What is the purpose of the umbilical cord? Some ultrasound data show images of a baby in the belly playing with the umbilical cord. The image of a cute baby diving in the darkness of the womb while playing with her first toy, the umbilical cord, is really touching. The umbilical cord is a tubular structure and a bridge between the fetus and the mother, and is also a bridge to the life of the fetus. The umbilical cord itself has no blood vessels and is wrapped around two arteries and a vein. The normal umbilical cord is 1~1.5cm in diameter and is about 50cm in length at full-term pregnancy, similar to the full-term length of the fetus, and often twisted in a spiral pattern. Through the umbilical cord, the fetus receives oxygen and various nutrients it needs, and excretes metabolic waste. Changes in the length, thickness, arteries and veins of the umbilical cord can cause fetal malformation and death. The obstruction of blood flow in the umbilical artery and vein can lead to intrauterine distress, neonatal asphyxia, low Apgar score, aspiration pneumonia, perinatal intracranial hemorrhage, etc. The mortality rate is extremely high, and it can also lead to chronic intrauterine hypoxia and fetal growth retardation. Presentation of umbilical cord and umbilical cord prolapse When the fetal membranes are not broken, the umbilical cord is located in front or on one side of the fetal previa, which is called presentation of umbilical cord or occult cord prolapse. When the umbilical cord comes out of the cervical opening after the rupture of the membranes and is exposed in the vagina or in the vulva, it is called prolapse of umbilical cord, with an incidence of 0.4% to 10%. In what cases does prolapse of the umbilical cord occur? Prolapse of umbilical cord mostly occurs when the fetal previa is not articulated: 1) abnormal fetal position, including foot previa, breech previa, shoulder previa, occipital posterior position, etc.; 2) abnormal pelvis and fetus, such as pelvic stenosis, difficult entry of fetal head into the pelvis, high floating fetal head, small fetus, etc.; 3) excessive amniotic fluid; 4) excessive length of umbilical cord; 5) abnormal attachment of umbilical cord and low lying placenta, etc. When to consider cord prolapse! If the fetal membranes are not broken and the fetal heart rate suddenly slows down after fetal movement or contraction, and then quickly recovers after changing the position, pushing up the fetal first dew and elevating the buttocks, or if the fetal membranes are broken and the fetal heart rate is abnormal and the baseline fetal heart rate decelerates and flattens during fetal heart monitoring, the possibility of umbilical cord prolapse should be considered, and a vaginal examination can be performed immediately to find out whether there is cord prolapse and whether there is pulsation of the umbilical cord vessels. The diagnosis can be confirmed if the umbilical cord is palpated next to or in front of the fetal previa and in the vagina, or if the umbilical cord is prolapsed in the vulva; ultrasound and color ultrasound can help in the diagnosis. Once the cord is found to be prolapsed, the fetus should be delivered as soon as possible if the fetal heart is normal and the fetus is alive. If the uterus is fully opened and the fetal previa is +2, forceps should be performed; if the breech previa is present, breech traction should be performed. If the opening of the uterus is not complete, the mother should immediately take the head-low-hip-high position, push up the fetal previa and apply contraction-inhibiting drugs to relieve or reduce the pressure on the umbilical cord; while closely monitoring the fetal heart, perform a cesarean section as soon as possible. For the case of umbilical cord prolapse in the news, the obstetrics department where I work also encountered a case a few months ago, the same is a pregnant woman with premature rupture of membranes in the delivery room to receive contractions to induce labor, the night shift doctor visiting the delivery room suddenly detected a slowed fetal heartbeat of 100 beats per minute when listening to the fetal heartbeat of the pregnant woman. The night doctor immediately examined the mother and found that the umbilical cord had come out of the vaginal opening during the vaginal examination. Because she was a primigravida, her uterine opening was only 2 cm wide and her heartbeat was normal on auscultation, our obstetrician gave a verbal order: prepare for surgery immediately! The obstetrician’s hand was always inside the woman’s vagina protecting the umbilical cord until the newborn was delivered smoothly and the newborn cried loudly before the obstetrician took his hand out of the woman’s vagina! If the umbilical cord prolapse occurs, timely detection and effective treatment can ensure the smooth delivery of the newborn and avoid neonatal complications. Prevention is more important than cure: in late pregnancy and after delivery, ultrasound examination should pay attention to the presence or absence of umbilical cord pre-disclosure. For those who have too much amniotic fluid or whose fetal previa does not enter the pelvis after delivery, do not perform anal or vaginal examinations as much as possible. If you need to break the membranes manually, you should perform high level rupture of membranes when you are prepared to avoid the umbilical cord from coming out with the amniotic fluid.