Introduction:
Rupture of umbilical vessels is a rare condition that can result in major loss of blood by the fetus within a short period of time. This in turn can lead to hypoxia (decreased oxygen to the cells), and ischemia (decreased blood supply to the tissue). The rupture of the umbilical cord can be either partial or complete which can occur due to any twist, infection, increased pressure, injury, or short length of the chord. These all can lead to stillbirths, fetal distress, and damage to the brain.
What Is an Umbilical Cord?
The umbilical cord is a coiled, pipe-like (cylindrical) structure, which is fully developed by the 12th week of pregnancy, and it acts as a bridge between the placenta and the fetus carrying the blood from the fetus to the placenta and vice versa. It is only visible during the ultrasound taken during the periodic check-ups of pregnant women.
Morphology of Umbilical Cord:
The umbilical cord is about 50 to 60 cm (19.69 to 23.62 inches in length on average. Lengthy cords cause prolapse (where the umbilical cord exists out of the vagina), twisting the cord around the neck of the fetus - this causes fetal distress and leads to death. Too short cords may cause early placental separation, restricted growth of the fetus, fetal abnormalities, and ultimately death.
The diameter of the umbilical cord is usually 3 mm (millimeters) during the 10th week of pregnancy and gradually increases in size up to 33 mm in the 34th week of pregnancy.
For every 5 cm (1.97 inch) of cord length, there is one coil, the coil is also called a spiral. There are 40 such spirals throughout the length of the umbilical cord.
Umbilical Cord Blood Vessels:
The umbilical cord consists of two arteries called umbilical arteries and one vein known as the umbilical vein, Wharton’s jelly (the mucous connective tissue that surrounds the blood vessels and acts as a cushion). All three are surrounded by amnion. Umbilical veins carry the oxygenated blood from the placenta to the fetal heart and the
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Umbilical Arteries: Return the deoxygenated blood from the fetus's heart to the placenta. In some conditions, umbilical cord arteries are completely absent (agenesis), part of the artery is missing (atresia), or abnormally developed (aplasia). These anomalies usually are seen with the left umbilical artery, in such instances single umbilical artery carries out the function leading to restricted growth of the fetus in the uterus.
Hyrtl Anastomosis: Before the arteries enter into the placenta a long stunt (a tiny tube that keeps the arteries open) connects the umbilical arteries to the placenta this is called Hyrtl anastomosis. The main cause of this Hyrtl anastomosis is to balance the blood pressure in the umbilical arteries before entering into the placenta. This is regarded as a safety valve in conditions of blockage and constriction of placental arteries.
Two umbilical arteries in the cord form a helical structure around the veins, but in some cases, veins form a twist or helix around the straight or uncoiled arteries.
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Umbilical Veins: They carry oxygenated blood from the placenta to the. Pressure in the umbilical vein increases as the gestation period increases. The pressure gradient is because of the fetal heart contractions and fetal breathing rate. During fetal emergencies blood flow through the umbilical vein is checked through pulsations in the vein, this indicates whether the fetus is receiving uninterrupted blood flow through the umbilical cord or not.
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NO (Nitric Oxide) and ANP (Atrial Natriuretic Peptide): These are also present in the umbilical cord blood vessels.
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Umbilical cord blood vessels are delicate to vasoactivators (oxytocin, serotonin, angiotensin-2).
What Are the Risk Factors for Rupture?
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Twist or torsion of the umbilical cord.
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Any infections to the cord.
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Trauma or injury to the cord.
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A short length of the cord.
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Weakening and too much pressure on the cord can also cause rupture of the cord.
Rupture mostly occurs at the fetal end of the cord, in very cases, it occurs at the placental end.
What Are the Symptoms of Rupture of Umbilical Cord?
Symptoms include:
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Excessive bleeding during childbirth.
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Rupture reduces the amount of blood flow to the baby.
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Decreased blood flow causes fetal distress.
What Are the Complications of Umbilical Cord Rupture?
Umbilical cord rupture can be partial (incomplete), or complete:
The umbilical cord is the blood connection between the mother and the fetus, placenta is a round-shaped, copper-colored structure that connects the mother and the baby in the uterus through the umbilical cord. The function of the placenta is to supply both oxygen and food to the developing fetus and carry back the waste materials from the fetus through the umbilical cord. Umbilical cord rupture generally occurs during childbirth (parturition), and in very rare instances it can occur in the gestation period. There are no routine tests to diagnose umbilical cord rupture. Some complications include:
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Stillbirths: Babies die before or during the delivery.
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Fetal Distress: Because of the rupture baby in the uterus faces limited oxygen supply, decreased heart rate, and restricted movements, on the whole, it is a non-reassuring condition for the baby.
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Cerebral Palsy of the Newborn: It is a condition where the brain gets damaged due to improper blood supply.
How to Manage the Umbilical Cord Rupture?
Umbilical cord rupture can not be prevented, but it is a mortal condition and should be treated in an emergency.
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Delivering the child should be done with no delay because the main aim is to save the baby from the possible complications of rupture.
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In case of delay, it causes serious health complications in the unborn baby, and it may lead to the death of the unborn also.
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Though it cannot be prevented, regular periodic check-ups should be advised to pregnant women to assess the status of blood flow to the fetus.
Conclusion:
The umbilical cord consists of two arteries, and one vein, embedded in the Wharton’s jelly and they are surrounded by amnion. Umbilical cord rupture is an emergency condition that needs immediate medical attention. Delay in the treatment leads to complications for both mother and the child. Successful delivery of the baby indicates a good treatment outcome.
