Umbilical cord complications
The umbilical cord is a lifeline between mother and baby, providing vital nutrients and oxygen to the fetus for the nine months of a mother’s pregnancy. It’s comprised of two arteries and one vein, which supply oxygenated blood to the baby so he or she can continue to grow and develop.
If umbilical cord complications arise, the baby’s oxygen supply can be cut off and cause serious damage. Hypoxia, a lack of oxygen to the fetus, can lead to birth injuries including cerebral palsy, brain damage, hypoxic-ischemic encephalopathy (HIE), and in the most dire circumstances, infant death.
Medical personnel must act quickly when umbilical cord problems are identified to protect the baby against life-long health complications. Learn about the most common umbilical cord problems and what steps to take when they arise.
Umbilical cord prolapse
During most deliveries, the baby’s head exits before the umbilical cord. Sometimes, though, the umbilical cord will drop through the cervix ahead of the baby, and the cord can get trapped and compressed. When this happens, the blood supply can slow or even stop—leaving the baby’s developing brain without vital oxygen.
The condition often develops because of a premature rupture of the amniotic sac; in fact, about half of prolapses occur within five minutes of sac rupture. Other circumstance can increase its likelihood as well, including:
- Premature delivery
- Multiple babies in the womb
- Breech birth (baby exiting the womb feet first)
- Abnormally high amount of amniotic fluid
- Low birth weight
When the fetal monitor shows that the baby’s heart rate decelerates during delivery, cord prolapse could be the reason. A doctor may also be able to see or feel the cord ahead of the baby. If umbilical cord prolapse is diagnosed, the mother likely will need an emergency C-section so the baby doesn’t go without oxygen for too long.
Umbilical cord prolapse is considered an obstetric emergency, and doctors should quickly intervene to prevent fetal death or other complications. Without oxygen, a baby’s brain cells quickly begin to die and cerebral palsy or other types of brain damage can result. Babies with umbilical cord prolapse are also at a much high risk for being stillborn.
When the umbilical cord becomes wrapped around the baby’s neck before delivery, it’s known as a nuchal cord. Up to 37% of babies will have a nuchal cord, and many will resolve with no complications.
Rarely, a nuchal cord can deprive the baby of oxygen and blood flow. If a mother feels decreased fetal activity after week 37, a nuchal cord may be the cause. An ultrasound is typically used to diagnose the condition. If the nuchal cord begins causing problems with blood flow during labor, a fetal monitor will detect the heart decelerations. This is likely because the cord has become compressed, and it may be a sign that the baby is in distress.
Doctors can resolve nuchal cords in a number of ways during delivery:
- If the cord is loose, it can be slipped over the infant’s head.
- If the cord is too tight, it can be slipped over the infant’s shoulders.
- If the cord is too tight to slip over the shoulders, the physician may use a “somersault maneuver.”
Umbilical cord knot
When babies move around in the womb, they can sometimes create knots in the umbilical cord. About 1 percent of babies are born with at least one umbilical cord knot, with identical-twin pregnancies being the most likely to have knotted cords.
There are no risks for the baby if the knot remains loose. However, a tight knot will cut off the baby’s oxygen supply. This is called a true umbilical cord knot, and it occurs in 1 out of every 2000 babies. It can be an emergency if the oxygen supply is cut off for too long, resulting in brain damage such as hypoxic-ischemic encephalopathy (HIE).
Similar to a nuchal cord, a true umbilical cord knot can be detected with an ultrasound before delivery or with proper fetal monitoring during delivery. If a mother feels a decrease in fetal activity after week 37, she should ask her doctor about the possibility of a true umbilical cord knot.
Vasa previa occurs when the exposed blood vessels of the placenta or umbilical cord become trapped between the fetus and the birth canal opening. Without protection from the cord, these blood vessels can rupture (resulting in a hemorrhage) when the cervix dilates or the amniotic sac ruptures.
This is a life-threatening condition for a baby still in the womb. The baby can bleed to death—resulting in a stillbirth—or the lack of oxygen can lead to cerebral palsy, intellectual disabilities, hypoxic-ischemic encephalopathy (HIE), and seizures.
Unfortunately, vasa previa is not always detected. Although the blood vessels may be trapped for weeks, improper prenatal care may not find the abnormality until the situation becomes dire. If vasa previa is diagnosed before labor, a baby’s chances of survival are much higher. The condition can be detected as early as the 16th week of pregnancy with transvaginal sonography and a color Doppler. If the condition is diagnosed as labor begins, doctors must act quickly and deliver the baby through an emergency C-section to protect the baby from losing too much blood.
Women are at a higher risk of developing vasa previa if they have a low-lying placenta, a condition known as placenta previa. In-vitro fertilization and multiples in the womb have also been found to increase the likelihood of vasa previa.
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Dr. Jack Tolliver is a successful physician and medical malpractice lawyer who understands the complexities of both hospitals and courtrooms.
If you or a loved one had umbilical cord complications that may have led to a birth injury, we encourage you to contact our firm. With our team’s medical experience, we can thoroughly and quickly review your case at no charge. If we accept your case, we will pursue maximum compensation. We never pass on costs and expenses if we do not recover damages.
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