The prolapse of the funiculus

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Philippe Gloaguen
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Umbilical cord prolapse

We are in labor childbirth, everything is going well, at a certain point the midwife who is visiting you internally notices something strange: instead of being able to hear your baby's head, the umbilical cord.



UMBILICAL CORD PROLAPSE, CAUSES - This is the cord prolapse, and it is an emergency / urgency in the obstetric field. It is a rather rare occurrence, around 0,3-0,6% of cases, but if it happens there is no time to waste. What are the factors that predispose to this situation? The real motivation is not known but situations that prevent the normal birth position should be considered as "at risk", when the baby's head takes up as much space as possible during labor. 



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Some examples of cases can be: the presence of aexcessive amount of amniotic fluid, un premature baby o gemelli, when the waters break very early during labor or when the placenta is defined "previa", ie when its volume occupies the uterine cervix making vaginal birth impossible.



  • The question arises: if the waters break, do I have to run to the hospital to prevent this from happening?
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The answer is no, obviously there breaking of the waters indicates that you must go to the hospital but there is no need to rush urgently. The only case is that you feel a kind of weight coming out. However, do not go to the hospital but call 118, they will know how to intervene or how to reassure you.

  • How can you tell if it's happening right during my labor?

When you arrive at the hospital for the labor a suspicion may come to the midwife if while checking the baby's heartbeat he notices that it slows down more than it should. This happens because during the contraction the baby inside the uterus is normally compressed, every part, especially the one closest to the cervix that is dilating, is squeezed. As long as the amniotic fluid protects the baby or its position is such as to cover the entire cervix with the head, as I said before, then there are no problems. However, if the umbilical cord occupies this position then it will be compressed instead of the head.

How do you know the umbilical cord it is the means through which blood, oxygen and nutrients pass from mother to baby, so you can understand that if it is crushed this transport is interrupted and as a first reaction the baby's heart rate decreases. Unfortunately, excessive and continuous drops in heartbeat cause brain damage to the child.

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  • If this happens, what does the midwife do and what can the mother do to avoid damage?

The purpose of any intervention that is done at this time is to protect the health of the child. The first attempt if the labor is not very advanced, is to move the umbilical cord so that the baby's head can proceed without crushing it.

It is a maneuver that is done during the internal visit, it could also be slightly annoying for the mother. In this case, I ask you to listen very carefully and follow the advice given by the midwife who is next to you in labor. Most likely he will ask you to first turn on your left side, this so that the weight of the belly does not crush the vena cava and helps the circulation, yours and consequently that of the baby.

If, on the other hand, labor is already very advanced and therefore it is not possible to move the umbilical cord, it is absolutely necessary that the birth take place in a few minutes, so they will set up an operating room for a emergency cesarean. I know that the word "emergency" is scary, unfortunately in this case it really is, the life of the child is at risk, so any procedure is legitimate.

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In this case, be patient if the midwife or doctor does not immediately answer your questions clearly, keep them for the period after the baby is born, at that moment they are focused on the result.

I imagine that every woman wants her birth to be as similar as possible to what she imagined, serene, calm, peaceful. The vast majority of cases this is how it happens. However, we cannot ignore the emergencies, that unfortunately happen and that disturb what we have imagined for months. At this point, however, it is necessary focus attention on the child's health and abandon your dreams and desires. As I always say, keep in mind what is the greatest joy for you, your child, and do everything to make it be born well without risk, I think that for this joy even the childbirth so dreamed of can be put aside.

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