1. Abnormal Umbilical Cord 、 Puerperium Women ’ s Hospital School of Medicine Zhejiang University Wang Zhengping

2. Abnormal Umbilical Cord Abnormal cord length Cord entanglement Knot of cord Torsion of cord Abnormal cord insertion Cord presentation and cord prolapse Single umbilical artery

3. Abnormal cord length Normal cord length is 30-70cm, averagely 50cm Short cord: <30cm is defined as short cord, may lead to fetal distress, placental abruptio, prolonged labour Long cord: >80cm is defined as long cord, higher occurrence of cord around neck, cord around body, cord knot, cord prolapse and cord compression

4. Abnormal cord insertion Marginal cord insertion into placenta, known as racket placenta Cord insertion onto membrane, runs between chorionic membrane and amniotic membrane before inserting into placenta, known as velamentous cord insertion Blood vessels on membrane passing internal cervical os anterior to fetal presenting part, known as vasa previa Velamentous cord insertion, commonly seen with single umbilical artery In vasa previa rupture, blood loss of 200-300ml can lead to fetal demise

6. velamentous cord insertion

8. Cord presentation and Cord prolapse Cord located anterior or lateral to fetal presenting part, known as cord presentation, also known as occult cord prolapse At membrane rupture, cord prolapse out of cervical os, descending into vagina, known as cord prolapse Cord prolapse is life-threatening to the fetus

9. Cord presentation

10. Cord prolapse

11. Knot of cord

12. Cord entanglement

14. The puerperium and complications definition puerperium puerperial morbidity puerperial infection late postpartum hemorrhage involution of uterus lochia