An umbilical cord wrap (NSU) refers to a wrapping of the baby’s body by the umbilical cord. The entwining may be single or multiple. Only in rare cases does it present a dangerous complication.
What is an umbilical cord wrap?
Umbilical cord entanglement of the fetus occurs in approximately 30 percent of pregnancies. This is a single or multiple wraps of the umbilical cord around a body part such as the neck, arm, leg or trunk. Multiple body parts may also be involved at the same time. The umbilical cord wraps around the neck in about 20 percent of cases. Boys are more commonly affected than girls. In the medical literature, it is referred to as a birth complication, although umbilical cord entanglement occurs in a high percentage of pregnancies. Only in very rare cases is it truly a complication. It is even rarer as a cause of death for the fetus. In most cases, the wrap is flaccid and therefore does not pose a threat to the oxygen supply to the fetus. However, complications are sometimes observed during delivery, when the wrap may become tighter. Only in exceptional cases is primary sectomy necessary for umbilical cord looping.
Causes
There are many causes of umbilical cord entanglement. Often, the umbilical cord is very long. In other cases, there is a large increase in the amount of amniotic fluid (polyhydramnios). Observations have shown that boys are more frequently affected by NSU than girls. This fact is probably due to the greater mobility of male fetuses in the amniotic fluid. Increased amniotic fluid increases the likelihood of NSU because the fetus has a greater range of motion in this case. In turn, polyhydramnios can be triggered by several causes. Fetal causes include malformations of the digestive tract, spinal cord malformations, heart defects, absence of the cerebrum, fetal infections, genetic disorders of cartilage and bone formation, cleft lip and palate, or chromosomal aberrations. Other causes of polyhydramnios from the maternal side may include incompatibility of maternal and fetal blood types with development of hemolysis in the fetus or diabetes mellitus. In diabetes mellitus, the amount of amniotic fluid is increased due to polyuria of the fetus. Polyhydramnios secondary to other disorders may cause umbilical cord entanglement, but in these cases the majority of the time the underlying disorder is the main risk to the fetus.
Symptoms, complaints, and signs
Umbilical cord entanglement of the neck occurs in 20 percent of pregnancies. However, noticeable changes in blood flow and heart rate occur in only half of cases. In most cases, the decrease in fetal heart rate (deceleration) is short-term and has no major effects. However, in exceptional cases of prolonged tight NSU around the neck, intrauterine fetal death may occur due to fetal hypoxia|fetal hypoxia (fetal oxygen deprivation). However, due to the nature of the umbilical cord, oxygen deprivation is rare. The fetus is supplied with oxygenated blood from the maternal circulation via the umbilical cord. This supply can only be disrupted by compression of the umbilical cord and the vessels within it. However, the umbilical cord is not easily compressed due to its nature and structure. Thus, it is internally equipped with a connective tissue of fine collagen fibrils, hyaluronic acid, and proteoglycans that protects against compression and is known as Wharton’s sulcus. Fetuses with low levels of Wharton’s sulcus are at increased risk for hypoxia during NSU. Furthermore, the umbilical cord has spirals that are twisted to the left, which further protects it from kinking and compression.
Diagnosis and course of the disease
Umbilical cord looping is easily detected prenatally by Doppler ultrasonography. However, this examination is recommended only in cases of previous miscarriage or stillbirth, where an association with NSU is suspected. During delivery, umbilical cord entanglement in the expulsion phase can lead to pathologic changes in fetal cardiac activity. Cardiotocography can detect these changes. Variable decelerations (decreases in heart rate) are indicated, which usually last only a short time.A microblood test should then be performed to estimate the infant’s oxygenation.
Complications
Umbilical cord entanglement is itself a complication during pregnancy. However, it is rarely dangerous. Only in exceptional cases can it lead to serious complications that may even be fatal for the fetus. In an umbilical cord wrap, the arms, legs, torso or neck are wrapped by the umbilical cord. Particularly if the neck is tightly wrapped, the blood supply to the brain of the fetus may be at risk. This is when so-called fetal hypoxia occurs, which is characterized by an undersupply of oxygen to the child. As a result, intrauterine fetal death may occur. Although umbilical cord entanglement is usually harmless and does not require any special measures, constant medical monitoring should nevertheless take place if a diagnosis is made. This is the only way to ensure that rapid emergency medical assistance is available if the situation comes to a dangerous head. During medical monitoring in the event of umbilical cord entanglement, the oxygen content of the blood and regular heart rate measurements are used to examine the child’s heart rate. A very severe drop in heart rate may indicate a fatal risk to the fetus. In that case, action should be taken quickly. In individual cases, a primary cesarean section may be necessary. In this case, birth is induced by cesarean section before labor begins. However, the necessary medical measures always depend on the condition of the fetus.
When should you go to the doctor?
Umbilical cord entanglement affects only fetuses in the womb and occurs in a large number of pregnant women. In most cases, there is no cause for concern. The looping is detected in imaging procedures at a gynecologist. An expectant mother should generally attend all offered preventive and check-up examinations during pregnancy. At these routine appointments, the developmental and health status of the growing child is documented and compared with general guideline values. If umbilical cord entanglement is detected during this process, there is further observation until the end of the pregnancy, as there is a possibility of complications at birth. If a pregnant woman notices sudden irregularities despite attending all scheduled check-ups, she should consult a doctor immediately. If the fetus stops moving, there are changes in the heart rhythm or an abnormality in the heart’s activity, a doctor must be consulted. A diffuse feeling that something might be wrong with the fetus is enough to warrant another visit to a doctor. Changes in blood flow, anxiety, or a general feeling of malaise should be discussed with a doctor. If a sudden and therefore unplanned birth occurs, the information of cord entanglement should be relayed by the expectant mother to the obstetricians present.
Treatment and therapy
Umbilical cord entanglement usually does not require any special measures. However, the infant’s heart rate should be monitored via cardiotocography during the birth process. At the same time, if prolonged decelerations occur, it is indicated to determine the oxygen supply by microblood tests in order to respond quickly in an emergency. In individual cases, primary sectio (incisional delivery, cesarean section) may be necessary. Especially pregnant women who have undergone a previous stillbirth require special attention. It should be noted, however, that primary cord entanglement is usually not the cause of death of the child. As mentioned earlier, various preexisting conditions and diseases of the child or mother, may increase the likelihood of NSU due to polyhydramnios, for example. Often, however, the cause of stillbirth is related to these impairments.
Prospect and prognosis
Umbilical cord entanglement is not uncommon. According to statistical surveys, it occurs in one in five births. It is often detected during ultrasound examination. However, the child in the womb is usually unimpressed by the umbilical cord looping. Since it is very stretchable, it usually does not result in any complications. The birth proceeds without any problems. Overall, this results in a positive prognosis.It should be noted that umbilical cord entanglement need not be present at the neck. Many medical laypersons wrongly fear that the child will strangle itself. In contrast, a looping can also be present on an arm or leg. Such a position significantly reduces the risk in the run-up to birth. While the prognosis is consistently positive, the treatment options, on the other hand, are inadequate. Doctors are not able to change an embrace of the unborn child in the womb. All that remains is to check the heartbeat regularly. Experience has shown that nature knows best how to help itself. If the child’s condition deteriorates during pregnancy, a Caesarean section may be indicated as a life-saving measure. In practice, however, this action is an exception.
Prevention
Prevention of umbilical cord entanglement in the growing fetus is not possible. NSU is a common side effect of childbirth and usually does not have a major impact on the child. Only in high-risk cases should Doppler ultrasonography and cardiotocography be performed during pregnancy. There is a risk if a pregnancy has already ended in miscarriage or stillbirth in the past. Also, if the mother has certain diseases such as diabetes mellitus, closer monitoring is recommended. In this case specifically, however, the expectant mother can help mitigate the risk of umbilical cord entanglement by maintaining a healthy lifestyle.
Follow-up
In most cases, the person affected by umbilical cord looping has very few aftercare measures available to them, some of which are limited. For this reason, affected individuals should see a physician early on to prevent the occurrence of other symptoms or complications. It is usually not possible for the condition to heal on its own, so a doctor should be contacted at the first signs and symptoms. The treatment of umbilical cord entanglement is usually performed by a minor surgical intervention. There are no particular complications, although regular check-ups and examinations by a doctor are necessary even after the operation. However, if the umbilical cord looping leads to the death of the child before birth, no further treatment is possible. Most of those affected are then dependent on psychological help, whereby especially loving and intensive conversations with one’s own family can have a very positive effect on the psychological state of the parents. Further measures of an aftercare are not available to the parents. Possibly, umbilical cord entanglement also reduces the life expectancy of the child if it is detected late.
What you can do yourself
Umbilical cord entanglement is often detected by chance during ultrasound examinations during pregnancy. This shows how important it is for pregnant women to take advantage of all the examinations offered. This is the best way to ensure, on a day-to-day basis, that screening services detect identifiable problems and health risks to the unborn child. The mother herself cannot do anything if umbilical cord entanglement is detected. There is no way to remove the umbilical cord from the baby’s neck from the outside. That is why self-monitoring plays an important role in everyday life. Pregnant women whose child has been found to have such a looping of the umbilical cord in the abdomen must recognize possible warning signs of impending undersupply so that they can act quickly. If, for example, they notice decreasing fetal movements, they cannot clearly diagnose or treat these themselves. The only way to take action is to visit a gynecologist’s office or a hospital with obstetrics and have the baby’s supply clarified via CTG. A known umbilical cord loop should not only be recorded in the maternity record. In unclear situations, the pregnant woman should always address this known danger again, because not all loops that can cause problems for the child can always be recognized as such on the ultrasound.
