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[1.50] Brigid reads out listener Samantha’s question asking about the different types of cord insertions.
[2.11] Brigid reminds listeners to have a listen to episode 37. All about the umbilical cord for more information about the umbilical cord.
[2.31] Dr Pat talks about how cord insertion is about where the cord meets the placenta and how this is starting to be routinely reported on a second trimester 18-20 week ultrasound.
[3.17] Dr Pat covers the different types of cord insertions, such as, a central insertion where the cord meets in the middle of the placenta, an eccentric cord insertion where the cord and placenta join somewhere other than the middle of the placenta but not right on the edge of the placenta either. A marginal cord insertion which joins on the edge and a velamentous insertion which is where the cord lining stops around 4 or 5 cm before the placenta and the unprotected blood vessels insert into the placenta.
[4.26] Dr Pat confirms to Brigid that all 4 types of cord insertions can be identified with an ultrasound.
[4.33] Brigid asks Dr Pat about the prevalence of velamentous insertions, and Dr Pat talks about how around 1% of single babies will have a velamentous insertion and how they are more common with a multiple pregnancy.
[5.09] Brigid asks Dr Pat if a marginal cord insertion can turn into a velamentous insertion, Dr Pat talks about how rather than the cord insertion changing the opinion may have just changed between scans as velamentous insertions can sometimes be hard to identify and may not have picked up on the first scan.
[7.18] Brigid asks about the main problems with cord insertions that aren’t central, Dr Pat talks about uncommon or abnormal cord insertions do have a correlation with problems in the third trimester such as poor growth and in some severe and tragic circumstances sudden fetal loss.
[8.41] Dr Pat talks about the extra step that may be put in place for a pregnancy with an uncommon or abnormal cord insertion to ensure that the rest of the pregnancy is managed well, Dr Pat also talks about the importance of educating women on monitoring fetal movement in third trimester and how additional ultrasounds to monitor normal growth.
[9.05] Dr Pat talks about the ‘1 percenters’ that are relevant in these circumstances like the position that you sleep in.
[9.33] Brigid asks if all types of abnormal cord insertions can result in fetal loss, Dr Pat talks about how some abnormal cord insertions are worse than others but as a group they are pregnancies that should be particularly focused on in the third trimester in the same way that a care provider would focus in on a pregnancy with gestational diabetes, pre-eclampsia or thyroid disease for example.
[10.28] Brigid asks about whether pregnancies with abnormal cord insertions who are in a non-obstetric care provider program would be considered high risk and have to change care models. Dr Pat says how this would generally be dependent on each individual hospital’s policies, but some findings from ultrasounds may suggest that a pregnancy that needs more intense third trimester monitoring, in these cases a pregnancy may be required to move to a different care model or make changes to their current care model.
[11.43] Dr Pat talks about how it is good for the extra growth scans to be done by the same person where possible.
[12.16] Brigid asks about the pregnancy patients that may not see anyone until around 20 weeks into their pregnancy or aren’t having ‘gold standard’ surveillance, and if there are any noticeable sign towards the end of pregnancy or during labour that may highlight a cord insertion problem. Dr Pat discusses how regardless of where someone is having their pregnancy care a morphology scan in the middle of the pregnancy should be the bare minim ask that scan can help to pick up any problems with the pregnancy. Dr Pat also covers some of the features of cord issues that may occur during labour, such as, an abnormal fetal heart rate which contractions in labour.
[13.31] Brigid asks Dr Pat if any of the different cord insertions can change the way a woman may birth her baby, Dr Pat talks about how the type of cord insertion does not necessarily impact the way a woman can birth her baby, if the cord insertion is unusual but the fetal growth is normal then that can be managed in the normal way, with coming to spontaneous labour a term and just monitoring the labour carefully with continuous fetal monitoring as opposed to intermittent auscultation.
[14.28] Dr Pat says his overall advice is to have a second trimester ultrasound between 18 and 20 weeks, get an accurate diagnosis of the cord insertion type and then get some expert advice on what that cord insertion really means and then put that advice into practice.
[15.54] Myth or Fact? If you are pregnant, you should avoid low calorie sweeteners such as aspartame?
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