Umbilical Cord around Neck: Causes, Signs & Remedies

The umbilical cord connecting the mother to the foetus is the integral part responsible for the development of the foetus. The cord is the source of blood and oxygen to the foetus as the foetus is incapable of breathing by itself. It is also a source through which nutrients, vitamins, fats and proteins are supplied to the foetus. The reverse scenario of carrying waste products and deoxygenated blood back to the mother’s body is also carried out by the umbilical cord where the waste is excreted. During pregnancy, the baby keeps moving around in the womb and this could result in the cord getting wrapped around the neck. A common occurrence during pregnancy and afflicting almost 20%-30% of expectant mothers, the nuchal cord is a complication when the umbilical cord is wrapped around the neck of the baby.

What Is Nuchal Cord?

A normal and healthy umbilical cord is well protected from blood vessel compression by a soft, gelatinous textured filling called “Wharton’s Jelly”. This substance keeps the cord free from knots regardless of how many times or directions, the baby turns in the uterus. Umbilical cord entanglement occurs when the cord entwines itself around the entire body of the fetus. However, when the umbilical cord is wrapped around neck region during pregnancy or delivery, the knot is known as the nuchal cord.
But there are times when the nuchal cord could turn into a complication. When the nuchal cord wraps around the foetus’s neck before delivery, it disrupts the blood flow, oxygen and nutrient supply from the mother to the foetus causing severe injuries or birth complications like asphyxia and cerebral palsy.

What Is Nuchal Double Cord?

A double nuchal cord, another birth complication that occurs when the baby’s umbilical cord wraps around his or her neck twice, is a less frequent occurrence. However, if it does happen the outcomes are similar. There are exceptional cases when the double nuchal cord could put a baby at risk of hypoxia, reduced blood flow and other birth complications and injuries.
The umbilical cord is generally long enough to wrap comfortably around the neck of the baby with enough length left over. Nature has essentially designed the umbilical cord to be wrapped around the neck without causing any problem. Doctors and midwives don’t mention the nuchal cord during the childbirth and just slip the cord over the baby’s head during childbirth. It is medically proven that unless there is a dire consequence posed, the cord should be left alone during birth, to avoid complications.
There have been instances when babies have the cord wrapped around their neck multiple times- this is termed as double nuchal. The babies are still fine given the design of a healthy cord. Only one in 2000 birth cases have a “true knot” in the cord which poses grave risks. In majority of cases, the cord is harmless and does not tighten, even during childbirth to pose any danger.

How Common Are Nuchal Cords?

Proven medically, nuchal cords are very common and about one in every third childbirth has this condition. Babies born under these conditions are perfectly healthy unless there is a serious complication with the cord. Most medical practitioners cannot tell if the baby has a nuchal cord even after looking at an ultrasound.

What Are Causes Of Nuchal Cord?

Unborn babies are little gymnasts and acrobats in their mother’s womb. Pregnant mothers do enjoy their moves, kicks and butts but then these movements are some of the factors resulting in a nuchal cord. There are proven biological and medically ascertained reasons as to why a cord may end up around the baby’s neck or in loose knots:
• Insufficient Wharton Jelly – A soft, gelatinous substance protecting the blood vessel inside the cord, it protects the cord against compression and too much of knotting due to the baby’s movements. An insufficient presence of this substance could result in a nuchal cord.
• Excess Of Amniotic Fluid In The Sac – Since the foetus floats in the amniotic fluid, the knots do not affect the foetus. However, if the amniotic sac is filled with too much fluid, it could pose some amount of risk.
• Length Of Umbilical Cord – A foetus generally has a long umbilical cord and in cases where nuchal cord occurs the umbilical cord is longer than usual. But medical science is yet to prove if it is the length of the umbilical cord that causes the nuchal cord or the nuchal cord that causes the umbilical cord to stretch and lengthen.
• Having More Than One Foetus (Twins Or Multiples) – The presence of two or more foetuses means an equal number of umbilical cords. With the movement of two babies in the uterus, the possibility of cords getting entangled with each other is more. This does not pose a great risk. Twins that share the same amniotic sac have cord entanglement to a certain degree. The cords could get wrapped around the neck of the other twin or their own.

• Excessive Movement By The Foetus – If the baby tends to move a lot in the uterus, there is a likelihood that the cord could get entangled around the neck. As the gestation period increases, the probability of a nuchal cord increases proportionately.

What Are the Symptoms of Umbilical Cord Around Neck

There are no proven signs or symptoms that manifest in the body of expectant mothers to prove the presence of an umbilical cord around the neck of the baby. Some potential signs are as below:
• Reduced Movement Of The Baby – If the baby seems to be moving less after 37 weeks of gestation, it could be a possible warning sign of a nuchal cord.
• Abnormal Heart Rate  – During labour, the foetal monitor detects the presence of a nuchal cord by gauging the abnormal heart rate.
Ultrasound scans could detect if the baby is suffering from hypoxia or respiratory difficulties caused by a nuchal cord. However, a medical practitioner will not be able to assess the measure of risk associated with it to the life of the baby.

How Is The Diagnosis Made?

An obstetrical ultrasound diagnoses the presence of nuchal cords. An ultrasound scan can tell the doctor how many times the umbilical cord has been entwined around the neck. Doctors look at the multiple views of the fetal neck to identify a nuchal cord. If the umbilical cord is encircled around three-quarters of the fetal neck, then it is ascertained as a nuchal cord. If the cord is encircled to only half of the neck, it is classified as a trigger to the presence of a nuchal cord. With grayscale imaging, the chances of an ultrasound detecting a nuchal cord are 70%. However, with colour Doppler, nuchal cords can be detected with an accuracy and precision of 83% to 97% via an ultrasound. Nuchal chord ultrasound does give you an idea of the presence of an issue but no intervention is possible.

Treatment

The presence of the nuchal cord ascertained by ultrasound is only a possible indication of any complications that could arise in future. There is no known treatment to get rid of the problem. Doctors keep a close watch on the compression of the umbilical cord during labour or in the weeks leading to delivery to prevent any complications. Doctors recommended C Section in some cases, as nuchal cords can cause birth complications or hypoxia.

Is There Any Possibility Of Strangling The Baby Due To The Umbilical Cord?

The umbilical cord is the passage through which the baby receives oxygen to breathe. If the cord happens to be prolapsed, compressed or knotted, the supply of oxygen is reduced causing asphyxiation. This results in the umbilical cord ‘strangling’ the baby by cutting off the flow of oxygen. The presence of the umbilical cord around the baby’s neck also poses the additional risk of tightening itself around the neck during labour thereby decreasing the flow of the blood to the baby’s brain.

What Is The Relation Between Nuchal Cord And Birth Asphyxia?

The umbilical cord is about 20 inches long and about an inch in diameter with a loosely coiled appearance. The cord has two veins supplying oxygenated and nutrient-rich blood to the baby and two arteries carrying de-oxygenated and nutrient deficient blood back to the placenta. Occasionally, the umbilical cord will have only one vein and artery. The nuchal cord can be broadly classified as

• Type A Nuchal Cord – the umbilical cord is wrapped by 360 degrees around a baby’s neck.
• Type B Nuchal Cord – the cord cannot be undone and ends up as a true knot.
A common prevalence, nuchal cords can entwine and disentangle anytime. Although not known to cause any serious harm in most cases, it could lead to restricted blood flow ( ischemia), decreased oxygen (hypoxia), reduced foetal movement, diminished foetal development and complications in delivery. All of this puts the baby at risk for birth asphyxia. Ischemia and Hypoxia are caused by
• Restriction of blood flow from carotid artery if the nuchal cord is entangled tightly.
• Congestion of venous blood flow.
• Compression of the umbilical cord vessels if the nuchal cord becomes constricted against itself or the baby’s neck.

Complications And Birth Injuries

Potential complications and effects of the umbilical cord wrapped around neck include the below:
• Hypoxic-Ischemic Encephalopathy/ Birth Asphyxia : Umbilical cord wrapped around the neck can cause brain damage. It is caused by the deprivation of oxygen or limited blood flow to the baby’s brain during or near the time of birth. This leads to cell death, subsequently leading to brain damage causing disabilities like cerebral palsy, seizures, developmental and learning disabilities.
• Intrauterine Growth Restriction (IUGR) – A condition in which abnormal intrauterine growth causes a foetus smaller than average. Babies with IUGR are at risk of asphyxia and are delivered prematurely.

• Meconium Aspiration Syndrome – A medical condition in which the foetus swallows a mixture of meconium (baby’s stool) and amniotic fluid into the lungs during delivery.

How To Prevent Umbilical Cord Around Neck

With the foetus constantly moving inside the uterus, there is no sure way to prevent the umbilical cord from entangling around the neck of the fetus. The cord entwines and unwraps several times during pregnancy. Only in rare occasions, when a cord gets twisted many times, does it prove to be a “cord accident”.

Dealing With Umbilical Cord Stump

The baby does not need the umbilical cord after birth and hence it is clamped and cut off. This leaves a short stump which does not affect the baby or prove to be a source of discomfort. The stump does not have any nerve fibres that are pain-sensitive and it dries and drops off within three weeks after birth leaving a wound which heals in a couple of days. A few tips to take care of the umbilical cord stump
• Clean it with plain water and keep it dry with a clean cloth or a tissue.
• Keep the cord exposed to air to let it dry faster. The front portion of the diaper should be folded to keep it exposed to air.
• Give the baby a sponge bath until the stump falls off.

The stump must fall off on its own and you should not be tempted to pull it, even though it hangs precariously. If your child has a fever, swelling around the stump, the presence of pus or foul-smelling discharge, seek intervention from the doctor immediately.
Don’t entangle yourself in fear of the winding characteristic of the umbilical cord. Remain calm and unravel every stage of your pregnancy with joy so that your baby will feel the happiness.