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Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier
The umbilical cord extends from the fetus to the placenta and transmits the umbilical blood vessels, two arteries and one vein. The cord is cover with a layer of amnion continuous with that covering the placenta. The average length of the cord is 50 cm.
Cord blood sampling
This may be required when:
The sample should be taken from the fetal surface of the placenta where blood vessels are easily visible.
After the birth of the baby (or during the birth if the cord is tightly round the baby's neck) the cord is clamped.
Early clamping is carried out in the first 1 - 3 minutes immediately after birth, regardless of whether cord pulsation has ceased.
Proponents of late clamping suggest that no action be taken until cord pulsation has ceased or the placenta has been delivered.
The optimal time for umbilical cord clamping remains unknown. Delaying cord clamping for at least 2 minutes in a term neonate can be beneficial. A term baby at birth can be drawn up onto the mother's abdomen but raised no higher. A preterm baby should be kept at the level of the placenta to avoid blood draining from the baby to the placenta, resulting in anaemia; if held below the level of the placenta, the baby in effect receives a transfusion.
The Practising Midwife featured article
2013; 16(2): 23 - 26
Author: Lucy Webbon
American Congress of Obstetricians and Gynecologists (ACOG) (2012). Timing of umbilical cord clamping after birth. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth
Controlled cord traction
See Labour, third stage
Usually occurs as a result of a poorly applied cord ligature. A purse-string suture should always be inserted if umbilical bleeding does not stop after 15 to 20 minutes.
Signs can include localised inflammation and an offensive discharge. Untreated infection can spread to the liver via the umbilical vein and cause hepatitis and septicaemia. Treatment may include:
Cord presentation and prolapse
The umbilical cord lies in front of the presenting part, with the fetal membranes still intact
The cord lies in front of the presenting part and the fetal membranes are ruptured
Occult cord prolapse
The cord lies alongside, but not in front of, the presenting part
Any situation where the presenting part is neither well applied to the lower uterine segment nor well down in the pelvis may make it possible for a loop of cord to slip down in front of the presenting part. Such situations include:
This is diagnosed on vaginal examination when the cord is felt behind intact membranes. It is, however, rarely detected but may be associated with aberrations in fetal heart monitoring such as decelerations, which occur if the cord becomes compressed.
Diagnosis is made when the cord is felt below or beside the presenting part on vaginal examination. A loop of cord may be visible at the vulva.
Whenever there are factors present that predispose to cord prolapse, a vaginal examination should be performed immediately on spontaneous rupture of membranes. Variable decelerations and prolonged decelerations of the fetal heart are associated with cord compression, which may be caused by cord prolapse.
Immediate action and management