection of the cord immediately

after the delivery of the baby.
A woman whose baby is diagnosed
with single umbilical artery = prenatal
tests to diagnose or rule out birth
defects.
Detailed ultrasound
Amniocentesis=
to
detect
Chromosomal abnormalities
Echocardiography=
Ultrasound
to
evaluate the fetal heart
The provider also may recommend that
the baby have an ultrasound after
birth.
Routine postnatal examinations

CAUSES:

Occurs when the cord slips into the

vagina after the membranes (bag of
waters) have ruptured, before the baby
descends into the birth canal.
This complication affects about 1 in
300 births.
The baby can put pressure on the cord
as he passes through the cervix and
vagina during labour and delivery.
Pressure on the cord reduces or cuts
off blood flow from the placenta to the
baby, decreasing the baby's oxygen
supply.
Umbilical cord prolapse can result in
stillbirth unless the baby is delivered
promptly, usually by caesarean section.

If the woman's membranes rupture

and she feels something in her

PROM
UMBILICAL
CORD
ULTRASOUND

COMPRESSION=

The risk of umbilical cord prolapse increases if:

1.
2.
3.
4.

Breech delivery
Premature delivery
An excessive amount of amniotic fluid
An umbilical cord thats unusually long

MANAGEMENT:

UMBILICAL CORD PROLAPSED

vagina, she should go to the

hospital immediately.
A health care provider may suspect
umbilical cord prolapse if the baby
develops heart rate abnormalities
after
the
membranes
have
ruptured.
The provider can confirm a cord
prolapse
by
doing
a
pelvic
examination.
Cord prolapse is an emergency.
Pressure on the cord must be
relieved immediately by lifting the
presenting fetal part away from the
cord while preparing the woman for
prompt caesarean delivery.

Amnioinfusion= Process that involves

introducing a saline solution, at room
temperature, into the uterus during
labour in order to relieve pressure that
can potentially lead to the umbilical
cord becoming compressed.
Increase mothers oxygen= In order to
increase the blood flow through the
umbilical cord
Constant monitoring
C-section= If baby is distress

VASA PREVIA

Occurs in 1/2500 births

Occurs when one or more blood vessels
from the umbilical cord or placenta
cross the cervix underneath the baby.
The blood vessels sometimes tear
when the cervix dilates or the
membranes rupture.
This can result in life-threatening
bleeding in the baby.

Even if the blood vessels do not tear,

the baby may suffer from lack of
oxygen due to pressure on the blood
vessels.
When vasa previa is diagnosed
unexpectedly at delivery, more than
half of affected babies are stillborn

However,
when
vasa
previa
is
diagnosed by ultrasound earlier in
pregnancy, fetal deaths generally can
be prevented by delivering the baby by
cesarean section.
Pregnant women with vasa previa
sometimes have painless vaginal
bleeding in the second or third
trimester.

A
pregnant
woman
who
experiences
vaginal
bleeding
should always report it to her
health care provider so that the
cause can be determined and any
necessary steps taken to protect
the baby.

RISK FACTORS:
1.
2.
3.
4.

2.

3.

Has a Velamentous insertion of the

cord (the umbilical cord inserts
abnormally into the fetal membranes,
instead of the center of the placenta)
Has placenta previa (a low-lying
placenta that covers part or the entire
cervix) or certain other placental
abnormalities.
Is expecting more than one baby

NUCHAL CORD

25% of babies are born with a nuchal

cord
The umbilical cord wrapped around the
baby's neck.
A nuchal cord= nuchal loops
Rarely causes any problems.
Babies with a nuchal cord are
generally healthy.
Sometimes fetal monitoring shows
heart rate abnormalities during labour
and delivery in babies with a nuchal
cord.
This may reflect pressure on the cord.

Carrying twins
Large infant size
Breech or shoulder position during birth
Excessive amniotic fluid

UMBILICAL CORD KNOTS

RISK FACTORS:
1.

However, the pressure is rarely serious

enough to cause death or any lasting
problems, although occasionally a
caesarean delivery may be needed.
Less frequently, the umbilical cord
becomes wrapped around other parts
of the baby's body, such as a foot or
hand.
Generally, this doesn't harm the baby.

1% of babies are born with one or more

knots in the umbilical cord
Some knots form during delivery when
a baby with a nuchal cord is pulled
through the loop.
Others form during pregnancy when
the baby moves around.
Knots occur most often when the
umbilical cord is too long and in
identical-twin pregnancies.
Identical twins share a single amniotic
sac, and the babies' cords can become
entangled.
Umbilical cord knots occur when an
infant maneuvers around in amniotic
fluid and moves through the umbilical
cord, creating a knot.
As long as the knot remains loose, it
generally does not harm the baby.
However, sometimes the knot or knots
can be pulled tight, cutting off the
baby's oxygen supply. Cord knots result
in miscarriage or stillbirth in 5% of
cases.
During
labour
and
delivery,
a
tightening knot can cause the baby to
have heart rate abnormalities that are
detected by fetal monitoring.
In some cases, a caesarean delivery
may be necessary.

RISK FACTORS:
1. Babies with long cords
2. Those who are large-for-gestational.

3.

4.

Nutritional deficiencies that affect the

structure and protective barrier of the
cord
Other risk factors such as smoking or
drug use, carrying multiples.

S/S:
Decreased fetal activity after week 37.
If the knot occurs during labor, a fetal
monitor will detect an abnormal heart
rate.

MANAGEMENT:
Wharton's jelly provides cushioning
around the important blood vessels of
the cord and protects them even if the
cord gets knotted.
VELAMENTOUS
CORD

INSERTION

OF

THE

Situation in which the cord, instead of

entering
the
placenta
directly,
separates into small vessels that
reaches the placenta by spreading
across a fold of amnion.
Found mostly in multiple gestations
CAUSE:
The exact cause of Velamentous
Insertion of Umbilical Cord is unknown
However, some researchers believe
that an abnormal development of the
placental tissue may result in the
condition
S/S:
Excessive hemorrhage/bleeding during
childbirth
Blood vessel compression
Decreased blood flow to the fetus
RISK FACTORS:
1. Increased incidence in twin pregnancy
2. Uterine anomalies
3. Presence
of
an
intrauterine
contraceptive device
4. Single umbilical artery
5. Placenta previa
6. Advanced maternal age
7. Cigarette smoking
MANAGEMENT:
Treatment somewhat depends on the
location of Velamentous vessels and if
in the lower segment, a caesarean
section to avoid the risks of a Vasa
previa is often considered.

UNUSUAL CORD LENGTH

Although umbilical cord rarely varies in

length, some abnormal lengths may
occur
Unusually
short
UC=
premature
separation of placenta/ abnormal fetal
lie
Unusually long UC= may be easily
compromised because of its tendency
to twist or knot.
Occasionally= cord forms a knot, but
the natural pulsations of the blood
through the vessels and the muscular
vessel walls usually keep the blood flow
adequate.

CAUSE:
Causes of differences in cord length are

unknown
RISK FACTORS:
SHORT CORD
1.

2.
3.
4.
5.

6.
7.

A woman who is of average weight or

less (normal or below normal body
surface area)
A woman who is pregnant for the first
time
A female fetus
A fetus that is small for gestational age
Lack of fetal movement during the first
half of pregnancy / intrauterine
constraint / conditions that limit the
babys movement in the womb
Smoking and alcohol consumption
Preeclampsia

UMBILICAL CORD ANOMALIES

Narrow
tube-like
structure
that
connects the developing baby to the
placenta.
The baby's supply line
Because it carries the baby's blood
back and forth, between the baby
and the placenta.
It delivers nutrients and oxygen to the
baby.
Removes the baby's waste products.
Umbilical cord begins to form at
5weeks after conception.
It becomes progressively longer until
28 weeks of pregnancy, reaching an
average length of 22 to 24 inches.

As the cord gets longer, it generally

coils around itself.
The cord contains three blood vessels:
two arteries and one vein.
The vein carries oxygen and nutrients
from the placenta to the baby.
The two arteries transport waste from
the baby to the placenta (where waste
is transferred to the mother's blood
and disposed of by her kidneys).
A number of abnormalities can affect
the umbilical cord. The cord may be too
long or too short. It may connect
improperly to the placenta or become
knotted
or
compressed.
Cord
abnormalities can lead to problems

during pregnancy or during labour and

delivery.

In some cases, cord abnormalities are

discovered before delivery during an
ultrasound. However, they usually are
not discovered until after delivery when
the cord is examined directly. The
following are the most frequent cord
abnormalities and their possible effects
on mother and baby.