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Endoscopic determination of umbilical cord complications in labor

Endoscopic determination of umbilical cord complications in labor

Journal of Perinatal Medicine 9(1): 48-53

Umbilical cord complications are the most frequent cause of perinatal morbidity and mortality. When the umbilical pathology is diagnosed in time, the prognosis for the fetus is better. Women [60] with premature rupture of membranes were examined in labor with the help of an endoscope inserted into the amniotic cavity. The indications for the endoscopic examinations were suspicious of umbilical cord pathology after cardiotocography. Results obtained in 2 groups with umbilical cord pathology were compared as follows: group I, examined endoscopically in labor; group II (60 cases), without endoscopic examination. For detection of possible looping of umbilical cord around the fetal neck, the distal end of fibroscope should be inserted as deep as 20-25 cm. In cases of a single loop around the neck (23 cases - 38.3%) a blue-white cord-like structure with dark-blue vessels under its surface was visualized. The presence of 2 or more loops around the fetal neck or body and extremities were diagnosed. The determination of true and false knots of the umbilical cord during labor is a more complicated task because it is not always possible to follow the full length of the cord. In 95% of the cases the endoscope results coincided with results after the birth. In 5% the results were false negative. When the pathology of the umbilical cord was diagnosed in time, the obstetric tactic was changed. The number of cesarean sections in group I was 11.7%, 5% in group II; forceps deliveries were in 26.7% in group I vs. 15% in II; deliveries by vacuum-extraction were in 3.3% vs. 9% in group II. The number of intranatal deaths was higher in group II [6 cases]. The number of neonates born with severe asphyxia was also higher in group III [4 cases]. In recent years great progress was obtained in the diagnosis of umbilical cord pathology with the use of ECG, FCG [phonocardiography] and cardiotocography. The number of false results was 20-40%. The use of endoscopic examination reduces the number of diagnostic mistakes. Endoscopic examination can determine the type of umbilical cord pathology which helps in choosing the proper obstetric tactic for the benefit of the fetus.

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Accession: 005359156

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PMID: 7218125

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