An umbilical cord wrap (NSU) refers to the umbilical cord wrapping around the child’s body. The wrapping can be single or multiple. Only in rare cases does it represent a dangerous complication.
What is an umbilical cord wrap?
The umbilical cord is wrapped around the fetus in about 30 percent of pregnancies. This is a single or multiple looping of the umbilical cord around a part of the body such as the neck, arm, leg or torso. Several parts of the body can also be affected at the same time. The umbilical cord is around the neck in about 20 percent of cases. Boys are affected more often than girls. See psyknowhow for Klatskin Tumor Explained.
The medical literature speaks of a birth complication, although a high percentage of umbilical cord entanglement occurs during pregnancy. Only in very rare cases does it really represent a complication. It is even less likely to cause death for the fetus. The entanglement is usually loose and therefore does not pose a threat to the oxygen supply to the fetus.
However, complications are sometimes observed during childbirth, since the entanglement can become tighter here. A primary caesarean section is only necessary in exceptional cases where the umbilical cord is wrapped.
Causes
The causes of entanglement of the umbilical cord are manifold. The umbilical cord is often very long. In other cases there is a strong 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 more range of motion.
Polyhydramnios can in turn be triggered by several causes. Fetal causes are, for example, malformations of the digestive tract, spinal cord malformations, heart defects, lack of the cerebrum, fetal infections, genetic disorders of cartilage and bone formation, cleft lip and palate or chromosomal aberrations.
Other causes of polyhydramnios on the maternal side can be incompatibility of the maternal and fetal blood groups with formation of haemolysis in the fetus or diabetes mellitus. In diabetes mellitus, the amount of amniotic fluid is increased due to fetal polyuria. Although polyhydramnios as a result of other disorders can cause entanglement of the umbilical cord, in these cases the underlying disorder usually represents the main risk for the fetus.
Symptoms, Ailments & Signs
Wrapping of the umbilical cord around the neck occurs in 20 percent of pregnancies. However, only half of the cases result in noticeable changes in blood flow and heart rate. In most cases, the drop in fetal heart rate (deceleration) is only temporary and has no major effects. However, with a longer tight NSU around the neck, intrauterine fetal death due to fetal hypoxia|fetal hypoxia (fetal oxygen deficiency) can occur in exceptional cases.
However, due to the nature of the umbilical cord, hypoxia is rare. The fetus is supplied with oxygen-rich blood from the mother’s bloodstream via the umbilical cord. This supply can only be disrupted by compression of the umbilical cord and the vessels in it. However, the umbilical cord, due to its nature and construction, is not easily compressed.
Inside, it is equipped with connective tissue made of fine collagen fibrils, hyaluronic acid and proteoglycans, which protects against compression and is known as Wharton’s jelly. Fetuses with a low proportion of Wharton jelly have an increased risk of hypoxia with NSU. Furthermore, the umbilical cord has spirals twisted to the left, which additionally protect it from kinking and compression.
Diagnosis & course of disease
An umbilical cord entanglement can easily be detected prenatally by means of a Doppler sonography. However, this examination is only recommended in the case of a previous miscarriage or stillbirth, where a connection with the NSU is suspected. During childbirth, entanglement of the umbilical cord during the expulsion phase can lead to pathological changes in fetal cardiac activity.
These changes can be detected by cardiotocography. Variable decelerations (drops in heart rate) are displayed, which usually only last for a short time. A blood micrograph should then be performed to assess the child’s oxygenation.
Complications
Wrapping the umbilical cord is itself a complication during pregnancy. However, it is rarely dangerous. Only in exceptional cases can serious complications occur, which can even be fatal for the fetus. When the umbilical cord is wrapped, the umbilical cord wraps around the arms, legs, torso, or neck. The blood supply to the brain in the fetus may be endangered, especially if the neck is wrapped tightly.
This leads to what is known as fetal hypoxia, which is characterized by an undersupply of oxygen to the child. As a result, intrauterine fetal death can occur. Although the entanglement of the umbilical cord is usually harmless and does not require any special measures, constant medical monitoring should take place if a corresponding diagnosis is made.
This is the only way to ensure that rapid emergency medical assistance is possible in the event of a dangerous escalation of the situation. During the medical monitoring when the umbilical cord is wrapped, the oxygen content of the blood and regular heart rate measurements are used to examine the child’s heart rate using micro blood tests.
A very sharp decrease in heart rate can indicate a fatal danger to the fetus. Then you should act quickly. In some cases, a primary caesarean section may be necessary. In this case, the birth is induced by caesarean section before labour. However, the necessary medical measures always depend on the condition of the fetus.
When should you go to the doctor?
Umbilical cord entanglement only affects fetuses in the womb and occurs in a large number of pregnant women. In most cases there is no cause for concern. The entanglement is determined in imaging procedures by a gynecologist. As a matter of principle, an expectant mother should take part in all preventive and check-up examinations offered during pregnancy.
In these routine appointments, the development and state of health of the growing child are documented and compared with the general guidelines. If an entanglement of the umbilical cord is found, there is a further observation until the end of the pregnancy, since there is a possibility of complications during the birth.
If a pregnant woman notices any sudden irregularities despite attending all scheduled check-ups, she should consult a doctor immediately. If the fetus no longer moves, if there are changes in the heart rhythm or if the heart activity is abnormal, a doctor must be consulted.
Ein diffuses Gefühl, dass etwas mit dem Fötus nicht stimmen könnte, genügt für einen weiteren Besuch bei einem Arzt. Veränderungen der Durchblutung, Angst oder ein allgemeines Unwohlsein sollten mit einem Arzt besprochen werden. Kommt es zu einer plötzlichen und damit ungeplanten Geburt, sollte die Information der Nabelschnurumschlingung von der werdenden Mutter an die anwesenden Geburtshelfer weitergeleitet werden.
Behandlung & Therapie
Wrapping the umbilical cord usually does not require any special measures. However, the heart rate of the child should be monitored during the birth process via cardiotocography. If there are longer decelerations, it is also indicated to determine the oxygen supply through micro blood tests in order to be able to react quickly in an emergency. In individual cases, a primary caesarean section (section delivery, caesarean section) may be necessary.
Especially pregnant women who have had a previous stillbirth require special attention. However, it should be pointed out that the entanglement of the umbilical cord is usually not the primary cause of the child’s death. As already mentioned, various previous injuries and diseases of the child or mother can increase the probability of an NSU, for example due to polyhydramnios. However, the cause of the stillbirth is often to be found in this damage.
Outlook & Forecast
Umbilical cord entanglement is not uncommon. According to statistical surveys, it appears in every fifth birth. It is often detected during an ultrasound scan. However, the child in the womb is usually unimpressed by the entanglement of the umbilical cord. Since it is very elastic, there are usually no complications. The birth goes smoothly. Overall, the prognosis is positive.
It should be noted that the umbilical cord does not have to be wrapped around the neck. Many medical laypeople wrongly fear that the child will strangle itself. On the other hand, an arm or a leg can also be wrapped around. Such a position significantly reduces the risk in the run-up to the birth.
While the prognosis is consistently positive, the treatment options are inadequate. Doctors are unable to change the way the unborn child is embraced in the womb. It remains only to periodically check the heartbeat. 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
It is not possible to prevent umbilical cord entanglement in the growing fetus. NSU is a common symptom of childbirth and usually does not have a major impact on the child. Doppler sonography and cardiotocography should only be carried out during pregnancy in high-risk cases.
There is a risk if a pregnancy in the past ended in a miscarriage or stillbirth. Closer monitoring is also recommended for certain maternal diseases such as diabetes mellitus. Especially in this case, however, the expectant mother can help reduce the risk of an umbilical cord entanglement through a healthy lifestyle.
Aftercare
When the umbilical cord is wrapped, in most cases the affected person has very few, and in some cases only limited, aftercare measures available. For this reason, those affected should consult a doctor at an early stage to prevent the occurrence of other symptoms or complications. As a rule, it cannot heal on its own, so a doctor should be contacted as soon as the first signs and symptoms appear.
The treatment of the entanglement of the umbilical cord is usually carried out with a minor surgical intervention. There are no particular complications, although regular checks and examinations by a doctor are necessary after the procedure. However, if the entanglement of the umbilical cord 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 loving and intensive conversations with their own family in particular can have a very positive effect on the psychological state of the parents. No other follow-up measures are available to the parents. The entanglement of the umbilical cord may also reduce the life expectancy of the child if it is not recognized until late.
You can do that yourself
An umbilical cord entanglement is often discovered by chance during ultrasound examinations during pregnancy. This shows how important it is for pregnant women to take advantage of all the examinations that are offered. In everyday life, this is the best way to ensure that recognizable problems and health hazards for the unborn child are identified through the preventive services.
The mother herself cannot do anything if the umbilical cord is entangled. There is no way to remove the umbilical cord from the baby’s neck from the outside. That is why self-observation plays a major role in everyday life. Pregnant women whose child has been diagnosed with such entanglement of the umbilical cord in the womb must recognize possible warning signs of impending undersupply so that they can act quickly. If, for example, they determine that the movements of the child are decreasing, they can neither diagnose nor treat this themselves.
The only way to become active yourself is to visit a gynecological practice or a hospital with obstetrics and have the care of the child clarified via CTG. A known entanglement of the umbilical cord should not only be recorded in the maternity record. In unclear situations, the pregnant woman should always address this known danger aggressively again, because not all entanglements that can cause problems for the child can always be recognized as such on the ultrasound.
