Umbilical cord - Saitaikenraku (English spelling) Nuchal cord

Japanese: 臍帯巻絡 - さいたいけんらく（英語表記）Nuchal cord

What is the disease?

Umbilical cord entanglement is a condition in which the umbilical cord is wrapped around a part of the fetus's body, and occurs in 20-25% of all births. Most cases involve the neck, but it can also occur around the limbs or trunk. Most cases involve the umbilical cord being wrapped around a part of the fetus's body, but it can also occur around the limbs or trunk. Most cases involve the umbilical cord being wrapped around a part of the fetus's body, but it can also occur around the limbs or trunk.

The umbilical cord is an important lifeline for the fetus, providing oxygen and nutrients from the mother via the placenta. If there is an abnormality in the umbilical cord, the fetus will suffer from hypoxia. Asphyxiation ( snack ) The umbilical cord may become swollen and may even die. Ptosis ( Kasui ) There are various types, but umbilical cord entanglement is by far the most common problem compared to other umbilical cord abnormalities.

What is the cause?

It is said that active fetal movement and a long umbilical cord are the triggers, but the exact reasons are unknown. It is speculated that fetal movement is the cause, as fetuses that move a lot tend to have a twisted umbilical cord.

Also, fetuses with a twisted umbilical cord generally have a longer umbilical cord than those without, but it is not yet clear whether this is the cause or effect. Most people believe that it is the result of the cord being stretched by being pulled.

Testing and diagnosis

Ultrasound tomography is an effective method for prenatal diagnosis. It can diagnose the presence or absence of umbilical cord twisting with a high degree of accuracy, but ultrasound color Doppler and power Doppler methods can diagnose with nearly 100% accuracy and can also estimate the number of twists. The presence or absence of tight twisting that could cause blood flow disorders can be predicted by confirming the presence of umbilical vein pulses using the pulse Doppler method.

Treatment methods

Even if a twisted umbilical cord is diagnosed by ultrasound before birth, there is no way to untangle it before birth. Transient bradycardia ( First-year students ) If abnormal heart rate patterns such as these appear and fetal distress is diagnosed, rapid delivery is recommended.

During childbirth, when the fetal head is delivered Neck entanglement ( Keibu Kenraku ) If this is determined, in many cases it is possible to deliver the torso as is, or to deliver the torso by removing the umbilical cord towards the head or torso; however, if the umbilical cord is wrapped too tightly, it may be difficult to deliver the torso or the face may become congested, so the umbilical cord should be cut as soon as possible.

What to do if you notice an illness

If you are diagnosed with a twisted umbilical cord during pregnancy, you will be examined by a specialist doctor. Ultrasound will be used to assess the fetal development and position, and a non-stress test (NST) will be used to assess the fetal heart rate pattern, and the plan for delivery will be determined.

Akihiko Kikuchi

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　臍帯巻絡とは、臍帯が胎児の体の一部に巻きついている状態のことで、全分娩例の20～25％にみられます。頸部の巻絡がほとんどを占めますが、四肢、体幹に起こすこともあります。巻絡の回数は1回のことが多いのですが、2回以上の場合もあります。

　臍帯は、胎児にとって胎盤を介して母体から酸素や栄養をもらうための大切な命綱です。臍帯に異常が起これば、胎児は低酸素によって仮死(かし)状態となり、時には死亡することもあります。臍帯の異常には卵膜付着や臍帯下垂(かすい)などさまざまなものがありますが、臍帯巻絡はほかの臍帯異常に比べて圧倒的に頻度の高いトラブルです。

原因は何か

　活発な胎動や長い臍帯が誘因になるといわれていますが、はっきりとはわかっていません。胎動が原因であることは、胎動の激しい胎児に臍帯巻絡が多い傾向があることからも推測されます。

　また、臍帯巻絡がある胎児の臍帯は、ない場合よりも一般的に長いのですが、それが原因なのか結果なのかはまだわかっていません。引っ張られて伸びた結果であるとする意見が多いようです。

検査と診断

　出生前の診断法としては、超音波断層法が有効です。これによって臍帯巻絡の有無はかなり確実に診断できますが、超音波カラードプラー法やパワードプラー法なら100％近く診断ができ、巻絡の回数も推測できます。血流障害を引き起こすようなきつい巻絡の有無は、パルスドプラー法で臍帯静脈波動の存在を確認することにより推測できます。