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1、Abnormal Umbilical Cord Liquor Volume Abnormality Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy,Women Hospital , School of Medical, ZheJiang University Wang Zheng Ping,Abnormal Umbilical Cord,Abnormal cord length Cord entanglement Knot of cord Torsion of co
2、rd Abnormal cord insertion Cord presentation and cord prolapse Single umbilical artery,Abnormal cord length,Normal cord length is 30-70cm, averagely 55cm Short cord: 80cm is defined as long cord, higher occurrence of cord around neck, cord around body, cord knot, cord prolapse and cord compression,A
3、bnormal cord insertion,Marginal cord insertion into placenta, known as racket placenta Cord insertion onto membrane, runs between chorionic membrane and amniotic membrane before inserting into placenta, known as velamentous cord insertion Blood vessels on membrane passing internal cervical os anteri
4、or to fetal presenting part, known as vasa previa Velamentous cord insertion, commonly seen with single umbilical artery In vasa previa rupture, blood loss of 200-300ml can lead to fetal demise,velamentous cord insertion,velamentous cord insertion,Cord presentation and Cord prolapse,Cord located ant
5、erior or lateral to fetal presenting part, known as cord presentation, also known as occult cord prolapse At membrane rupture, cord prolapse out of cervical os, descending into vagina, known as cord prolapse Cord prolapse is life-threatening to the fetus,Cord presentation,Cord prolapse,Knot of cord,
6、Cord entanglement,Cord entanglement,Abnormal Liquor Volume,Polyhydramnios Oligohydramnios,Polyhydramnios,Defined as amniotic fluid volume more than 2000ml at any period of gestation Incidence 0.5% - 1.6% If amniotic fluid volume increase progressively over months, the symptoms are usually milder, kn
7、own as chronic polyhydramnios If amniotic fluid volume increase rapidly over days, can causse severe compression symptoms, known as acute polyhydramnios Fetal structural deformity: ( neural tube defect, NTD),Ultrasound examination,Amniotic fluid index, AFI 18cm or AFI 20cm Depth of largest amniotic
8、fluid pool (amniotic fluid volume, AFV) = 7cm AFV 8-11cm, as mild polyhydramnios AFV 12-15cm, as moderate polyhydramnios AFV = 16cm, as severe polyhydramnios,Oligohydramnios,Third trimester amniotic fluid volume less than 300ml is known as oligohydramnios Incidence 0.5% - 5.5% Fetal structural defor
9、mity,Ultrasound examination,AFV = 2cm AFI 5cm 5cm AFI 8cm, known as suspicious oligohydramnios,Preterm labour,Preterm labour,Defined as delivery after gestation 28 completed weeks till 37 weeks (196-258 days). Birth weight 1000g - 2449g Preterm labour makes up 5% - 15% of total number of delivery Ca
10、n the lower limit of preterm labour be brought earlier to 20 weeks gestation?,Diagnosis of preterm labour,Labour occurring between gestation 28 completed weeks and 37 weeks regular uterine contraction: 4 times in 20 minutes or 8 times in 60 minutes cervical shortening of 75% progressive cervical dil
11、atation of 2cm and above,Prediction of preterm labour,Ultrasound assessing cervical length and internal os funnel formation, when internal os funnel is longer than the total cervical length by 25%, or total cervical length 50ng/ml, indicates possibility of preterm labour. Its sensitivity is up to 93
12、%, specificity 82%,Premature rupture of membrane,Premature rupture of membrane,Membrane rupture occurring before labour, known as premature rupture of membrane (PROM) Occurring after 37 completed weeks gestation, is called premature rupture of membrane at term Occurring before 37 weeks gestation, ca
13、lled preterm premature rupture of membrane (PPROM),Effect to mother and fetus,Feto-maternal infection Placenta abruptio Premature infant: 30% - 40% of premature labour is associated with premature rupture of membrane Cord prolapse, cord compression Poor fetal lung development and fetal compression s
14、yndrome,Post-term pregnancy,Prolonged pregnancy,Prolonged pregnancy,Gestation at or beyond 42 weeks gestation (=294 days), known as post-term pregnancy Important factor for fetal distress, meconium aspiration syndrome, maturation disturbance syndrome, newborn asphysia, perinatal death, macrosomia an
15、d dystocia,Diagnosis,Determine gestational age Calculation based on last menstrual period Calculation based on ovulation Ultrasound examination to ascertain gestation age Period of manifestation of early pregnancy symptoms, quickening First trimester pelvic examination assessing uterine size,Diagnos
16、is,Assess placental function Fetal movement count Fetal electronic monitoring Fetal biophysical profile (Ultrasound) Urine E/C 10 or 24 hours urine E3 10mg amnioscopy,Management,Prevent post-term labour, effectively manage at term Decide appropriate mode of delivery based on integrated analysis of placental function, estimated fetal weight, cervical effacement, etc Induced labour Caesarean section Neonatal resuscitation,
