Insertion of the Cord

Central Insertion

The cord is commonly inserted in the center of the fetal surface, which is called a central insertion.

Battledore Insertion

The cord is inserted at the edge of the placenta.

Velamentous Insertion

This exists when the cord is inserted 5-10 cm from the edge of the placenta, with the blood vessels running between the placenta and the cord. It is very dangerous if the placenta is situated in the lower segment because the vessels may lie over the cervical os.

Care of the Cord

Immediate Care

1. Feel for the cord after the delivery of the head.

   • If it is tight around the baby’s neck, you must clamp it with two clamps and cut it with cord scissors.

   • If it is loose, you must slip it over the baby’s head.

2. Proper ligaturing: Apply the first ligature 5 cm from the stump of the baby. Apply a second ligature 2.5 cm from the first one, by use of sterile threads or rubber ligatures.

3. Check the cord every 10-15 minutes for hemorrhage.

4. Re-ligature the cord after an hour after the baby is born.

5. Apply normal saline and keep the cord always dry (spirit is no longer used).

Care in 24 Hours

1. Keep on observing or checking on the cord; exclude hemorrhage.

2. Keep the cord clean and dry.

3. Re-ligature after 24 hours.

Daily Care

1. The cord is cared for every time. It should be cleaned with normal saline swabs and left dry.

2. Daily shortening of the cord and re-ligature whenever necessary.

3. Proper observation to rule out bad healing, such as redness on the cord stump with pus discharge.

4. A well-treated cord should get off by the 5th day of life.

   • NB: A thick cord may take longer.

5. The cord should not be covered by the baby’s clothes.

6. Avoid applying native medicine.

Dangers of a Neglected Cord

1. Cord hemorrhage can lead to anemia, and this may result in neonatal death.

2. If clamped and cut with unsterile clamps or scissors, infections like tetanus can be introduced.

3. May expose poor healing and separation (i.e., redness, wet cord, and pus).

4. Low resistance to infection.

5. Anemia.

6. Jaundice, which may lead to permanent brain damage in case of kernicterus.

7. Dehydration.

8. Omphalitis (infection of the umbilical stump).

9. Convulsions, which may lead to brain damage.

10. Septicemia (blood poisoning).

11. Malnutrition as a result of illness and refusal to breastfeed.

12. Liver abscess (i.e., microorganisms may enter and cause an abscess).

13. Death.