Although the sheath attachment of the umbilical cord has nothing to do with its prolapse, nevertheless, by the nature of the adverse effect on the fetus, these two types of obstetric pathology are so close that it seems useful to highlight this feature. Sheath attachment of the umbilical cord refers to anomalies in the development of the placenta. With normal intrauterine development and membranes, the placental end of the umbilical cord is located in the center. However, there are some options for its location. It is often connected to the placenta eccentrically, and in some cases it does not reach the placenta at all. In the latter case, only the umbilical vessels are suitable for the placenta.

It is known that the umbilical cord contains a special tissue called Varton's jelly, which protects the umbilical vessels from injury. If the umbilical cord is not attached directly to the placenta, but enters the membranes, then for some distance the vessels passing from the umbilical cord to the placenta are deprived of this protection. On fig. 67, 68, 69, 70 and 71 show the normal insertion of the umbilical cord and some variants of the sheath.

Rice. 67. Normal attachment of the umbilical cord to the placenta.

Rice. 68. Marginal attachment of the umbilical cord.

Rice. 69. Placenta with an additional share. Vessels partially pass in shells (a).

Rice. 70. Sheath attachment of the umbilical cord. 1 - umbilical cord; 2 - shells; 3 - umbilical arteries; 4 - placenta; 5 - umbilical vein.

Rice. 71. Schematic representation of the rupture of vessels passing through the membranes. 1 - umbilical cord; 2 - shells; 3 - umbilical arteries; 4 - umbilical vein; 5 - the place of rupture of the vessel passing in the shells; 6 - rupture of shells.

Rice. 72. Sheath attachment of the umbilical cord. The place of attachment of the umbilical cord in the membranes is opposite the placenta. 1 - umbilical cord; 2 - umbilical vessels; 3 - shells; 4 - fruit surface of the placenta; 5 - edges of broken shells; 6 - placenta; 7 - shells.

This sheath-point attachment of the umbilical cord is called insertio velamentosa. It is not difficult to imagine what will happen if, during the membrane attachment of the umbilical cord, the vessels located in the membranes fall into the gap when the fetal bladder is opened. At the moment of rupture of the fetal bladder, a rupture of blood vessels can also occur. The bleeding arising from the umbilical vessels very quickly leads to the death of the fetus.

What should be done if this pathology is detected? If the opening of the pharynx turns out to be small, then one should strive to preserve the integrity of the fetal bladder. A colpeirinter can be used for this purpose. With full opening of the pharynx, it is necessary to carefully open away from the vessels amniotic sac(Fig. 72) and speed up delivery. In some cases, delivery can be carried out using.

Let's decipher the results of the ultrasound. With what trepidation every pregnant woman is waiting for the next ultrasound examination! She wants to see the baby, find out if he is well in the womb, see the arms and legs, see if the heart is beating. But the expectation of a miracle is often not justified. During the study future mom sees a screen with black and white dots and sticks, and at the end of the study - a conclusion on paper with incomprehensible numbers and phrases. Let's see what is written in this conclusion. First, about when and why the expectant mother needs to go for research. Indications for ultrasound can be divided into screening and selective. Screening is an examination of all pregnant women without exception at a certain time. These studies are carried out primarily in order to identify whether there are any malformations in the fetus. During the examination, the fetus is measured, it is determined whether the size of the fetus corresponds to the expected gestational age, the uterus and placenta are examined. Such screening studies are usually carried out 3-4 times during pregnancy: at 10-14 weeks, at 20-24 weeks, at 30-32 weeks and at the end of pregnancy - at 36-37 weeks. Selective studies are carried out if any trouble or complication is suspected. Since the need for such studies is dictated by the suspicion of pathology, their number is not limited. In some cases, ultrasound is performed 2-3 times a week.
The state of the fetus. During the first study, it is determined where the fetus is located, thus excluding the ectopic location of the fetal egg. Later, the position of the fetus in the uterus is determined - head or pelvic. At the time of the first study, the thickness of the collar zone is determined. Judging by the name, it is clear that this is a zone located in the collar area - on the back of the neck. There are certain sizes that must meet certain parameters. An increase in the size of the collar zone is a reason for genetic consultation, as it is a sign of fetal malformations. In the second and third trimesters of pregnancy during an ultrasound examination, signs of infection of the fetus, including changes in the structure of the brain, can be detected.
In the third trimester, an assessment of the structures of the fetal lungs is carried out, this is necessary to establish the degree of maturity of the lungs, if suspected or necessary premature birth. The structure of the lungs is also studied to exclude intrauterine pneumonia. All internal organs of the fetus (heart, intestines, liver, etc.) are subjected to careful study. During the study, especially carried out in the second trimester of pregnancy, it is possible to examine the facial skull of the fetus, the nose to diagnose such defects as the cleft palate and cleft lip. You can also diagnose the pathology of the laying of the teeth. Most future parents are interested in the question of whether Down syndrome can be detected using ultrasound. I would like to note that it is very difficult to make this diagnosis only on the basis of ultrasound data. Down syndrome for up to 14 weeks suggests an increase in the collar zone (for example, at 7-8 weeks of pregnancy, the collar zone should be no more than 3 mm), the absence of a back of the nose. Indirect signs is an increase in the interorbital distance, an open mouth, a protruding tongue, and some other signs. In 1/3 cases of Down's disease, heart defects are detected, more often in the form of ventricular septal defects. There may also be shortening of the bones of the lower leg. When these signs are detected, placentocentesis is performed - a study during which a piece of the placenta is taken. In the obtained material, the chromosome set of cells is studied. The ultrasound protocol reflects information about the size of the collar zone in. If during research internal organs do not detect any pathology, then this may be noted in a separate phrase or not reflected in any way, however, in case of detection of certain problems, the data must be entered into the study protocol.
In most cases, during an ultrasound examination performed at 12, 22 weeks, you can determine the sex of the child. These data are not included in the study protocol.
Already starting from the first study, it is possible to determine the fetal heartbeat. The documentation records the presence of a heartbeat (s / b +), heart rate - the number of heartbeats (normal heart rate is 120-160 beats per minute). Deviation in heart rate during the first study - an increase or decrease in the number of heartbeats - may be a sign that a recently born fetus has a heart defect. Later, in the second and third trimester, it is possible to distinguish and study the heart valves and chambers in detail, in detail. A change in the number of heartbeats in the second and third trimester may indicate fetal suffering, lack of oxygen and nutrients.
Fruit size. Abbreviations that can be found in ultrasound protocols have the following meanings. In the first trimester of pregnancy, the diameter of the fetal egg (DPR), the coccygeal-parietal size of the fetus (KTR), that is, the size from the top of the head to the tailbone, is determined. The size of the uterus is also measured. These measurements allow in the first trimester to accurately judge the duration of pregnancy, since at this time the size of the fetus is the most standard. Regarding the determination of the gestational age by the size of the fetus and the ovum, there is a small nuance. In conclusion, they may record a non-obstetric period, counted from the first day of the last menstruation, according to which the pregnancy lasts 40 weeks, and the gestational age from conception is the embryonic period. The gestational age from conception is 2 weeks less than the obstetric period. However, if the expectant mother compares the results of the ultrasound and the results of the examination, she may be bewildered, because the gestational age, according to various sources, can differ by 2 weeks. By asking your doctor what period is indicated at the conclusion of the first ultrasound, you will resolve your doubts. In subsequent studies, in the second and third trimesters of pregnancy, the following indicators of fetal development are determined:
* BDP - biparietal size - the size between the temporal bones,
* LZR - fronto-occipital size,
* OG - head circumference,
* OC - abdominal circumference.
Also measure the length femur, humerus, it is possible to measure the smaller bones of the forearm and lower leg. If the fetus is smaller than expected this period pregnancy, then they talk about IUGR - intrauterine growth retardation of the fetus. There are asymmetric and symmetrical forms of IUGR. An asymmetric shape is said to be when the dimensions of the head and limbs correspond to the term, and the dimensions of the torso are less than the expected gestational age. With a symmetrical form of fetal growth retardation, all sizes are reduced equally. With an asymmetric form of IUGR, the prognosis is more favorable than with a symmetrical one. In any case, if intrauterine fetal growth retardation is suspected, medications are prescribed to improve the supply of nutrients to the fetus. Such treatment is carried out for 7-14 days, after which a repeated ultrasound examination is mandatory. In case of fetal growth retardation, a cardiotocographic study is prescribed - a procedure during which the fetal heartbeat is recorded using a special apparatus, as well as a Doppler study, which determines the blood flow in the vessels of the fetus, umbilical cord, and uterus. Doppler examination is performed at the time of the ultrasound. If the degree of fetal growth retardation is large - if the size of the fetus is reduced by more than 2 weeks than the expected period, or malnutrition (fetal growth retardation) is detected early - in the second trimester of pregnancy, then treatment will certainly be carried out in a hospital.

Placenta. The placenta is finally formed by 16 weeks of pregnancy. Until this time, they talk about the chorion - the precursor of the placenta. Chorion - the outer shell of the embryo, which performs protective and nutritional functions. During an ultrasound examination, the site of attachment of the placenta is assessed - on which wall of the uterus the chorion or placenta is located, how far the placenta is removed from the internal pharynx of the cervix - the place of exit from the uterine cavity. In the third trimester of pregnancy, the distance from the placenta to the internal os of the cervix should be more than 6 cm, otherwise they speak of a low attachment of the placenta, and if the placenta overlaps the internal os, placenta previa. This condition is fraught with complications - bleeding during childbirth. Low attachment of the placenta is also noted during ultrasound examinations conducted in the first and second trimesters, but until the third trimester the placenta can migrate, that is, rise up the uterine wall. During ultrasound examinations, the structure of the placenta is also evaluated. There are four degrees of its maturity. Each degree corresponds to certain terms of pregnancy: the 2nd degree of maturity should be maintained up to 32 weeks, the 3rd degree - up to 36 weeks. If the placenta changes its structure ahead of time, they speak of premature aging of the placenta. This condition may be associated with impaired blood flow in the placenta due to preeclampsia (complication of pregnancy, manifested by increased blood pressure, the appearance of protein in the urine, edema), anemia (decrease in the amount of hemoglobin), and may be an individual feature of the organism of this pregnant woman. Premature aging placenta is a reason for conducting Dopplerography and cardiomonitoring studies. During ultrasound, the thickness of the placenta is determined. Normally, up to 36 weeks of gestation, the thickness of the placenta is equal to the gestational age ± 2 mm. From 36-37 weeks, the thickness of the placenta is from 26 to 45 mm, depending on individual features. With a change in the thickness and structure of the placenta, an assumption is made about placentitis - inflammation of the placenta. Conclusion Ultrasound "placentitis" is not an indication for hospitalization. If changes in the placenta are suspected, it is necessary to conduct a Doppler study, which confirms or refutes the assumption. Additional laboratory tests are also prescribed, in particular an examination for sexually transmitted infections. According to the ultrasound examination, it is possible to confirm the assumption of placental abruption, the reason for which is bloody discharge from the genital tract at any stage of pregnancy. Detachment areas are visible on the screen. All this information is reflected in the ultrasound protocol.
Umbilical cord. The umbilical cord connects the placenta to the fetus. At the time of ultrasound, the number of vessels in the umbilical cord is determined (normally there are three of them). In 80% of pregnant women, the umbilical cord loops are located in the neck or pelvic end - that part of the fetus that is supposed to leave the uterus. The loops of the umbilical cord "fall" there under the force of gravity. Cord entanglement in the fetal neck can only be diagnosed using a Doppler study. And although the entanglement of the umbilical cord is not the topic of this conversation, I would like to note that even the fact that the umbilical cord is entwined around the neck is not an indication for surgery. caesarean section.
Amniotic fluid. With ultrasound, the amniotic index is measured, which indicates the amount of water. The amniotic index (AI) is determined by dividing the uterus into quadrants by two perpendicular lines (transverse - at the level of the navel of the pregnant woman, longitudinal - along the midline of the abdomen) and summing the indicators obtained by measuring the largest vertical column amniotic fluid in every quadrant. At 28 weeks, the normal values ​​of AI are 12-20 cm, at 33 weeks - 10-20 cm. An increase in AI indicates polyhydramnios, a decrease indicates oligohydramnios. Significant polyhydramnios or oligohydramnios may indicate fetoplacental insufficiency - a violation of the blood supply to the placenta. An increase and decrease in water can also occur with other pathologies, but it also occurs in isolation. During the study, the absence or presence of impurities is also assessed - suspension in the amniotic fluid. The presence of a suspension may be evidence of infection or overdue pregnancy, but the suspension may contain only the original lubricant, which is a variant of the norm.
Uterus. During an ultrasound examination, the size of the uterus is measured, the walls of the uterus are examined for the presence or absence of myomatous nodes, for an increased tone of the muscle wall. Also measure the thickness of the walls of the uterus.
It should be noted that the diagnosis of "threatened miscarriage" cannot be made only in accordance with ultrasound data, such a diagnosis is made only when clinical signs - pain in the lower abdomen, in the lower back - are combined with ultrasound, which include a decrease in the thickness of the lower uterine segment (muscles in the lower part of the uterus) less than 6 mm, spindle-shaped contractions of the muscles of the uterus (an increase in the thickness of the uterine wall in a particular area), which indicate a contraction of a particular area of ​​​​the muscles of the uterus. Mechanical pressure with a sensor increases the tone of the uterine wall. This may be detected at the time of the study, but in the absence of clinical manifestations(pain in the lower abdomen, in the lower back), the diagnosis of "threatened abortion" is not made, speaking only of increased tone. During all studies, especially when there is a threat of termination of pregnancy, the length of the cervix, the diameter of the cervix at the level of the internal os, the condition of the cervical canal (open, closed) are measured. The length of the cervix during pregnancy should normally be 4-4.5 cm. The shortening of the cervix is ​​up to 3 cm in the primigravida, and up to 2 cm in the re-pregnant woman, the opening of the uterine os makes it possible to diagnose isthmic-cervical insufficiency, in which the cervix of the uterus begins to open already at 16-18 weeks, unable to hold developing pregnancy. So, we have listed a lot, but not all the signs that are determined during an ultrasound examination. Often, one sign can indicate completely different pathological or physiological conditions, so only a specialist can evaluate the complete ultrasound picture, and the attending doctor will compare the ultrasound data with the results of observations, complaints, analyzes, and other studies. This is the only way to draw correct conclusions.
I would especially like to note that if there is a suspicion of an unfavorable course of pregnancy, for those women who previously, during previous pregnancies, had certain complications (malformations of the fetus, etc.), it is necessary to conduct an expert study - using advanced technology, and most importantly - a highly qualified specialist.
Ultrasonic placentography. It is necessary to evaluate: localization, size of the placenta, structure, presence of pathological changes. Determining the localization of the placenta allows you to choose the optimal tactics for managing pregnancy and childbirth, predicting some obstetric complications. The final idea of ​​the location of the placenta can only be obtained in the third trimester of pregnancy. The establishment of previa or low attachment of the placenta is possible with a moderately filled bladder by standard longitudinal and a number of oblique sections.
Placenta previa is characterized by the presence of placental tissue in the area of ​​the internal os: complete - covers the internal os, passing from one wall to another, incomplete - the lower edge of the placenta reaches the internal os, without blocking it. Low insertion of the placenta: the lower edge is less than 5 cm from the internal os in the second trimester of pregnancy and less than 7 cm in the third trimester
The size of the placenta. The area and volume of the placenta are the most objective indicators, but it is difficult to evaluate them. In practice, the thickness of the placenta is measured. Measurement of the thickness of the placenta is carried out at the level of the confluence of the umbilical cord. There are normative tables for the thickness of the placenta and the duration of pregnancy.
Placenta thickening criterion: thickness more than 4.5 cm, with dropsy of the fetus, Rhesus conflict, diabetes, infectious process.
The criterion for thinning of the placenta: the thickness of the placenta is up to 2 cm or less.
Stages of maturity of the placenta:
0 st. - up to 30 weeks.
1 st. - 27 - 36 weeks.
2 tbsp. – 34 – 39 weeks
3 art. - after 37 weeks.
Premature maturation of the placenta, criteria: 2 tbsp. up to 32 weeks and 3 tbsp until 36 weeks.
Delayed maturation of the placenta: 0 - 1 tbsp. in full-term pregnancy.
Premature detachment of a normally located placenta, ultrasound criteria: the presence of an echo-negative space between the wall of the uterus and the placenta (retroplacental hematoma). Visualization of a hematoma is possible only in 25% of cases. In the second half of pregnancy, small hematomas are detected only when they are localized on the anterior wall. A fresh hematoma is a liquid formation with a fine suspension, the boundaries are clear, the sound conductivity is increased.
From the second - third days - an echogenic formation without clear contours with increased sound conductivity. Thus, it is unequivocally impossible to either make or remove the diagnosis of placental abruption.
Placental infarcts are defined as irregularly shaped formations with clear hyperechoic external contours, homogeneous hypoechoic contents in the placental parenchyma. The deposition of calcium and fibrin salts, intervillous thrombosis are visualized as formations of increased echogenicity with uneven contours.
Placental cysts appear as single-chamber fluid formations.
Tumors of the placenta: chorionangiomas are echographically detected as nodular formations of low echogenicity with a heterogeneous structure, external contours have clear boundaries, polyhydramnios in 25-30% of cases.
Placental edema: detected during maternal Rh immunization, ABO conflict, diabetes mellitus, infection, fetal dropsy. Ultrasound signs are an increase in the thickness of the placenta by 30-100% or more, an increase in the echogenicity of the placental tissue and an increase in sound conductivity.
Anomalies in the development of the placenta are found in the form of: additional lobe, annular placenta, fenestrated placenta.
The umbilical cord on a transverse section contains 2 arteries, 1 vein.
With ultrasound, it is necessary to evaluate:
* place of attachment of the umbilical cord to the placenta,
* place of attachment of the umbilical cord to the anterior abdominal wall of the fetus,
* the number of vessels of the umbilical cord.
Attachment of the umbilical cord can be marginal, sheath, split.
Anomaly of attachment of the umbilical cord to the fetus - omphalocele: the umbilical ring and the fetal part of the umbilical cord are expanded due to the internal organs, the free part of the umbilical cord departs from the top of the hernial sac
Syndrome of the only umbilical artery. In 20% it is combined with congenital malformations and chromosomal aberrations.
Cord entanglement around the fetal neck: Ultrasound criteria - one or more loops of the umbilical cord on the proximal and distal surface of the neck.
Umbilical cord cysts: ultrasound signs: anechoic formations that do not disrupt the course of blood vessels.
Amniotic fluid.
Oligohydramnios, ultrasound signs: the presence of 1 pocket of water with two perpendicular sizes less than 1 cm (at full-term pregnancy);
Polyhydramnios, ultrasound signs: the presence of more than 2 pockets of water with two perpendicular dimensions of more than 5 cm (at full-term pregnancy).

The normal course and development of pregnancy cannot be imagined without two extremely important organs - the placenta and the umbilical cord. They are directly related to each other during fetal development. This article will talk about the types of attachment of the umbilical cord to the placenta, as well as the norm and danger of deviations.

Norm

The umbilical cord or, as it may also be called, the umbilical cord is an elongated flagellum, inside which blood vessels pass. They are necessary so that the fetus during its intrauterine life receives all the necessary nutrients for growth and development. The normal umbilical cord looks like a gray-blue cord that attaches to the placenta. Normally, it is formed on the very early term pregnancy and continues to develop with the growing baby.

The umbilical cord can be easily visualized as early as the 2nd trimester of pregnancy. It is well defined during the ultrasound examination. Also, by means of ultrasound, the doctor can also assess the condition of the actively forming placental tissue. During the examination, the doctor also evaluates how the umbilical cord attaches to the placenta.

Finally, the umbilical cord is formed only by 2 months from the moment of conception. As the umbilical cord grows, so does its length. At first, the umbilical cord is only a few centimeters long. Gradually, it increases and reaches, on average, 40-60 cm. The length of the umbilical cord can be finally determined only after childbirth. While the baby is in the womb, the umbilical cord may curl up somewhat.

Normally, the umbilical cord is attached to the center of the placenta. Doctors call this location central. In this case, intrauterine development proceeds physiologically. The blood vessels that are in the umbilical cord reach the placenta and provide sufficient blood flow.

With an eccentric attachment of the umbilical cord, it is attached not to the central part of the placental tissue, but closer to its edge. Usually in this case, the umbilical cord does not reach a couple of centimeters to the edge of the placenta. Eccentric attachment of the umbilical cord is usually not accompanied by the development of any adverse functional disorders. However, the paracentral attachment of the umbilical cord to the placental tissue requires a fairly careful attitude of doctors to the development of pregnancy.

The easiest way to determine the type of attachment of the umbilical cord to the placenta is if the placental tissue is located on the anterior or lateral wall of the uterus.

If for some reason the placenta is located on the back wall, then in this case it becomes much more difficult to determine the type of attachment. In this case, it is better to conduct examinations on expert-level devices. This allows you to get more informative and accurate results.

However, the central attachment of the umbilical cord to the placental tissue is not always formed during pregnancy. Abnormal attachment variants in this case can lead to the development of various functional disorders.

Pathologies

Doctors identify several abnormal options for attaching the umbilical cord to the placenta. So, the umbilical cord can be directly attached to the edge of the placenta. Such an attachment is called edge attachment. This condition is characterized by the fact that the blood vessels in the umbilical cord are close enough to the edge of the placenta.

Lateral attachment of the umbilical cord to the placenta is not always the cause leading to the development dangerous complications during pregnancy. Obstetricians and gynecologists emphasize the condition in which the umbilical cord is located at a distance of less than 0.5 of the radius of the placenta from the edge. In this case, the risk of developing various complications is quite high.

Another clinical option for attaching the umbilical cord to the placenta is the sheath. Also, this state is called plevisty. In this case, the blood vessels that are in the umbilical cord are attached to the amniochorial membrane.

Normally, the arterial vessels that are in the umbilical cord are covered with Wharton's jelly. This gelatinous substance protects the arteries and veins that are in the umbilical cord from various damage. With sheath attachment of the umbilical cord to the placenta, the blood vessels are not covered with Wharton's jelly along their entire length. This contributes to the fact that the risk of developing various traumatic injuries of arteries and veins is quite high.

According to statistics, sheath attachment of the umbilical cord occurs during pregnancy with one baby in approximately 1.2% of cases. If the expectant mother is expecting twins, then in such a situation the risk of developing this pathology increases and is already almost 8.8%.

In obstetric practice, there are cases when the umbilical cord can change its attachment to the placenta. The reasons for this may be different. This may be due to inaccuracies in determining the initial place of attachment of the umbilical cord to the placenta (the notorious human factor), as well as due to the migration of placental tissue during pregnancy. Note that a change in the place of attachment of the umbilical cord still occurs infrequently.

Possible consequences

Abnormal attachment of the umbilical cord to the placenta threatens the development of a number of complications that can occur at different stages of pregnancy. In order to identify them in a timely manner, doctors resort to different ways diagnostics, the main of which is ultrasound examination. Ultrasound in this case is prescribed several times. This is necessary so that doctors can assess the dynamics of the development of the pathology and correct the violations that occur in time.

Since blood vessels pass through the umbilical cord, to assess the intensity of blood flow, doctors resort to prescribing another diagnostic method - dopplerography. This examination allows you to assess whether there are any defects in the blood supply to the placenta and the body of the fetus. Possible complications largely depend on how the umbilical cord is attached to the placenta.

With sheath attachment of the umbilical cord to the placenta, the risk of developing various traumatic injuries is quite high. Also, with this option of attachment, the risk of developing dangerous bleeding that can develop during childbirth is quite high. Some researchers believe that with this type of attachment of the umbilical cord to the placenta, the risk of developing intrauterine growth retardation is quite high.

In some cases, sheath attachment of the umbilical cord to the placenta is accompanied by the development of comorbidities. So, in this condition, anomalies and malformations of the internal organs of the fetus can also develop (including heart and vascular defects, defects in the structure of the musculoskeletal system, esophageal atresia), vascular pathologies, the appearance of additional lobules in the placental tissue and other disorders.

Another possible complication, which can develop with sheath attachment of the umbilical cord to the placenta, is the development of intrauterine fetal hypoxia. In this case, in children's body does not receive enough oxygen necessary for "tissue" respiration. The resulting oxygen deficiency contributes to the fact that the functioning of the internal organs of the fetus is disturbed. This situation is fraught with the development of dangerous pathologies that can manifest themselves even after the birth of a child.

With sheath attachment of the umbilical cord to the placenta, a caesarean section is often the method of delivery. In some cases natural childbirth can be dangerous for the development of dangerous birth injuries and injuries. In order to avoid them, doctors prescribe a caesarean section.

Note that the choice of the method of obstetrics is chosen individually, taking into account the various characteristics of the course of a particular pregnancy.

For low placentation during pregnancy and the location of the placenta, see the following video.

The umbilical cord is an organ that connects the fetus to the child's place. This is a kind of cord, consisting of 1 vein and 2 arteries, fastened together and protected from damaging effects by vartan jelly. The cord between the mother and the fetus is necessary to provide the baby with blood saturated with oxygen, nutrients, and the removal of carbon dioxide.

How does the umbilical cord attach to the placenta?

A normal fixation option is considered to be the umbilical cord leaving the center of the child's place. Anomalies are called lateral, marginal, sheath attachment of the "cord". It is best to consider them in the 2nd trimester with ultrasound diagnostics when the placenta is located on the anterior or anterolateral uterine wall. When it is localized on the back wall, it may be difficult to determine it. The use of color Doppler ultrasound allows you to recognize the exact variant of the pathological exit of the cord to the child's place.

Consider several types of abnormal fixation of the umbilical "cord":

1. Central - in the middle of the inner surface of the placenta. It occurs in 9 out of 10 pregnancies and is considered normal.
2. Lateral (eccentric) - not in the center, but on the side of the embryonic organ, closer to its edge.
3. Regional - from the edge of the placenta. The umbilical arteries and vein pass to the child's place close to its periphery.
4. Shell (plevistoe) - attached to the membranes of the fetus, not reaching the placenta. The vessels of the umbilical cord are located between the membranes.

What is the marginal attachment of the umbilical cord

Marginal discharge means that fixation is not in the central zone, but in the peripheral one. The umbilical arteries and vein enter the child's place too close to the very edge. Such an anomaly usually does not threaten the normal course of pregnancy or childbirth, being considered a feature of a particular period of bearing crumbs.

Experts say that the marginal discharge is not an indication for a caesarean section: a natural delivery is performed. This attachment does not increase the risk of complications in the mother or baby. However, when doctors try to isolate the placenta by pulling on the umbilical cord, the latter may come off.

Possible reasons for this condition

Experts consider the primary cause of pathological attachment to be the primary defect in the implantation of the umbilical cord, when it is not localized in the area of ​​the trophoblast that forms the child's place.

The risk factors for anomalies are:

1. First pregnancy;
2. Young age, not exceeding 25 years.
3. Excessive physical activity in combination with a forced upright position of the body.
4. Obstetric factors - oligohydramnios, polyhydramnios, weight, position or presentation.

Most often, abnormal fixation of the umbilical cord occurs simultaneously with several variants of the pathology of the cord - true nodes, non-spiral arrangement of vessels.

The sheath site of attachment of the strand between the mother and fetus is much more often fixed when a woman is carrying twins or triplets, or when repeated births. Often, such an anomaly accompanies malformations of the child and organs: congenital uropathy, esophageal atresia, heart defects, the only umbilical artery, trisomy 21 in crumbs.

What is the danger of diagnosis

The marginal variant of the exit of the umbilical cord is not considered a serious condition. Doctors pay attention to a similar localization of the attachment of the "cord" in the case when the umbilical cord is located at a distance not exceeding half the radius of the child's place from the edge. This situation leads to the development of obstetric complications.

For example, the radius of the placenta is 11 cm. If the cord in this form does not exceed 5.5 cm from the edge, close monitoring of the child's condition is necessary: ​​there is a high risk of developing oxygen starvation in the womb. To this end medical workers monitor the movements of the children, conduct CTG at least 2 times a week for the entire gestation period.

The shell version poses a much greater threat. Violation is typical to a greater extent for multiple pregnancies. The vessels are located between the membranes, are not covered with vartan jelly, and the fibrous tissue is also less developed there. For this reason, they cannot be protected from damage during childbirth.

With the location of the arteries and veins in the lower segment of the fetal bladder, the rupture of the membranes leads to bleeding. A baby with amniotic fluid squeezes blood vessels, leading to massive blood loss in a child. Acute hypoxia develops, and if timely medical care is not provided, fetal death may occur.

When the region of the membranes passes over internal os cervix, located at the bottom of the presenting part of the child, a diagnosis of vascular presentation is made. This is a variant of the plevisty type of discharge of the "cord". Pathology is accompanied by the outflow of amniotic fluid with bleeding. An emergency delivery is required. At the birth of a baby with moderate or severe anemia and hypoxia, blood products are transfused immediately after birth.

How is the pregnancy

With marginal attachment, the gestation period and subsequent delivery are most often not accompanied by the development of any complications. With the shell variant during pregnancy occurs intrauterine hypoxia followed by growth retardation. The risk of preterm birth increases.

With sheath fixation of the umbilical cord, damage to the arteries and veins sometimes occurs during gestation. This is accompanied by bleeding from the genital tract in the expectant mother and such manifestations as oxygen deficiency in the baby, heart palpitations followed by a slowdown, muffled heart tones, meconium discharge during cephalic presentation.

Seek immediate medical attention if symptoms occur medical care in order to avoid the development of complications from the mother and fetus.

Features of childbirth with sheath attachment of the umbilical cord

Such an anomaly of the cord discharge is accompanied by a high risk of damage to the umbilical vessels, followed by fetal bleeding and rapid death of the child. To prevent their rupture and death of the crumbs, timely recognition of the pathological variant of the “cord” exit is necessary.

Natural childbirth requires good specialist skills, constant monitoring of the baby's condition due to the high risk of death of the mother and baby. Childbirth should be quick, careful. Sometimes the doctor can feel the pulsating arteries. The doctor opens the fetal bladder in such a place that it is distant from the vascular zone.

If there is a rupture of the membranes with vessels, a turn on the leg and extraction of the fetus are applied. When the head is in the cavity or exit of the pelvis, the imposition of obstetric forceps is used. These benefits can only be applied when the child is alive. To avoid adverse consequences, experts choose surgery - caesarean section.

Can this feature be removed?

In many forums, expectant mothers ask themselves the question: how to get rid of the pathological discharge of the umbilical cord. During gestation, it is impossible to eliminate the anomaly: it is not treated either medically or surgically. There are no exercises to correct the abnormal attachment of the cord between mother and baby. The main goal of the specialist is to prevent the rupture of the membranes and the subsequent death of the baby at birth.

Conclusion

In some women, the period of bearing the crumbs is overshadowed by various pathologies of the placenta or umbilical cord. Many of them do not affect the course of pregnancy and childbirth, but in rare cases there is a real threat to the health and life of the mother and child. We are talking about abnormal fixation of the umbilical cord.

Passing planned ultrasound examinations, the doctor can detect pathology, and based on the data, choose the appropriate delivery. Do not panic, trust a specialist: he will help you carry and give birth to a healthy baby.