The umbilical cord is a strong and elastic cord that reliably connects the baby growing in the mother's womb with the placenta, with the mother. If the umbilical cord is healthy and has no structural abnormalities, the baby receives a sufficient amount of oxygen and nutrients. Its development is not disturbed. However, umbilical cord abnormalities can cause pathologies and even fetal death. We will describe in this article what types of umbilical cord attachments exist, what consequences they can entail for the child.
Norm
A normal, healthy umbilical cord has three vessels: two arteries and one vein. Through the vein, the mother's blood enriched with oxygen, vitamins, microelements that are needed for the growth and development of the fetus comes to the baby. Through the arteries back to the placenta, and from there the products of the child's metabolism (creatine, carbon dioxide, urea, and so on) are excreted into the mother's body.
Normally, the umbilical cord is about 50-70 centimeters long. A longer umbilical cord creates the danger of entanglement and suffocation of the fetus during its active movements. A shorter one restricts the movement of the baby, and also poses a danger during childbirth: its tension can provoke placental abruption, bleeding and acute fetal hypoxia.
One side of the umbilical cord is adjacent to the anterior abdominal wall of the fetus, and the other to the placenta. Central attachment of the umbilical cord is considered normal. With it, the umbilical cord is attached to the central part of the "child's seat".
Attachment anomalies
Anomalies in obstetrics include any structural changes in the umbilical cord: a change in the number of vessels, the presence of blood clots, insufficient or excessive length, as well as the presence of nodes, cysts, and options for attachment of the umbilical cord that are not considered normal.
There are several types of abnormal attachment of the umbilical cord to the placenta:
- Regional. With this attachment, the cord is docked with the placenta along its peripheral edge.
- Shell. With this attachment, the umbilical cord is connected to the membranes.
With marginal attachment, the vein and the two arteries that support the child's life are attached too close to the edge of the "child's seat". This type of attachment does not carry great danger; in most cases it does not affect pregnancy in any way. The opinions of doctors regarding the marginal attachment are usually similar: a woman can give birth naturally. A cesarean section, unless otherwise indicated, is not required.
The only threat that the marginal (lateral) attachment of the umbilical cord can create is the wrong actions of the obstetric team during childbirth. At birth, doctors sometimes help by pulling on the umbilical cord. In the case of marginal attachment, such actions can lead to separation of the cord, and the placenta will have to be removed manually.
Sheath (or sheath) attachment of the cord to the umbilical cord in the womb is quite rare - in about 1-1.5% of cases. The cord itself is adjacent to the membranes that are distant from the placenta. During this very distance, the umbilical vessels are completely unprotected; they approach the placental disc directly. This is a more dangerous abnormality of the placenta than the marginal attachment.
With the membranous type, a child often has developmental delay syndrome (due to insufficient nutrition and oxygen supply during the gestation process). Such babies are often born small. Chronic hypoxia, which babies are exposed to in the womb, often leads to a delay in not only physical, but also mental development, as well as to disorders of the central nervous system.
In almost 9% of cases of revealing the sheathing of the umbilical cord attachment, the child is diagnosed with malformations: absence of the esophagus, cleft palate, congenital dislocation of the hip, abnormal head shape, and so on.
Doctors say that the meningeal attachment can independently transform into a normal, central one, but this option is not very common.
Such attachment is very dangerous not even during pregnancy, but at the time of childbirth. If the integrity of the fetal bladder is violated, the umbilical cord is detached, which leads to bleeding and may result in fetal death. Doctors try to deliver this abnormal umbilical cord by caesarean section to minimize the risks.
These two main types of umbilical cord anomalies are also called eccentric attachments. If the cord is attached to the umbilical cord in the central part, but is slightly shifted in any direction, they speak of paracentral attachment, which is considered a variant of the norm.
Causes
The reason for the marginal attachment of the umbilical cord is anomalies in the development of the umbilical cord even at the stage of formation of the placenta. Most often, such an anomaly appears in women who are carrying their first child, as well as in expectant mothers who become pregnant at a fairly young age (from 18 to 23 years old).
The risk group includes pregnant women who have to spend a lot of time on their feet, in an upright position due to long work or other circumstances (especially if they often experience severe physical exertion).
Not the last place among the causes of abnormal attachment of the umbilical cord is occupied by pathologies of pregnancy: polyhydramnios and oligohydramnios, placenta previa, abnormal location of the fetus in the uterus. Most often, the marginal attachment is combined with other pathologies of the umbilical cord: with nodes, a violation of the location of the vessels inside.
The reasons for the sheath attachment of the umbilical cord are still not completely clear, but observations show that most often the pathology is characteristic of women who carry twins or triplets, as well as women who give birth a lot and often.
Genetic pathologies of the fetus are also considered among the causes of abnormal meningeal (pleat) attachment. Very often, with Down syndrome, the sheathing attachment of the umbilical cord is formed in a child.
Treatment
Unfortunately, medicine today can not offer any way to treat abnormal attachment of the umbilical cord to the placenta. During pregnancy, pathology cannot be eliminated either with medication, or gymnastics, or diets, or surgery. There is no way to influence the location of the umbilical cord. For this reason, doctors, when diagnosing abnormalities in the location of the umbilical cord, adopt the tactics of waiting and observation.
A woman with marginal or shell attachment is recommended to visit antenatal clinics more often, to do ultrasound more often, and at a later date - CTG to make sure that the child is not experiencing hypoxia. If signs are found that speak of fetal dysfunction (impaired condition and heartbeat according to CTG, developmental delay on ultrasound), pre-term birth can be performed: by caesarean section with shell or naturally with marginal attachment.
If the gestational age is not long enough for doctors to be confident in the viability of the fetus (no 36 weeks), the woman is admitted to a hospital, where the standard conservation therapy is performed in such cases. These are antispasmodics for relieving symptoms of uterine tone, vitamins and drugs that improve uteroplacental blood flow.
The diagnosis of "abnormal attachment of the umbilical cord" on the edge or shell principle means not only that a woman will receive a lot of attention from the attending physician, but also that she will have to go to the hospital before others. At 37-38 weeks, such patients are tried to be hospitalized in order to decide on the tactics of childbirth. With shell attachment, it is important to prevent spontaneous rupture of the membranes, and therefore the cesarean section is carried out in advance, before the start of independent labor.
There is also good news: in most cases, with abnormal attachment, if it is not accompanied by fetal malformations and genetic pathologies, as well as other anomalies of the umbilical cord and placenta, women safely give birth (themselves or with the help of surgeons) perfectly normal children, and the postpartum period goes without features. It is only important to follow all the doctor's recommendations while carrying crumbs.
For hypoxia and umbilical cord entanglement of the fetus, see the following video.
