Umbilical cord prolapse

　　There are many causes of cord prolapse. Any situation where the presenting part of the fetus cannot closely fit the pelvis entrance, leaving a gap between them, can lead to cord prolapse, such as breech, transverse, narrow pelvis, cephalopelvic disproportion, and small fetus. There are also some contributing factors, such as early rupture of membranes, long umbilical cord, and excessive amniotic fluid.

　　1. Abnormal presentation is the main cause of cord prolapse. According to statistics, about 1 in 500 cephalic presentations results in cord prolapse (only 0.2%), while in breech presentations, 1 in 25 cases results in cord prolapse (4%), and the incidence of shoulder presentation is even higher, with 1 in 7 cases (14%). The ratio of cord prolapse in vertex, breech, and transverse presentations is approximately 1:20:70, indicating a close relationship between cord prolapse and abnormal presentation. Most breech presentations occur with footling breech, while single breech presentation often closely fits the pelvis, and fewer cases of cord prolapse occur. Abnormal presentations such as occiput posterior and face presentation, which do not completely fill the pelvis entrance, only engage after membrane rupture, are prone to induce cord prolapse.

　　2. Floating fetal head. Narrow pelvis or overdeveloped fetus, the fetal head does not fit the pelvis entrance (cephalopelvic disproportion), or in multiparous women, the abdominal wall is often relaxed, and the fetal head remains high during the onset of labor. The force of amniotic fluid flowing out after membrane rupture can cause the umbilical cord to prolapse. Especially in women with flat pelvis, there is often a gap between the presenting part and the pelvis entrance, and the fetal head is difficult to enter the pelvis, early rupture of membranes, which is prone to induce cord prolapse.

　　3. Long umbilical cord or low-lying placenta (or with marginal cord insertion) When the presenting part fits the pelvis, the length of the umbilical cord is not the main cause of cord prolapse. However, when the fetal head cannot be engaged, a long umbilical cord is more prone to prolapse. Statistics show that in 10 cases of cord prolapse, 1 case has an umbilical cord length exceeding 75cm. The probability of prolapse in those with an umbilical cord length over 75cm is 10 times higher than in those with a normal umbilical cord length (50-55cm).

　　4. Premature delivery or twin pregnancy. The latter is more likely to occur before the second fetus is delivered, which may be related to the fetus being too small, the presenting part not being able to closely fit the pelvis entrance, or a high incidence of abnormal presentation.

　　5. Other factors such as early rupture of membranes and excessive amniotic fluid. The latter can cause cord prolapse when the amniotic fluid is discharged too quickly due to high intrauterine pressure at the time of membrane rupture, and the umbilical cord can be flushed out and form cord prolapse.

　　In cases of cord prolapse, the prolapsed umbilical cord is compressed between the presenting part and the pelvis, which obstructs the placental blood circulation and can cause severe fetal distress. Especially in cases with cephalic presentation, when the umbilical cord is compressed behind the pubic symphysis, the degree of compression is particularly severe, which can completely block the umbilical cord blood flow, leading to immediate fetal death. It can also cause fetal hypoxemia and anemia.

　　Generally, cord prolapse does not have a significant impact on the mother, but it increases the rate of cesarean section. However, it is very harmful to the fetus.

　　1. Abnormal fetal heart rate. In cases where the presenting part of the fetus has not entered the pelvis and the amniotic membrane has not ruptured, the presenting part of the fetus can be forced down during uterine contractions, and the umbilical cord can be abnormally affected by transient compression.

　　2. Changes in fetal heart rate. If the presenting part has entered the pelvis and the amniotic membrane has ruptured, the umbilical cord is compressed between the presenting part and the pelvis, causing fetal hypoxia, and the fetal heart rate will necessarily change, even completely disappear, with vertex presentation being the most serious and shoulder presentation being the least. If the umbilical cord blood circulation is blocked for no more than 7 to 8 minutes, the fetus will die in utero.

　　The period of pregnancy is the most fragile time in a woman's life, the most attention and protection should be given, therefore, to avoid umbilical cord prolapse, pregnant women must be cautious, do a good job of pregnancy management and examination.

　　1) Strengthen the management of pregnancy, regular prenatal examinations, reduce the incidence of breech presentation, and detect and correct breech presentation in a timely manner.

　　2) Strengthen the observation of the labor process and closely listen to the fetal heart sound, and prepare the equipment and drugs for rescue in advance.

　　3) For women in labor with floating fetal heads and breech position, they should rest in bed, do not perform enema, be gentle during examinations to avoid premature rupture of membranes.

　　4) For those with clinical vertex presentation that has not entered the pelvis, be vigilant and try not to perform or perform fewer anal or vaginal examinations.

　　5) Pay more attention to the fetal heart sound, which can help detect umbilical cord prolapse in time, and inform the pregnant woman not to use force too early during uterine contractions. For women with premature rupture of membranes, maintain a flat lying position. If the presenting part has not entered the pelvis, assume a head-low buttock-high position to prevent umbilical cord prolapse.

　　6) Those who perform artificial membrane rupture should take high-position membrane rupture to avoid the umbilical cord being prolapsed along with the amniotic fluid. After membrane rupture, listen to the fetal heart sound immediately. If changes in fetal heart rate such as acceleration, deceleration, or irregularity are found, oxygen inhalation should be immediately given to increase blood oxygen concentration, assume a lateral position, and notify the doctor to perform a vaginal examination. If the umbilical cord protrudes out of the vaginal orifice, instruct the pregnant woman to elevate her buttocks and gently support the presenting part to avoid the presenting part descending and compressing the umbilical cord. Use warm and moist gauze to wrap the umbilical cord and gently place it in the lower third of the vagina.

　　7) If the fetal head is slightly mobile and induction is necessary, head-pelvic disproportion should be excluded, and the fetal head should be pushed into the pelvic inlet after piercing the amniotic membrane, bandage the abdomen, pay attention to the position, and frequently listen to the fetal heart sound.

　　8) Strictly control the indications for artificial membrane rupture induction: cervical ripening, complete dilation, vertex presentation, fetal head engagement, and those who must undergo artificial membrane rupture should take high-position membrane rupture to avoid the umbilical cord being prolapsed along with the amniotic fluid.

　　The umbilical cord prolapse should be diagnosed according to the condition, selecting blood, urine, stool routine tests, biochemical tests, electrocardiogram, B-ultrasound, Doppler, and other examinations. According to the relationship between membrane rupture and fetal heart sound changes, as well as vaginal examination, umbilical cord prolapse is not difficult to diagnose. When hidden umbilical cord prolapse is found before membrane rupture, the pregnant woman should rest in bed, assume a buttock-high head-low position, and closely observe the fetal heart rate. Due to the action of gravity, the presenting part retreats from the pelvic cavity, reduces the compression of the umbilical cord, and after changing the position, there is a possibility that the umbilical cord can recede. If it is a vertex presentation with good uterine contractions, the presenting part enters the pelvis while the fetal heart rate is normal, and the cervix dilates progressively, it can be delivered vaginally. However, the key to checking for umbilical cord prolapse is to have an impression of it all the time, especially to pay attention to hidden prolapse. In addition, it is also required to judge the fetal condition, fetal position, and the extent of cervical dilatation for rescue.

　　1. Malpresentation of the fetus. This is manifested by changes in fetal heart rate after rupture of membranes in cases of narrow pelvis or preterm birth, and one should consider the possibility of umbilical cord prolapse and immediately perform a vaginal examination. Or, if there is no rupture of membranes but changes in fetal heart rate, a vaginal examination is also needed. A cord-like object with a pulsation can be felt in the amniotic sac, and its frequency is consistent with the fetal heartbeat, which can be diagnosed as a cord prolapse. However, it should be distinguished from the cord's帆状attachment (the cord is an active cord-like object).

　　2. The amniotic membrane has broken and the fetus is alive. This type of umbilical cord prolapse is easier to diagnose, but in the following situations, it cannot be diagnosed that the fetus has died: a palpable pulsating cord-like object can be clearly felt in front of the presenting part. The umbilical cord pulse can disappear due to compression. However, one should carefully listen to the fetal heartbeat, and only if the fetal heartbeat disappears can it be confirmed that the fetus has died in utero.

　　3. Hidden umbilical cord prolapse often occurs in the early stage of labor. This means that the umbilical cord is placed next to the presenting part on one side, sandwiched between the presenting part and the soft tissue of the lower uterine segment, and cannot be touched in general examination. Even a vaginal examination often cannot get an early and clear diagnosis. The latter, when the cord is too short during uterine contractions, often pulls the fetal head, making it difficult to descend, extending the duration of labor and slowing down the descent of the fetal head.

　　Based on the needs of their own nutrition and the growth and development of the fetus, pregnant women must obtain sufficient nutrients from their diet. The quality of a pregnant woman's nutrition not only affects the growth of the fetus and the development of its brain cells but is also crucial for the intellectual development of the baby. Malnutrition in pregnant women is also prone to causes such as miscarriage, preterm birth, stillbirth, and fetal malformation.

　　1. Protein: Research proves that a lack of protein in pregnant women not only increases the risk of miscarriage but also affects the normal development of fetal brain cells, leading to developmental disorders in infants. Insufficient protein supply can also cause anemia during pregnancy, nutritional edema, and gestational hypertension. Pregnant women must consume an adequate amount of protein to meet their own needs and the normal growth and development of the fetus. The World Health Organization recommends that women in the second half of pregnancy should increase their intake of high-quality protein by at least 9 grams per day, which is equivalent to 300 milligrams of milk. If plant-based foods are the main source, an additional 15 grams of protein is needed, equivalent to 40 grams of soybeans, 75 grams of tofu, or 200 grams of staple food. It is clear that pregnant women should eat more animal foods rich in protein such as lean meat, poultry, fish, and eggs during the middle and later stages of pregnancy. If the economic conditions are limited, they should consume more soy products.

　　2. Calcium and Phosphorus: The growth of the fetus's skeleton requires a large amount of calcium and phosphorus. Therefore, the mother's body must supply enough calcium and phosphorus to the fetus. If the mother's intake of calcium and phosphorus is insufficient, it can lead to bone softening in pregnant women and congenital rickets or hypocalcemic convulsions in infants, which will also seriously affect the physical and intellectual development of infants and young children. The daily calcium requirement of pregnant women is more than double that of normal people. Milk, egg yolks, soy products, shrimp, shrimp skin, etc., contain a lot of calcium, while phosphorus is present in foods such as oatmeal, soybeans, lamb, and chicken. Eating these foods can increase the calcium and phosphorus needed by pregnant women. After the fifth month of pregnancy, pregnant women can drink more bone soup, or fry small fish and eat them with the meat and bones together, which can supplement more calcium and phosphorus.

　　3. Iron: The fetus needs about 5 milligrams of iron every day for development in the mother's body, and the blood volume of pregnant women increases during pregnancy, and some blood is also lost during delivery. Therefore, pregnant women need a large amount of iron. If the iron supply is insufficient, pregnant women will become anemic, which will then affect the development of the fetus, causing neonatal anemia. Therefore, pregnant women should eat more iron-rich foods, such as eggs, lean meat, liver, heart, etc., among which eggs are the best, which can be fully utilized. In staple foods, wheat contains more iron than rice, and the absorption rate is also higher than that of rice, so when conditions permit, it is encouraged to eat more wheat products such as noodles and bread.

　　4. Zinc: Women need a dramatic increase in zinc during pregnancy. If the zinc supply is insufficient, it can easily lead to fetal malformation and may also cause taste abnormalities and decreased appetite in pregnant women. Animal foods are reliable sources of zinc, such as beef, pork, oysters, liver, kidneys, etc., which contain easily absorbable organic zinc.

　　Umbilical cord prolapse refers to the situation where the amniotic membrane has broken, the umbilical cord has exceeded the presenting part and prolapsed into the cervical canal and even outside the cervix. It is one of the causes of fetal intrauterine distress, neonatal asphyxia, stillbirth, and perinatal death.

　　Once the umbilical cord prolapse or prolapse is found, and the fetal heart is still present, the fetus should be delivered within a few minutes; if there are no conditions for cesarean section or the family members of the mother do not agree to surgery, umbilical cord repositioning surgery can be performed; if the fetus is confirmed to be dead, natural childbirth can be allowed.

　　There is no traditional Chinese medicine diagnosis and treatment method.