# Umbilical Cord --- The **umbilical cord** is the thing that connects the [[placenta]] to the mother's body. ![[Pasted image 20240205182404.png]] During [[prenatal development|fetal]] development, oxygenated blood enters the fetus through the umbilical vein. ![[compressed umbilical cord.png]] other bad things: - nuchal cord - true knots if there's a lot of amniotic fluid there's more room to move around and flip and get caught up in itself. ## Delayed Cord Clamping ✓ Delayed cord clamping refers to the practice of delaying the clamping of the umbilical cord for at least 30-60 seconds after birth or until the cord stops pulsating. This practice has been associated with several benefits for the newborn. ✓ Improved iron status: Delayed cord clamping allows for a greater transfer of iron-rich blood from the placenta to the newborn, which can help to prevent iron deficiency anemia in the first year of life. ✓Better cardiovascular stability: Delayed cord clamping has been associated with higher blood pressure and better circulatory stability in the newborn immediately after birth. ✓ Reduced risk of intraventricular hemorrhage: Delayed cord clamping has been linked to a decreased risk of intraventricular hemorrhage, a serious condition that can occur in premature infants. ✓ Decreased risk of respiratory distress syndrome: Delayed cord clamping has also been associated with a reduced risk of respiratory distress syndrome in premature infants. ✓ Improved neurodevelopmental outcomes: A 2019 systematic review and meta-analysis found that delayed cord clamping was associated with better neurodevelopmental outcomes in infants at 2 years of age. Potential benefits of delayed cord clamping in the newborn include increased blood volume, decreased risk of brain hemorrhages, increased blood pressure, lower risk of necrotizing enterocolitis, decreased anemia, and improved neurodevelopmental outcomes. Delayed cord clamping allows more blood to flow from the placenta to the baby, which can increase the baby's iron stores (Choice E) and reduce the risk of iron deficiency anemia. Current research indicates that cord clamping can be delayed for 30-60 seconds in vigorous newborns as long as the team manages the newborn’s **temperature to keep the infant warm.** Potential adverse effects of delayed cord clamping include an increased risk of polycythemia and jaundice and possible delay in resuscitation efforts for at-risk newborns. ## Prolapsed Umbilical Cord •Occurs when the cord lies below the presenting part of the fetus •May be occult (hidden, rather than visible) at any time during labor whether the membranes are ruptured •Most common to see frank (visible) prolapse directly after rupture of membranes, when gravity washes the cord in front of the presenting part Prolapsed Cord: Management • Prompt recognition is important • Fetal hypoxia resulting from prolonged cord compression (> 5 minutes) can result in CNS damage or death • Pressure on the cord may be relieved by the examiner holding the presenting part off the umbilical cord • Assist into a position such as a modified side-lying Trendelenburg, or knee-chest position, so gravity can help keep the pressure of the presenting part off the cord • Usually, a cesarean birth is performed ![[cord prolapse.png]] vaginal birth is now *contraindicated* and the only thing maintaining perfusion is the person lifting the baby's presenting part off the ___