Diagnosis

An umbilical cord knot can possibly be recognized in ultrasound in the form of a larger distension. However, it usually remains undetected during pregnancy and is only noticed when it becomes symptomatic. During pregnancy, the bending of the umbilical cord leads to a deficiency in the supply of the child, which becomes noticeable by decreasing child movements.

In this case a CTG control must be performed immediately. In the CTG (cardiotocography = recording of the child’s heartbeat and maternal contractions) a decrease in the child’s heart rate (bradycardia) can be detected. However, a decrease in heart rate can also have other causes. If a node in the umbilical cord is suspected, Doppler sonography can be used to measure the blood flow in the umbilical cord or placenta and in the child, thus revealing any constrictions. The diagnosis of an umbilical cord node can ultimately only be made after birth.

By these symptoms you can recognize a navel node

If a real umbilical cord node occurs, an acute undersupply of oxygen (hypoxia) occurs. This represents an absolute emergency situation. The fetal organism cannot compensate for this condition for long and reacts quickly by changing the heart rate.

Normally, the fetal heartbeat is 140-160 beats per minute. At the beginning there may be an increase in the heart rate >160 beats per minute (tachycardia), but as it progresses the heart rate drops rapidly, resulting in bradycardia < 110 beats per minute (drop in heart rate). The same applies to the movements of the child.

As a reflex, the child tries to move into a position in which it receives better care. In the case of an umbilical cord knot, however, this can even lead to a deterioration and tightening of the knot. If the supply is continuously insufficient, the child’s movements decrease increasingly until it stops moving.

Treatment/therapy of an umbilical cord node

The umbilical cord has a spiral structure, so that if a loose knot is present, the blood flow in the vessels is usually not affected. In this case no acute therapy has to be initiated. The knot cannot be loosened from the outside and in very rare cases the knot will dissolve by itself.The child must therefore be closely monitored with the help of a CTG and ultrasound.

If the child is mature, early induction of labor must be considered. The birth should only be performed by caesarean section, because in a spontaneous birth the lump will be tightened by pulling on the umbilical cord. An external twist should not be used if an umbilical cord knot is suspected, since the knot can be tightened by further movement of the child.

As soon as the umbilical cord node becomes symptomatic, i.e. the child’s heart rate drops, therapy must be initiated immediately. An emergency C-section (Sectio) must be performed immediately. The child does not receive oxygen-rich blood from the mother due to the pressed umbilical cord.

This condition leads to severe undersupply within a few minutes, which has serious consequences especially for the development of the child‘s brain. If a real umbilical cord node is suspected, the pregnant woman is immediately taken to the operating room and general anesthesia is administered. As soon as the mother is asleep, the child is born through an abdominal incision.

The baby is cut by the mother and can unfold its lungs and take in oxygen by screaming or by assisted ventilation. Depending on which week of pregnancy the birth was initiated or how long the lack of oxygen lasted, the newborn baby may need further intensive medical treatment. In any case, the child must be closely examined by a pediatrician and monitored for several days.