Complications with the umbilical cord

Complications of the umbilical cord include umbilical cord entanglement, umbilical cord knots and umbilical cord prolapse. In some cases, these umbilical cord complications can be recognized before birth or become apparent during birth due to changes in the so-called CTG (cardiotocography; recording of fetal heart sounds and contractions). Umbilical cord wrapping occurs in about 20 percent of all children and describes a single or multiple wrapping of the neck by the umbilical cord.

Causes include increased physical activity of the child or a long umbilical cord. Umbilical cord nodes occur in about one percent of all births. They can also be caused by increased movement of the child.

Rarely does the contraction of the nodes during birth lead to an oxygen deficiency in the child. In most cases, however, umbilical cord wrappings or nodes do not lead to major complications during birth. An emergency, however, is the prolapse of the umbilical cord. It occurs in 0.5 percent of all births and describes an incarceration of the umbilical cord between pelvis and head after the rupture of the bladder. As a result, the child may be deprived of oxygen, which is why quick action must be taken and an emergency C-section performed.

Complications due to a pelvic end position

A breech presentation describes a child’s position in which not the child’s head but the end of the pelvis (breech, foot or knee presentation) precedes it. It occurs in five percent of all births, in premature births it is about ten to 15 percent. The causes of a breech presentation are often unclear.

A normal, vaginal birth with the breech presentation involves many risks, especially during the first birth. Firstly, the birth of the head is more difficult because the birth canal has been insufficiently dilated by the previous passage of the breech or buttocks. On the other hand, umbilical cord prolapses and entrapments occur more frequently with subsequent oxygen deficiency of the child.

Under certain conditions a vaginal birth is possible – but the decision for this should be weighed very carefully, requires some examinations in the run-up to the birth and should take place in certain specialized centers. Mostly, however, children are born vaginally in the breech presentation either after a successful external rotation or a planned caesarean section is performed. An external turn can be performed from the 37th week of pregnancy. This involves an attempt to turn the child into the correct position from the outside. It is performed under the strict supervision of mother and child.