The marginal attachment of the umbilical cord to the placenta is a relatively rare occasion for the experiences of the expectant mother. However, such an anomaly in the fixation of the umbilical cord in some cases (especially if complicated by other problems) can cause heavy bleeding during childbirth and fetal death. To reduce the risks, a pregnant woman may be advised to have a Caesarean section.
Pregnancy Watch
The key to successful bearing a child is regular observation in the antenatal clinic. In the necessary time, the doctor will send the pregnant woman for tests and other diagnostic procedures, conduct additional studies if there are indications or if pathology is suspected.
Among the many possible complications of gestation, there are anomalies in the attachment of the umbilical cord to the placenta. In the early stages, such pathologies are not detected, but in the later stages they can affect the management of childbirth or worsen the condition of the child.
Diagnosis of attachment abnormalities is usually done in the second trimester of pregnancy, provided the placenta is located on the anterior or lateral walls of the uterus, although the umbilical cord can be considered at an earlier date. If the placenta is located on the back wall or the woman has a lack of water, then the diagnosis of anomalies in the attachment of the umbilical cord is difficult. The main diagnostic procedure is ultrasound diagnostics. Ultrasound is performed as part of the first and second screenings, in the third trimester of pregnancy, as well as if indicated.
What is pregnancy screening? This is a set of studies that are conducted to identify a group of pregnant women with possible fetal malformations. Screening includes a biochemical blood test and an ultrasound scan. These are fairly proven and reliable diagnostic methods, however, the need for screening still causes a lot of controversy (mainly among expectant mothers themselves).
Attaching the umbilical cord
The umbilical cord, or umbilical cord, is a "cord" of three vessels: two arteries and one vein. Blood enriched in oxygen and nutrients enters the fetus through a vein, and blood that carries carbon dioxide flows through the arteries. After birth, the umbilical cord on the baby’s side is clamped and cut off, and the appendix and umbilical wound remain in its place. The shoot disappears within four to five days, and the wound gradually heals.
How is the umbilical cord attached to the placenta by the mother? In nine out of ten pregnancies, the cord attaches to the middle of the placenta. This is considered the norm. The departure of the umbilical cord from the center of the child's place is considered as a feature of fixation. Attachment anomalies include shell, lateral and marginal attachment of the umbilical cord to the placenta.
Attachment anomalies
Shell attachment is characterized by attachment not to the placental tissue, but to the membrane. Moreover, the vessels in some area are not protected, which creates a risk of damage and bleeding when the shells rupture. In addition to the danger of intense bleeding during childbirth, some doctors argue that such a pathology increases the risk of intrauterine growth retardation.
A similar complication occurs only in 1.1% of singleton pregnancies, and with twins and triplets is more common - in 8.7% of cases. The anomaly can be accompanied by fetal malformations in 6-9% of cases, especially defects in the atrial and interventricular septa of the heart, esophageal arthresis, and congenital uropathies. It happens that in the umbilical cord there is only one artery or there are additional shares of the placenta. Shell attachment is described in trisomy 21 (Down syndrome) in the fetus.
Doctors can suspect dangerous diagnoses at the planned screening of the first and second trimesters, which are carried out respectively at 11-13 weeks, at 18-21 weeks, as well as at the ultrasound of the third trimester (what is the screening during pregnancy described above).
In case of increased risk, a woman is recommended additional methods for diagnosing pathologies: umbilical cord puncture (cordocentesis), fetal electro- and phonocardiography, fetal cardiotocography, dopplerography, biophysical profile, amnioscopy (studying the state of amniotic fluid and fetus), aminocentesis (amniotic fluid puncture) and so on .
Umbilical cord attachment
The umbilical cord can be attached to the placenta laterally, closer to the edge. So, fixation is noted not in the central zone, but in the peripheral. Arteries and veins enter too close to the edge. Typically, such an anomaly does not threaten the normal course of pregnancy and childbirth. Edge attachment is considered a feature of a particular period of gestation.
If the marginal attachment of the umbilical cord to the placenta is diagnosed, what should I do? Gynecologists say that such a pathology does not threaten the development of the fetus and the normal course of pregnancy, and is also not an indication for cesarean section, that is, a natural delivery is performed. The only important feature: when medical personnel try to separate the placenta in the third stage of labor by pulling on the umbilical cord, the umbilical cord can break off, which threatens bleeding and requires manual removal of the placenta from the uterine cavity.
The reasons for this condition
The marginal attachment of the umbilical cord in the placenta occurs as a result of a primary defect in the implantation of the umbilical cord, when it is localized in the area forming the child's place. Among the risk factors are:
- mother's age is under 25;
- excessive physical activity;
- first pregnancy;
- some obstetric factors (polyhydramnios or oligohydramnios, position or presentation of the fetus, weight).
Often abnormal attachment is accompanied by other pathology options - non-spiral arrangement of nodes, true nodes.
Danger of diagnosis
What threatens the regional attachment of the umbilical cord to the placenta? Such an anomaly, in most cases, is not a serious condition. Doctors pay special attention to localization if the umbilical cord is too short or too long, because this creates an additional risk of developing various obstetric complications. In addition, it is important how close to the edge the cord is attached. If too close, then there is a risk of oxygen starvation. Usually, with such a diagnosis, CTG is performed twice a week throughout the pregnancy period in order to determine in time the possible fetal malaise.
How is the pregnancy going?
The marginal attachment of the umbilical cord to the placenta is rarely accompanied by complications. In a small number of cases, there is a risk of fetal hypoxia of the fetus, developmental delay, and premature birth. Shell attachment is much more dangerous. In this case, damage to the vessels of the umbilical cord during pregnancy is possible. This is accompanied by the release of blood from the genital tract of the mother, rapid heart rate of the fetus, followed by a decrease in frequency, muffling of heart sounds and other manifestations of oxygen deficiency in the child.
Features of childbirth
With regional attachment during childbirth, damage to blood vessels is possible, followed by bleeding, which creates a danger to the life of the child. To prevent complications in the delivery process, timely recognition of the umbilical cord exit is necessary. Childbirth should be careful and quick, the fetal bladder should be opened in a place that will be distant from the vascular zone. A doctor can let a woman have a natural birth, but this requires good skills of medical personnel, as well as constant monitoring of the condition of the mother and child.
If during the birth there was a rupture of blood vessels, then the baby is turned on the leg and removed. If the fetal head is already in the cavity or at the exit of the pelvis, then the application of obstetric forceps is applied. These methods can be used if the child is alive.
Often (and especially in the presence of additional medical indications), doctors recommend a woman with marginal attachment of the umbilical cord to the placenta planned cesarean section. The operation avoids the negative consequences that may occur in natural birth.
Feature elimination
Expectant mothers are interested not only in what is the regional attachment of the umbilical cord, but in ways to eliminate this feature, so that there are fewer risks in childbirth. But during pregnancy, it is impossible to eliminate the anomaly. There is no medical or surgical treatment. No physical exercise will correct the incorrect attachment of the cord between the mother and the fetus. The main purpose of observation is to prevent rupture of the membranes of blood vessels and subsequent death of the child during childbirth.
Short conclusion
A certain number of pregnancies are complicated by various pathologies of the umbilical cord or placenta, one of which includes attachment anomalies. Many of these anomalies do not affect the gestation and childbirth in any way, but in some cases there is a serious threat to the health and life of the mother or child. The doctor can detect pathology with a planned ultrasound examination. Based on the data obtained, the most suitable delivery method is selected. Expectant mother needs to try less nervous. It is necessary to trust specialists who will help to endure and have a baby.