-
Journal of Neurology, Neurosurgery, and... Nov 1994Two cases of anterior spinal hernia are presented. The medical literature is reviewed, the syndrome characterised, and its cause and treatment discussed. The patient is... (Review)
Review
Two cases of anterior spinal hernia are presented. The medical literature is reviewed, the syndrome characterised, and its cause and treatment discussed. The patient is typically middle aged with a history of stepwise slowly progressive mid-thoracic anterior hemicord syndrome manifesting as hemianalgesia below the affected segment, followed by contralateral lower limb spasticity that develops into an asymmetric paraparesis with sparing of dorsal column sensation. Radiological investigation demonstrates an enlarged dorsal arachnoid space in association with an apparently focally narrowed thoracic cord, kinked towards the anterior dura. At operation the cord is found to be prolapsed into an anterolateral dural diverticulum. The most likely cause of this syndrome is anterior spinal artery segmental branch ischaemia, in a cord chronically incarcerated in a congenital anterior meningocele. This readily treatable condition should be considered in all cases of thoracic cord dysfunction and surgical repair effected early to prevent stepwise progression to paraplegia.
Topics: Adult; Female; Hernia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paraplegia; Spinal Cord Diseases; Syndrome
PubMed: 7964829
DOI: 10.1136/jnnp.57.11.1433 -
Cureus Oct 2022Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord...
Umbilical cord prolapse with ruptured membranes is an obstetric emergency with management consisting of delivery via emergent cesarean delivery. If the umbilical cord prolapses beyond the internal os with intact membranes, there is an opportunity to intervene and reduce the risk of fetal morbidity and mortality. A healthy 30-year-old, gravida 1 para 0 was incidentally found to have a short cervical length at 25 weeks five days on routine anatomy ultrasound evaluation. On evaluation via ultrasound by the maternal-fetal medicine service, the umbilical cord was noted to be prolapsing through the cervix with membranes intact. The cord prolapse with intact membranes resolved after placing the patient in the Trendelenburg position and nifedipine was administered for tocolysis given the uterus was noted to be contracting. For the remainder of the pregnancy, the patient underwent close follow-up and serial ultrasound scans with confirmation of the fetal head as the presenting part. The patient ultimately delivered vaginally at term. Cord prolapse with intact membranes, when identified via ultrasound, can be managed conservatively via Trendelenburg positioning and tocolysis to avoid premature cesarean delivery.
PubMed: 36348877
DOI: 10.7759/cureus.29870 -
The Australian & New Zealand Journal of... Oct 2002
Topics: Abdominal Pain; Adult; Diagnosis, Differential; Female; Humans; Laparotomy; Pregnancy; Pregnancy Trimester, Second; Prolapse; Rupture, Spontaneous; Surgical Wound Dehiscence; Umbilical Cord; Urethra; Urinary Bladder Diseases; Uterine Rupture
PubMed: 12403295
DOI: 10.1111/j.0004-8666.2002.409_5.x -
BMJ Case Reports May 2021
Topics: Female; Humans; Labor Presentation; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prolapse; Umbilical Cord
PubMed: 33947682
DOI: 10.1136/bcr-2021-243320 -
Journal de Gynecologie, Obstetrique Et... 1996Identify the role of cord prolapse in modern obstetrics by estimating the frequency of this obstetrical accident, its conditions, prognosis and treatment and by... (Review)
Review
OBJECTIVES
Identify the role of cord prolapse in modern obstetrics by estimating the frequency of this obstetrical accident, its conditions, prognosis and treatment and by analyzing factors favoring development of cord prolapse.
METHOD
From a retrospective study of 50 observations of cord prolapse occurring in the department of obstetrics from January 1985 to June 1994. Results were compared with those reported in the literature.
RESULTS
The frequency of cord prolapse was 0.21% over the 10-year period. Cesarean section was required in 72% of the cases, and obstetrical manoeuvers were used in some of the vaginal deliveries (28%). Neonatal mortality was 20/1000. Predisposing factors were breech presentation, prematurity, twin pregnancy and multiparity.
CONCLUSION
Despite much progress in obstetrics, the frequency of cord prolapse has not changed over time. The consequences are not as lethal as in the past, because of progress in diagnosis and neonatal resuscitation. Fetal prognosis remains however severe.
Topics: Adult; Causality; Female; Humans; Incidence; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prognosis; Prolapse; Retrospective Studies; Umbilical Cord
PubMed: 9026515
DOI: No ID Found -
Journal of Obstetrics and Gynaecology... Sep 2018
Topics: Adult; Female; Fetal Membranes, Premature Rupture; Humans; Pregnancy; Prolapse; Ultrasonography, Doppler, Color; Umbilical Cord
PubMed: 29066017
DOI: 10.1016/j.jogc.2017.05.026 -
BMC Pregnancy and Childbirth Mar 2022The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord...
BACKGROUND
The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications.
METHODS
This case-control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications.
RESULTS
There were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001).
CONCLUSION
Hypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery.
Topics: Adult; Birth Injuries; Case-Control Studies; Cerebral Palsy; Female; Heart Rate, Fetal; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Newborn, Diseases; Male; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Prolapse; Umbilical Cord
PubMed: 35241026
DOI: 10.1186/s12884-022-04508-2 -
Nursing Jul 2015
Topics: Adult; Apgar Score; Documentation; Emergency Nursing; Female; Humans; Obstetric Labor Complications; Obstetric Nursing; Patient Care Team; Pregnancy; Prolapse; Risk Factors; Simulation Training; Terminology as Topic; Time-to-Treatment; Umbilical Cord
PubMed: 26083296
DOI: 10.1097/01.NURSE.0000466449.65548.4a -
The Journal of Maternal-fetal &... 2016To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).
OBJECTIVES
To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).
METHODS
A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan.
RESULTS
A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048).
CONCLUSION
An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.
Topics: Adult; Female; Humans; Infant, Newborn; Japan; Perinatal Death; Pregnancy; Prolapse; Risk Factors; Surveys and Questionnaires; Umbilical Cord
PubMed: 26135792
DOI: 10.3109/14767058.2015.1058772 -
BMJ Open Jun 2021This study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of...
OBJECTIVE
This study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.
DESIGN
Retrospective cohort study.
SETTING
Single institution.
PARTICIPANTS
This study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.
RESULTS
The rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).
CONCLUSIONS
Abnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin's umbilical cord insertion using ultrasonography would be beneficial.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Prolapse; Retrospective Studies; Twins; Umbilical Cord
PubMed: 34135046
DOI: 10.1136/bmjopen-2020-046616