An Overview of Different Umbilical Cord Complications

What Is an Umbilical Cord?

The umbilical cord is a thin tube that connects the mother and the baby during pregnancy. An infant cannot survive during the gestational period without an umbilical cord. The umbilical cord starts forming at about four weeks of pregnancy and normally grows to be about 22 inches long. It has three blood vessels, one vein to carry food and oxygen from the placenta to the baby, and two arteries to carry waste from the baby to the placenta. Wharton's jelly is a jelly that cushions and protects these blood vessels. After the baby's delivery, the umbilical cord is clamped and cut, so the baby can breathe independently.

What Are the Complications Caused Due to Umbilical Cord?

Several umbilical cord problems can arise and put babies at risk for serious health problems. In conditions where the umbilical cord is too short or too long, does not connect well to the placenta, or gets squeezed or knotted. These conditions can cause problems during pregnancy. If a pregnant woman has any of these conditions, the health care providers may find it with the help of ultrasounds taken during prenatal visits. An ultrasound uses sound waves and a computer screen to show a picture of the baby inside the womb.

Some common umbilical cord complications are as follows:

• Umbilical cord compression.

• Nuchal cords.

• True knots.

• Umbilical cord prolapse.

• Short umbilical cords.

• Vasa Previa.

• Umbilical cord infection.

What Is Umbilical Cord Prolapse?

Umbilical cord prolapse occurs when the umbilical cord drops into the vagina ahead of the baby during labor and sometimes even before the onset of labor. This can cause the cord to get compressed between the rim of the cervix and the baby's body leading to less oxygen supply. Umbilical cord prolapse can happen in about 1 in 300 births.

The most common risk factors for umbilical cord prolapse are as follows:

• Premature rupture of membranes.

• Long umbilical cord length.

• Low birth weight.

• Malpresentation of the baby.

• Twin or more babies.

• Premature delivery.

• Pelvic deformities.

• Uterine malformations.

• Unengaged presenting part.

• Low-lying placenta.

• Excessive amniotic fluid.

Signs - The emergence of the cord before the baby is a sign of prolapse. The cord can sometimes come down the canal along withthe baby. Signs of fetal distress also clue the health care professionals into the possibility of cord prolapse.

Management - The physician might move the baby away from the cord with the help of forceps or a vacuum extractor. But mostly, this method fails, so an emergency C-section delivery is necessary. The doctors will try to push the baby's presenting part back into the pelvis while preparing the mother for surgery.

If the treatment is not provided quickly, the oxygen supply may be cut off, leading to medical issues, including cerebral palsy, long-term cognitive problems, and in severe instances, a stillbirth.

What Is Vasa Previa?

Vasa Previa occurs when one or more blood vessels from the placenta or the umbilical cord cross the cervix (the opening to the uterus). The umbilical cord or the placenta does not protect these blood vessels, so they can tear during labor and cause life-threatening bleeding in the baby. Even if the blood vessels are not torn, pressure on them during labor can cause problems for the baby. Vasa Previa is very rare and happens in just 1 in 2,000 to 3,000 births. The exact cause is unknown, but the following are considered risk factors:

• Velamentous insertion of the umbilical cord. This occurs when the umbilical cord does not connect correctly to the placenta.

• Placenta problems like placenta previa (when a baby's placenta partially or covers the mother's cervix)

• Pregnant with more than one baby.

Diagnosis is made by prenatal ultrasound. If vasa previa is present, an early C-section delivery is recommended. When it is diagnosed during pregnancy, 97 percent of live birth is recorded. If the blood vessels rupture during delivery, the doctors should be prepared to provide a prompt blood transfusion to the baby.

Is a Nuchal Cord Life-Threatening Complication?

A nuchal cord is a life-threatening complication that occurs when the umbilical cord wraps around an infant's neck one or more times. Nuchal cords occur in around 10 percent to 30 percent of all births. Nuchal cords are typically discovered at birth.

Causes -

1. Random fetal movement.
2. Extra-long umbilical cord.
3. Excess amniotic fluid.

Complications - If the umbilical cord is twisted around the neck or another body part, blood flow may be decreased, causing the baby's heart rate to fall during contractions. A stillbirth can occur if blood flow is completely cut off before delivery.

Management - It is often not known if a baby has a nuchal cord, so it is routine that the doctor checks the baby's neck for a nuchal cord delivery of the baby's head. Normally the cord is loose and can be slipped over the baby's head, but at times it can be too tight to slip over the head. So the doctor will clamp and cut the cord before the delivery of the baby's shoulders.

What Is Known as a True Knot?

True knots or umbilical cord knots occur when a fetus moves around in the womb, creating a knot. The knot normally remains loose but can constrict and tighten during delivery. When the knot is loose, there is nothing to worry about, but if the knot becomes too tight and is not treated immediately, the baby may experience oxygen loss and, sometimes, death.

True knots often occur along with the following factors.

• Pregnancy of twins.

• Gestational diabetes.

• History of two or more pregnancies.

• Small-sized fetuses.

• Long umbilical cord.

• Excess amniotic fluid.

• Male fetuses.

• Amniocentesis.

What Is a Short Cord?

An umbilical cord is considered short if it is 35 cm or less. Short cords are often at risk of stretching and rupturing. When the cord is short, fetal movement also causes excessive pulling on the placenta, leading to the umbilical cord tearing. It can cause severe maternal bleeding and stop the baby's oxygen supply. A short cord may be visible in prenatal ultrasound. A sign of fetal distress can be seen in babies with a short cord. Management for a short cord includes both C-section and operative delivery.

What Causes Umbilical Cord Compression?

Umbilical cord compression occurs when the flow of oxygenated blood through the umbilical cord is prevented due to pressure. Minor compressions are usual during uterine contractions. But, if the cord is compressed more than normal, it can cause brain damage to the baby because of oxygen deprivation, inadequate nutrition, or experiencing fetal acidosis (which occurs during the accumulation of carbon dioxide in the baby's blood).

Conclusion:

Most umbilical cord conditions do not cause any harmful effects on the baby. Even so, there are some life-threatening complications. Umbilical cord conditions are mostly noticed during a baby's birth and, at times, during prenatal visits. The doctor may opt for a c-section if any umbilical cord complication arises.