The importance of umbilical cord insertion site for the physiological development of pregnancy

Abstract

Introduction. The study of the variability of the umbilical cord insertion site brings a further understanding of the pregnancy`s physiological development, as well as it could help in choosing the best strategy for birth-giving. It should be highlighted that annually 4000 deaths of newborns worldwide are caused by the umbilical cord pathology. Additionally, the pathology of the umbilical cord is present in 30% of pregnancies carried out until the term. Therefore, knowing the insertion of the umbilical cord in the placenta could help the obstetricians in having an individual approach to the pregnancy and the actual birth, in order to prevent complications and abnormalities. Aim of the study. This study is centered on the correlation between the type of umbilical cord insertion in the placenta and the physiological development of the pregnancy, but also on the obstetrical importance of the obtained results. Materials and methods. The data of this study were collected from the medical records of 4010 women aged between 15 and 46 that gave birth at the Public Health Institution ”Institute of Mother and Child” in 2014. According to the results, the subjects were divided into 4 groups, by the type of the insertion of the umbilical cord: 1st group - normal insertion, central and eccentric (n = 3995), 2nd group - velamentous insertion (n = 11), 3rd group - marginal insertion (n = 5) and 4th group - furcate insertion (n = 0). The experimental protocol included the abnormalities presented by the fetus and the occurred complications during pregnancy/birthgiving, correlated with the types of umbilical cord insertion. Results. Central and eccentric types of umbilical cord insertion represent 99.6% and are not correlated with any pathologies of the pregnancy, birth-giving process, or fetus. On the other hand, the velamentous insertion represents 0.27% and the marginal insertion - 0.12%. Both of them are associated with massive blood loss at birth, hemorrhagic complications in the antenatal period, miscarriage, hypotonia and cyanosis in the newborn, difficulties in approaching the birth and sudden intrauterine death of the newborn caused by hypoxia. Furcate insertion of the umbilical cord was not found, because it has the lowest incidence, as other studies have shown. Conclusion. Even if the incidence of the pathological types of the umbilical cord insertion is low, the associated abnormalities are severe and must be taken into consideration. Thus, punctilious and continuous monitoring of the development of the pregnancy, including the analysis of the insertion type could help the obstetricians in providing professional medical assistance. It should be said that the formation of the umbilical cord is finished at 7 weeks of pregnancy. So, by using an ultrasonographic examination in the 1st trimester, between 12 and 15 weeks, it is possible to determine the insertion type of the umbilical cord. To sum up, all the necessary precautions can be taken in time and pregnancy/birth-giving can occur physiologically, with no harm to the mother and fetus.