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Umbilical Cord Prolapse

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21. Umbilical Cord Complications (Treatment)

are differentiated from an acardiac twin because an acardiac twin has some recognizable anatomic structures, whereas the teratoma is totally disorganized. This condition cannot be specifically diagnosed prenatally. Ultrasonography may reveal an umbilical cord mass. [ ] Obstetric management for an umbilical cord tumor is described above. Previous Next: Cord Prolapse If the umbilical cord presents in front of the fetal presenting part and the membranes rupture, the risk that the cord will prolapse through (...) the cervix into the vagina is significant. Occult prolapse occurs when the cord lies alongside the presenting part. Cord prolapse occurs in 0.6% of deliveries. The risk is increased with fetal malpresentations, especially when the presenting part does not fill the lower uterine segment, as is the case with incomplete breech presentations (5-10%), premature infants, and multiparous women. [ ] Causes include abnormal presentation, a long umbilical cord, polyhydramnios, prematurity, and an unengaged

2014 eMedicine.com

22. Umbilical Cord Complications (Overview)

are differentiated from an acardiac twin because an acardiac twin has some recognizable anatomic structures, whereas the teratoma is totally disorganized. This condition cannot be specifically diagnosed prenatally. Ultrasonography may reveal an umbilical cord mass. [ ] Obstetric management for an umbilical cord tumor is described above. Previous Next: Cord Prolapse If the umbilical cord presents in front of the fetal presenting part and the membranes rupture, the risk that the cord will prolapse through (...) the cervix into the vagina is significant. Occult prolapse occurs when the cord lies alongside the presenting part. Cord prolapse occurs in 0.6% of deliveries. The risk is increased with fetal malpresentations, especially when the presenting part does not fill the lower uterine segment, as is the case with incomplete breech presentations (5-10%), premature infants, and multiparous women. [ ] Causes include abnormal presentation, a long umbilical cord, polyhydramnios, prematurity, and an unengaged

2014 eMedicine.com

23. Umbilical Cord Complications (Follow-up)

are differentiated from an acardiac twin because an acardiac twin has some recognizable anatomic structures, whereas the teratoma is totally disorganized. This condition cannot be specifically diagnosed prenatally. Ultrasonography may reveal an umbilical cord mass. [ ] Obstetric management for an umbilical cord tumor is described above. Previous Next: Cord Prolapse If the umbilical cord presents in front of the fetal presenting part and the membranes rupture, the risk that the cord will prolapse through (...) the cervix into the vagina is significant. Occult prolapse occurs when the cord lies alongside the presenting part. Cord prolapse occurs in 0.6% of deliveries. The risk is increased with fetal malpresentations, especially when the presenting part does not fill the lower uterine segment, as is the case with incomplete breech presentations (5-10%), premature infants, and multiparous women. [ ] Causes include abnormal presentation, a long umbilical cord, polyhydramnios, prematurity, and an unengaged

2014 eMedicine.com

24. Umbilical Cord Prolapse

Umbilical Cord Prolapse Umbilical Cord Prolapse - Gynecology and Obstetrics - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Vaginal (...) and Repair an Episiotomy SOCIAL MEDIA Add to Any Platform Loading , MD, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Umbilical cord prolapse is abnormal position of the cord in front of the fetal presenting part, so that the fetus compresses the cord during labor, causing fetal hypoxemia. The prolapsed umbilical cord may be Occult: Contained within the uterus Overt: Protruding from

2013 Merck Manual (19th Edition)

25. Delayed Cord Clamping in Infants Born by Cesarean Section

provided by (Responsible Party): Daniele Trevisanuto, University Hospital Padova Study Details Study Description Go to Brief Summary: Introduction: Placental transfusion supports an important blood transfer to the neonate, promoting a more stable and smooth transition from fetal to extra-uterine life. Cesarean section, especially elective one, reduces the placental transfusion, mainly because of uterine atony. Therefore, during an elective cesarean section umbilical cord management may play a relevant (...) role on blood passage to the neonate and, as consequence, it may affect neonatal hematological values and cardiovascular parameters. The most effective way to manage umbilical cord in in elective cesarean section remains to be established. Objective: The aim of the present study is to evaluate the effect of two different methods of umbilical cord management (Early Cord Clamping - ECC vs. Delayed Cord Clamping - DCC) on the hematocrit on the second day of life; in addition, we will assess the effect

2018 Clinical Trials

26. Prolapsed cord. (PubMed)

Prolapsed cord. 6018217 1967 04 13 2018 11 13 0007-1447 1 5538 1967 Feb 25 British medical journal Br Med J Prolapsed cord. 472-4 Kettle M J MJ eng Journal Article England Br Med J 0372673 0007-1447 AIM IM Cesarean Section Female Hernia, Umbilical surgery Humans Obstetric Labor Complications surgery Pregnancy 1967 2 25 1967 2 25 0 1 1967 2 25 0 0 ppublish 6018217 PMC1840850 Lancet. 1951 Mar 10;1(6654):561-2 14805128 Am J Obstet Gynecol. 1951 Jul;62(1):52-64 14846821 West J Surg Obstet Gynecol

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1967 British medical journal

27. Prolapsed Cord (PubMed)

Prolapsed Cord 13749886 1998 11 01 2018 11 30 0007-1447 2 5211 1960 Nov 19 British medical journal Br Med J Prolapsed cord. 1496-8 SELIGMAN S A SA eng Journal Article England Br Med J 0372673 0007-1447 OM Female Humans Pregnancy Pregnancy Complications Umbilical Cord UMBILICAL CORD 1960 11 19 1960 11 19 0 1 1960 11 19 0 0 ppublish 13749886 PMC2097626

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1960 British medical journal

28. Cord Milking Impacts Neurodevelopmental Outcomes in Very Low Birth Weight Infants

. Currently prenatal neuroprotective agents such as corticosteroids are utilized whenever a preterm birth is anticipated. However, there are no proven postnatal interventions to prevent brain damage and cerebral palsy in VLBW infants. Many recent studies show that delaying umbilical cord clamping (DCC) may improve hemodynamic stability and decrease intraventricular hemorrhage (IVH) in preterm infants. A decrease in incidence of IVH has a conceivable prospective benefit of decreasing brain injury (...) the infant to the resuscitation table for further care. The clinical care will be provided by the clinicians taking care of the infant. The research team will be trained and be responsible for requesting the obstetrician in advance to provide the maximum length of umbilical cord. No Intervention: Observational Observational infants will receive usual care with immediate cord clamping by the delivering obstetrician. The time of cord clamping will be recorded for both groups using a timer. Outcome Measures

2016 Clinical Trials

29. Premature Infants Receiving Milking or Delayed Cord Clamping: PREMOD2

Summary: This study is being done to find out whether umbilical cord milking (UCM) is at least as good as or better than delayed cord clamping (DCC) to reduce bleeding in the brain or prevent death in premature newborns. The investigators will study short and long term outcomes of infants delivered before 32 weeks gestation that receive either UCM or DCC. * The trial was stopped by the DSMB for safety in the small strata. They consequently allowed for continuation of the trial in infants 30-32+6 wk GA (...) . Condition or disease Intervention/treatment Phase Intraventricular Haemorrhage Neonatal Death; Neonatal Procedure: Umbilical cord milking UCM Procedure: Delayed cord clamping DCC Not Applicable Detailed Description: Aim 1. Compare the incidence of severe intraventricular hemorrhage (IVH) and/or death in premature newborns

2016 Clinical Trials

30. Delayed Cord Clamping in Preterm Neonates

Party): Weill Medical College of Cornell University Study Details Study Description Go to Brief Summary: Delayed cord clamping (DCC) from 30 to 60 seconds allows blood to continue to flow from the placenta through the umbilical cord to the infant, thus resulting in a placental transfusion. This transfusion may improve circulating volume at birth leading to a smoother postnatal transition and overall improved outcome for preterm infants. The average blood volume delivered with DCC up to 90 seconds (...) significance level. Condition or disease Intervention/treatment Phase Premature Birth of Newborn Infant, Very Low Birth Weight Delayed Separation of Umbilical Cord Placental Transfusion Other: 30 Seconds of placental blood transfusion Other: 60 Seconds of placental blood transfusion Not Applicable Detailed Description: Placental transfusion at birth is thought to have immediate, short-term and long-term benefits for the neonate. Delaying cord clamping is thought to allow for a smoother postnatal transition

2015 Clinical Trials

31. Neonatal prolapsed patent vitellointestinal duct (PubMed)

duct as a whole or part of it leads to a wide variety of anomalies-Meckel's diverticulum is the commonest lesion and a PVID is the rarest. Umbilical cord clamping flush with the abdominal wall may convert a Meckel's diverticulum prolapsing in the base of umbilical ring into a PVID. Careful assessment should be made for associated anomalies. Transumbilical exploration gives the best cosmetic and functional results. (...) Neonatal prolapsed patent vitellointestinal duct A case of a prolapsed patent vitellointestinal duct (PVID) in a 10-day-old neonate who presented with vomiting and poor weight gain with partial intestinal obstruction and a flower like pink, prolapsing lesion at his umbilicus has been reported. A limited contrast study through the tubular structure confirmed it to be a PVID. He underwent transumbilical exploration and resection and anastomosis uneventfully. Persistence of the vitellointestinal

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2013 BMJ case reports

32. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. (PubMed)

Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis-delivery interval (DDI).Retrospective cohort study.Large tertiary maternity unit within a University Hospital in the United Kingdom.All cases of cord prolapse with informative case record: 34 pre-training (...) , 28 post-training.Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993-99) and post-training (2001-07).Diagnosis-delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g).After training

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2009 BJOG

33. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation

neonatal morbidity and mortality, primarily from prematurity, sepsis, cord prolapse and pulmonary hypoplasia. In addition, there are risks associated with chorioamnionitis and placental abruption. The median latency after PPROM is 7 days and tends to shorten as the gestational age at PPROM advances. , This guideline comprises recommendations relating to the , , and timing of of women presenting with suspected PPROM from 24 +0 to 36 +6 weeks of gestation. It also addresses . An infographic and audio (...) study has shown that women with clinically diagnosed PPROM who have reduced amniotic fluid volumes on ultrasound are more likely to give birth within 7 days from membrane rupture. Evidence level 2+ A retrospective cohort study of women with PPROM who had planned home care, found that membrane rupture occurring before 26 +0 weeks’, non‐cephalic presentation and oligohydramnios were associated with an increased risk of ‘complication’ (defined as fetal death, placental abruption, umbilical cord

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2019 Royal College of Obstetricians and Gynaecologists

34. Approaches to Limit Intervention During Labor and Birth

in spontaneous labor, amniotomy alone did not shorten the duration of spontaneous labor (mean difference, –20.43 minutes; 95% CI, –95.93 to 55.06) or lower the incidence of cesarean births. Likewise, when compared with women who did not undergo amnioto- my, those who did were similar in terms of patient sat- isfaction, frequencies of 5-minute Apgar scores less than 7, umbilical cord prolapse, and abnormal fetal heart rate patterns (20). Another study evaluated the combination of early amniotomy with oxytocin (...) umbilical cord clamping, and early skin-to-skin contact (58, 59). A large body of evidence to support efficacy of these techniques, whether each on its own or in combination, is lacking, though the merits of delayed umbilical cord clamping and early skin-to-skin contact have been extensively reviewed elsewhere. One randomized trial of a number of family-centered cesarean birth interventions dem- onstrated greater parental satisfaction in the interven- tion group; skin-to-skin care was achieved in 72

2019 American College of Obstetricians and Gynecologists

35. Intrapartum fetal surveillance

cardiotocography 13 3.6.1 Special Considerations 14 4 Cardiotocograph 15 Features in labour 15 Normal CTG 16 Fetal compromise 17 Management of reversible causes of abnormal CTG 18 5 Intrapartum fetal blood sampling 19 Interpretation of fetal blood sampling results 20 5.1.1 *Special considerations for fetal scalp lactate measurements 20 6 Paired umbilical cord blood gas or lactate analysis 21 Normal cord blood values 22 7 Other methods of fetal monitoring 22 References 23 Appendix A: Interpretation of CTG 25 (...) . Description of normal FHR 16 Table 12. Compromised fetus 17 Table 13. Reversible causes of abnormal CTG 18 Table 14. Intrapartum fetal blood sampling 19 Table 15. Intrapartum fetal blood sampling results 20 Table 16. Paired umbilical cord sampling 21 Table 17 Cord blood sampling outcome 22 Table 18 Normal cord blood gas and lactate (at birth) 22 Queensland Clinical Guideline: Intrapartum fetal surveillance Refer to online version, destroy printed copies after use Page 7 of 30 1 Introduction The principal

2019 Queensland Health

36. Neuro-urology

Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol, 2015. 5. Nosseir, M., et al. Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn, 2007. 26: 228. 6. Panicker, J.N., et al. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol, 2015. 14: 720. 7. Guyatt, G.H., et al. GRADE: an emerging consensus on rating quality of evidence and strength (...) . Aruga, S., et al. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodyn, 2018. 37: 1053. 31. Singh, A., et al. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol, 2014. 6: 309. 32. Weld, K.J., et al. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology, 2000. 55: 490. 33. Kondo, A., et al. Neural tube defects: prevalence

2019 European Association of Urology

37. WHO recommendations: intrapartum care for a positive childbirth experience

and ergometrine) or oral misoprostol (600 µg) is recommended. a Recommended Recommended Recommended Delayed umbilical cord clamping 44. Delayed umbilical cord clamping (not earlier than 1 minute after birth) is recommended for improved maternal and infant health and nutrition outcomes. b Recommended Controlled cord traction (CCT) 45. In settings where skilled birth attendants are available, controlled cord traction (CCT) is recommended for vaginal births if the care provider and the parturient woman regard (...) of the baby for ambient temperature is recommended. This means one to two layers of clothes more than adults, and use of hats/caps. The mother and baby should not be separated and should stay in the same room 24 hours a day. f Recommended a Integrated from WHO recommendations for the prevention and treatment of postpartum haemorrhage. b Integrated from the WHO Guideline: delayed cord clamping for improved maternal and infant health and nutrition outcomes. c Integrated from WHO Guidelines on basic newborn

2018 World Health Organisation Guidelines

38. CRACKCast E171 – Pediatric Cardiac Disorders

of Cardiac Disorders in Infants and Children) See Box 170.3 (Key Elements to Elicit in the History of a Child with a Known Cardiac Disorder) Let’s start this sauna-sweat-shop episode with a little anatomy review: Trace the path of the RBC during foetal circulation, and describe the changes that occur following delivery. Oxygen flow: mom’s lungs/body/placenta → umbilical vein → ductus venosus → fetal heart (through IVC) → right atrium → shunted to the left atrium by the patent foramen ovale → left (...) and mixes with the well-oxygenated blood in the descending aorta. The mixed blood in the descending aorta then returns to the placenta for oxygenation through the two umbilical arteries.” Following delivery: Decrease in pulmonary vascular resistance (increased pulm. Blood flow) Increase in global 02 enhances closure of umbilical arteries, umbilical vein, ductus venosus, ductus arteriosus (complete closure by 2-3 weeks) – functional closure by 15-18 hours. Increase in pulmonary artery flow creates

2018 CandiEM

39. Resuscitation - neonatal

(epinephrine) 25 7.2 Volume expanding fluids 26 8 Special circumstances 27 8.1 Preterm baby 27 8.2 Other special circumstances 28 8.3 Congenital anomalies 29 9 Care after resuscitation 30 9.1 Cord blood sampling 30 9.1.1 Umbilical artery cord blood gases 30 9.2 Continuing clinical care 31 9.3 Monitoring and management 32 10 Ethical considerations 33 References 34 Appendix A Equipment and medications for neonatal resuscitation 35 Appendix B Oxygen/air mix and target oxygen saturation 36 Appendix C (...) Administration of volume expanding fluids 26 Table 23 Preterm baby 27 Table 24 Other special circumstances 28 Table 25 Congenital anomalies 29 Table 26 Cord blood gas sampling 30 Table 27 Umbilical artery cord blood gases 30 Table 28 Continuing clinical care 31 Table 29 Monitoring and management 32 Table 30 Ethical considerations 33 Table of Figures Figure 1 Rounded doses of IV adrenaline (epinephrine) 1:10,000 25 Queensland Clinical Guideline: Neonatal resuscitation Refer to online version, destroy printed

2018 Queensland Health

40. CRACKCast E180 – Labor & Delivery

breech), and complete (hips and knees flexed). The main mechanical problem with breech presentations is that the buttocks and legs do not provide a sufficient wedge, hindering cervical accommodation of the relatively larger head. In addition, because the presenting part does not occlude the cervical opening completely, umbilical cord prolapse may occur. Normally these presentations are managed in the OR; but we need to be ready to manage this in the ER! When the labouring woman comes in we need (...) in a full-term infant. If the after-coming head cannot be delivered quickly, the chances of good fetal outcome are poor. Complications: Overall, one-third of breech fetal deaths are believed to be preventable. Asphyxia is often due to umbilical cord prolapse or entrapment of the head. Other complications include labor arrest or brachial plexus injuries, and fetal head and neck trauma can occur if inappropriate delivery techniques are used. Infant complications are more common and severe than maternal

2018 CandiEM

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