Umbilical Cord

Morbidity and mortality of infants at birth with umbilical cord menumbung still quite high. Perinatal mortality rate ranges from approximately 0.3-0.6%.
The incidence of labor with umbilical cord menumbung can occur at birth with latitude location, presentation buttocks legs, premature babies, and the presentation of the head. In addition to labor with head presentation, talipusat menumbung terjadikarena PAP not terisipenuh by the fetus. In labor with head presentation accompanied with talipusat menumbung, fetal death rate will increase along with the occurrence of fetal asfiksi.

With the increased morbidity and mortality in infants with birth accompanied menumbung umbilical cord, then attempted some effort to avoid the occurrence of labor with umbilical cord menumbung, one of them is by trendelenberg position.


Goal
The purpose of the handling of labor with umbilical cord menumbung among others:
1. Provide first aid in birthing mother by the umbilical cord menumbung.
2. Decrease the mortality rate in the fetus.
3. Saves fetus from asfiksi threat.

Definition
According to Prof. Dr. Roestam Mochtar, MPH, 1998. Menumbung umbilical cord is palpable when out and usually have ruptured membranes.
Menumbung umbilical cord is a condition in which the umbilical cord was in front or beside the bottom of the fetus, or the umbilical cord has been in the birth canal before the baby and the situation gets worse when the umbilical cord depressed.

Classification Menumbung Cord
Menumbung umbilical cord, fetal membrane rupture. The umbilical cord occupies one of the 3 position, namely:
1. Menumbung cord in PAP, located next to the bottom of the fetus in PAP

2. Menumbung umbilical cord into her vagina, down into the vagina

3. Menumbung cord through and out of the vaginal introitus


Etiology
1. Fetal etiology
a. Abnormal Presentation
Most of the umbilical cord presentation menumbung occur in the head but
could also be because the location of latitude and the location of the breech / posterior presentation,
especially the posterior leg.
b. Prematurity
Frequent abnormal position on premature births, one of whom
due to small babies who are not resistant to trauma and anoksia.
c. Multiple pregnancy
These factors include disorders that affect the adaptation, the frequency
larger abnormal presentation, high incidence hydramnion
rupture second child.
d. Hydramnion
When the membranes rupture, a large amount of fluid flowing out and the umbilical cord
drifting downward.

2. Etiology of Maternal
a. Pelvic disproportion head
Disproportion between the pelvis and the baby's head can not cause the fall and
rupture of the membranes can be followed menumbung umbilical cord.
b. Lower part of the high
Delays decreased head for a while to happen though pelvis
normal, especially in multiparous.

3. The etiology of umbilical cord and placenta
a. Long umbilical cord
The longer the cord the more easily menumbung
b. The placenta lies low
If the placenta near the cervix so it will block the decrease in the
lowest. In addition, insertion of the umbilical cord closer to the cervix.


Diagnosis
Diagnosis of umbilical cord menumbung made in 2 ways:
1. Seeing the umbilical cord outside of the vulva
2. Touching the umbilical cord on vaginal examination (check in)

Vaginal examination should be performed:
a. In the event of fetal distress which is not known why and trauma if the
bottom has not dropped.
b. When the membranes rupture with the lowest part is still high.
c. When all the cases at the time of membrane rupture malpresentasi
d. When clearly premature baby
e. In cases of twins

Prognosis
Menumbung cord does not endanger the mother and not complicate the delivery, but threatening to the fetus. Hope for the baby depends on the degree and duration of cord compression and the interval between diagnosis and the birth of a baby.

Factors that influence the fate of the fetus:
1. The better the state of the fetus at the time the diagnosis is made, the greater the expectation
his life. Loud pulsating umbilical cord reduce both symptoms and
otherwise weak pulsating umbilical cord is not good.
2. The sooner the baby is born after the umbilical cord drops down, the better
results. The decline more than 30 minutes enlarge fetal death 4 x.
3. The fetus of the older age pregnancy is also a greater ability to survive
of traumatic processes.
4. More and less trauma to the baby's birth, the better the prognosis for mother and
children.
5. Opening the cervix may be the most important factor. If the opening is
complete at the time the diagnosis is made it will be many babies that can
saved. The smaller the opening of the bad prognosis. Exceptions
for this is if it can be done caesarea section immediately, in terms of
where the prognosis as good or better at the opening of the cervix that are still
small.
6. Fetal death increased with increasing length of the interval between the outbreak of
membranes and the birth of a baby.

Handling
The umbilical cord is left and labor menumbung forwarded the following circumstances:
1. When the fetus is dead
2. When the fetus is known abnormal
3. When the fetus is still very premature, so there is no hope to be able to live

Efforts to reduce cord compression and improve fetal condition is as follows:
1. Helper inserting one hand into the vagina and push the lowest to
top away from the umbilical cord. At the same time made preparations for
help delivery.
2. The patient is placed in a knee-chest position (knee CHOST) or Trendelenburg with
above your hips and head downstairs.
3. Given oxygen by mask to the mother
4. Fetal heart rate frequently checked
5. Vaginal examination to determine the presentation, the opening of the cervix,
decrease in the lowest and the state of the umbilical cord.

If the opening is complete:
1. Presentation of the head, head low in the pelvis: extraction with forceps
2. Presentation of the head, head height: Version extraction in this way contain hazards
occurrence of uterine rupture but because this is a business in a state
desperate to save the child then the risk must be taken
3. Presentation buttocks. Second leg is lowered and the baby was born as a presentation
ass feet as quickly as possible.
4. The location of latitude. Version in a presentation leg and immediately performed
extraction.

If the opening is not complete:
1. Sectio Caesaria, is the choice for a baby just month and in a state
good. The fate of infants in Caesaria section much better than the birth
other way. The danger to the mother is also very less compared to having a baby
forced the opening of the incomplete. While the preparation done
held operating businesses to reduce the compression of the umbilical cord as
mentioned above.
2. Reposition the cord to start if not feasible caesarea section.
The umbilical cord under upward into the uterus, while the lowest in the fetus
push down into the pelvis and then the resistance is sometimes repositioning the umbilical cord
successful but generally we lose much valuable time to time
do.
3. If these efforts do not succeed, keep the patient in the Trendelenburg position
in the hope that the umbilical cord was not pressured, so the baby can still live up to
opening to be wide enough to allow the birth of a baby.
4. Manual cervical dilatation, cervical incision and other ways to
impose the cervical opening will never be accepted. Little success has
whereas the risk for major capital.