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Umbilical Cord Prolapse

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181. Expectant management of preterm premature rupture of membranes and nonvertex presentation: what are the risks? (PubMed)

with vertex presentations (control group) comprised the 2 study groups. All patients that met the study admission criteria were treated in a similar manner at 1 of 3 level-III hospitals. The gestational ages at delivery of all patients were between 23-34 weeks, and the gestational ages between case and control patients were matched for gestational age.A statistically significant (P = .03) higher incidence of a prolapsed umbilical cord was found in the study group (n = 8; 10.8%) relative to the control (...) group (n = 1; 1.4%). More infants in the study group had low 5-minute Apgar scores (<5) and/or low cord pH (<7.20; n = 25 [33.8%]) than in the control group (n = 12 [16.2%]; P = .02). Five infants with breech presentations underwent a precipitous unplanned vaginal delivery. Significant morbidity was not detected in these 5 infants.After transfer to an antenatal ward, patients with PPROM with nonvertex presentations appear to have a significantly higher risk for prolapsed umbilical cords, lower Apgar

2007 American Journal of Obstetrics and Gynecology

182. In situ Malone antegrade continence enema in 127 patients: a 6-year experience. (PubMed)

males. Average patient age at the time of surgery was 9.6 years (range 2.9 to 28.4). Diagnoses included myelomeningocele in 116 cases, lipomeningocele in 6, spinal cord injury in 2, posterior urethral valves in 1, sacral agenesis in 1 and functional constipation in 1.Cecal plication/imbrication was performed in 100 patients, appendix intussusception and imbrication in 24, and creation of tenia flaps in 3. The abdominal stoma was umbilical in 50 cases, right lower quadrant in 74 and periumbilical (...) in 3. Concomitant genitourinary reconstruction was performed in 87% of patients. Mean followup was 26.9 months (range 0.7 to 68.1). Fecal continence was reported by 91% of the patients. Thirteen stomal revisions (stenosis 10, prolapse 2 and leakage 1) were required in 11 patients. Major complications included a cecal volvulus requiring a right hemicolectomy in 1 patient, small bowel obstruction in 2, and shunt infection and/or malfunction in 2. Four patients have elected to no longer use the MACE

2004 Journal of Urology

183. Comparison of obstetric outcomes between on-call and patients' own obstetricians. (PubMed)

and 2001 at the Royal Victoria Hospital in Montréal. We excluded breech deliveries, elective cesarean sections and deliveries with placenta previa or prolapse of the umbilical cord. Logistic regression analysis was used to compare obstetric outcomes (e.g., cesarean delivery, instrumental vaginal delivery and episiotomy) between the regular-care and on-call obstetricians after adjustment for potential confounders.A total of 28,332 eligible deliveries were attended by 26 obstetricians: 21,779 (76.9

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2007 Canadian Medical Association Journal

184. Prolapsed Cord

. You may find one of our more useful. In this article In This Article Prolapsed Cord In this article There are three varieties: Overt cord prolapse - if the presenting part of the fetus does not fit the pelvis snugly after membrane rupture, there is a risk that the umbilical cord can slip past and present at the cervix or descend into the vagina. This is known as overt cord prolapse. It represents an acute obstetric emergency, as prolapse exposes the cord to intermittent compression compromising (...) the fetal circulation. Depending on its duration and degree of compression, fetal hypoxia, brain damage and even death can occur. Exposure of the umbilical cord to air causes irritation and cooling, resulting in vasospasm of the cord vessels. Occult cord prolapse - where the umbilical cord lies alongside the presenting part. Cord presentation - where the cord can be felt to prolapse below the presenting part with or without membrane rupture. The cord may slip to one side of the head and disappear

2008 Mentor

185. Unusual presentations and positions and multiple pregnancy (PubMed)

Unusual presentations and positions and multiple pregnancy 10221949 1999 06 23 2008 11 20 0959-8138 318 7192 1999 May 01 BMJ (Clinical research ed.) BMJ ABC of labour care: unusual presentations and positions and multiple pregnancy. 1192-4 Chamberlain G G Steer P P eng Journal Article Review England BMJ 8900488 0959-8138 AIM IM Breech Presentation Delivery, Obstetric Dystocia etiology Female Humans Labor Presentation Pregnancy Pregnancy, Multiple Prenatal Care methods Prolapse Umbilical Cord 0

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1999 BMJ : British Medical Journal

186. Amnioinfusion: a review. (PubMed)

of operative deliveries, and improved umbilical artery and venous blood gas values. Amnioinfusion also has been suggested as means to instill antibiotics into an infected uterine cavity, or the uterine cavity of a woman with preterm premature rupture of the membranes. Transabdominal amnioinfusion may be used to improved prenatal ultrasound evaluation in pregnancies associated with oligohydramnios. Complications of amnioinfusion include umbilical cord prolapse, uterine overdistention, fetal bradycardia

1993 Obstetrical & Gynecological Survey Controlled trial quality: uncertain

187. The Doppler assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy. (PubMed)

was 11/1000 live births, and the Doppler group (n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01-1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance.In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 (...) The Doppler assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy. To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies.A prospective randomised controlled multicentre trial of women with twin pregnancies.Tertiary level referral hospitals in Australia, New Zealand and Southeast

2003 BJOG Controlled trial quality: predicted high

188. Prenatally diagnosed patent urachus with bladder prolapse. (PubMed)

Prenatally diagnosed patent urachus with bladder prolapse. We report 2 cases of patent urachus with bladder prolapse, which has a characteristic finding of "disappearance of cyst" antenatally. In the first case, a 34-year-old woman presented at 14 weeks gestation for evaluation of a cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared, and a solid mass bulged out inferior (...) to the umbilical cord. At term, the patient delivered a male infant. Examination of the neonate demonstrated mucosal protrusion inferior to the umbilical cord. Catheterization confirmed communication with the bladder. We diagnosed patent urachus with bladder prolapse. In the second case, a 36-year-old woman presented at 19 weeks gestation for evaluation of moderate bilateral hydronephrosis and an abdominal cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating

2007 Journal of Pediatric Surgery

189. Bladder prolapse through a patent urachus: fetal and neonatal features. (PubMed)

Bladder prolapse through a patent urachus: fetal and neonatal features. We report a term male neonate who was born with a large, red, tubular, mucosa-lined umbilical mass containing a patent lumen. Prenatal ultrasonographic screening at 20 to 28 weeks of gestation revealed a large cyst at the umbilicus, communicating with the urinary bladder. The cyst resolved at 32 weeks, and a small solid mass was newly seen on the fetal abdominal wall, inferior to the umbilical cord insertion. At operation (...) , the mass was discovered to be the prolapsed, open, everted dome of the urinary bladder. The dome was resected, and the bladder was repaired in 2 layers after identification of the ureteral orifices. Bladder prolapse through a patent urachus can be predicted by prenatal ultrasound and has a distinct neonatal appearance.

2006 Journal of Pediatric Surgery

190. Neonatal outcome following prolonged umbilical cord prolapse in preterm premature rupture of membranes. (PubMed)

Neonatal outcome following prolonged umbilical cord prolapse in preterm premature rupture of membranes. We assessed the outcome of thirteen neonates (five singletons and eight first twins) born after umbilical cord prolapse (UCP) following preterm premature rupture of membranes (PPROM) between 24 and 34 weeks of gestation. The median gestational age at PPROM was 29 weeks + 2 days. The median interval from the diagnosis of UCP to delivery was 60 and 150 minutes in singleton and twin pregnancies (...) , respectively. The median umbilical artery pH was 7.29 [0.06]. Apgar scores ranged between four and 10 at 5 minutes after birth. All infants had a normal neurodevelopmental outcome at two years follow up.

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2005 BJOG

191. Umbilical cord prolapse in current obstetric practice. (PubMed)

Umbilical cord prolapse in current obstetric practice. To assess the incidence, risk factors and outcomes of umbilical cord prolapse in current obstetric practice.This study was a retrospective chart review at both a community hospital and a tertiary referral center.There were 52 cases of cord prolapse in our patient population, for an incidence of 3.0/1,000, similar to that in the literature. Of viable singleton pregnancies with frank prolapse, the rate was 1.6/1,000. In this series we found (...) an approximately 40% higher rate of frank cord prolapse in induced patients at the community hospital than in the general population. Other than 2 fetal deaths related to extreme prematurity, all mothers and infants did well.The higher incidence of cord prolapse among women with induction of labor in this population merits further study. The lack of significant morbidity and mortality in the study suggests that modern obstetric practices may influenced the natural history of umbilical cord prolapse.

2005 Journal of Reproductive Medicine

192. Umbilical cord prolapse. (PubMed)

Umbilical cord prolapse. Prolapse of the umbilical cord is a rare obstetric emergency that in the viable fetus necessitates an expeditious delivery. A case of a periviable pregnancy complicated by preterm premature rupture of membranes and overt umbilical cord prolapse was prolonged 2 weeks with expectant management is described. An extensive review of the literature regarding the etiology, risk factors, and management options for umbilical cord prolapse in both viable and previable pregnancies

2006 Obstetrical & Gynecological Survey

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