Can Abnormalities in the Umbilical Cord Increase the Risk of Premature Labor?

The insertion of the membranous umbilical cord is associated with an increase in the frequency of a single umbilical artery, fetal growth problems,

premature births

, and also with heart rate abnormalities during delivery, which causes an increase in the frequency of delivery with forceps or with a suction cup, but not of cesarean section. Late umbilical cord clamping does not increase the risk of postpartum hemorrhage. As for maternal outcomes, the delay in clamping the umbilical cord does not increase the risk of postpartum hemorrhage or the need for a blood transfusion. In addition, maternal hemoglobin levels after delivery are not affected by the delay compared to immediate clamping of the umbilical cord.Pregnancies with a short umbilical cord showed a higher risk of non-cephalic presentation, both in full-term and in preterm births.

The short umbilical cord was also associated with a higher risk of delivery by emergency caesarean section and for any cause (table, in stratified analyses in both full-term and premature births). Pregnancies with a short umbilical cord also entailed a higher risk of placental complications, such as placenta praevia, detachment of the placenta, and the need to remove it manually after birth (table). The associated risk of placental abruption (Table) was particularly observed in full-term births (OR: 1.98 (95% CI: 1.72 to 2.7), but it was also significant in preterm births (OR: 1.35), (95% CI: 1.12-1.6). We saw a reduction in the risk of PPROM and

premature birth

when the cord was short.This was also the case with spontaneous preterm births (data not shown).

Pathological analysis of umbilical cord ulceration associated with fetal duodenal and jejunal atresia. There was no associated significant increase in the risk of perinatal death in 41-week births in which umbilical cord knots and entanglement were combined.This review defined late umbilical cord clamping as a delay of more than 30 seconds, with a maximum of 180 seconds, and included some studies in which umbilical cord milking was also used in addition to late umbilical cord clamping. However, the authors concluded that, given the benefit of delaying umbilical cord clamping in full-term infants, delaying umbilical cord clamping is generally beneficial, provided that the obstetrician, gynecologist, or other obstetric care provider has the capacity to control and treat jaundice.If the umbilical cord was long or short in the first pregnancy, the risk of recurrence of the long or short cord in the next was more than double (OR 2.53 (95% CI: 2.42—2.6) and OR 2.39 (95% CI: 2.29—2.4, respectively). Two studies suggest a small but statistically significant decrease in umbilical artery pH (decrease of approximately 0.03 if umbilical cord clamping is delayed) 23 24.Delay in umbilical cord clamping should not interfere with the active management of the third stage of labor, including the use of uterotonic agents after delivery to minimize maternal bleeding.There was a lower incidence of intraventricular hemorrhage (ultrasonographic diagnosis, all grades) (10 trials, 539 infants; RR, 0.59; 95% CI, 0.41-0.8), as well as of necrotizing enterocolitis (five trials, 241 infants; RR, 0.62; 95% CI, 0.43—0.90) compared to immediate umbilical cord clamping.

In preterm infants, the rates of intraventricular hemorrhage and necrotizing enterocolitis are lower, and fewer newborns require transfusions when late umbilical cord clamping is used.In cases of placental abruption, oligohydramnios, or presentation of buttocks, consideration may be given to measuring and documenting the length of the cord after birth, since an abnormal cord length indicates a long-term fetal condition. Late clamping of the umbilical cord is a simple process that allows for placental transfusion of warm, oxygenated blood to flow passively to the newborn. The Apgar timer can be useful to monitor the elapsed time and facilitate an interval of at least 30 to 60 seconds between birth and when the umbilical cord is pinched.The fact that a short cord entailed a higher risk of placental complications and a long cord was associated with a reduced risk of these complications (Tables 3) suggests that development of a short cord and abnormal placentation are related. Increased parity, maternal height and body mass index and diabetes were associated with a higher risk of having a long umbilical cord.

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