Umbilical Cord Problems During Labour and Delivery

The umbilical cord serves as a lifeline between mother and baby.  It supplies the baby with oxygen and nutrients from the mother while carrying away the baby’s waste. This bundle of blood vessels is incredibly important to a fetus’ well-being – which is why problems with the umbilical cord can cause birth injuries.

If an umbilical cord is compressed or damaged in some way, it can disrupt the flow of oxygen-rich blood to the baby. This can result in birth injuries such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP). In some cases, umbilical cord problems can lead to a baby being stillborn. 

If your baby has been diagnosed with a birth injury, then you may be able to file a claim against your doctor and other healthcare providers for medical negligence. At the Birth Injury Lawyers Alliance (BILA), we are strong advocates for families whose children have suffered preventable birth injuries. Reach out today to schedule a free consultation with a lawyer in your province.

Potential Umbilical Cord Issues

Throughout pregnancy and during labour and delivery, the umbilical cord provides oxygen and nutrients to a developing fetus as it grows. If something interrupts this blood flow, a baby may suffer brain damage that can lead to conditions like cerebral palsy. Several cord-related pregnancy complications may disrupt the flow of oxygenated blood to a baby during labour and delivery, as outlined below.

Nuchal Cord

A nuchal cord occurs when the umbilical cord is wrapped around a baby’s neck at least once. This condition is relatively common, but can still be dangerous. A tightly wrapped cord can strangle a fetus, and if the blood vessels in the cord become compressed, it can also cut off the baby’s oxygen supply.

Sometimes a nuchal cord resolves on its own. However, if the nuchal cord persists, then a doctor may need to intervene to maneuver the cord to unwrap it or to clamp and cut off the cord. In some cases, an emergency cesarean section is necessary to protect the infant’s health.

There are certain risk factors for nuchal cords. This includes a particularly long umbilical cord, excessive amniotic fluid (polyhydramnios), an active fetus, and multiples sharing an amniotic sac. If any of these risk factors are present or a doctor notices other signs of a nuchal cord – such as movement slowing after 37 weeks or decreased fetal heart rate – they may perform an ultrasound and develop a plan to treat the nuchal cord.

Umbilical Cord Knot

An umbilical cord knot – or true knot – is a knot that forms in the cord when a baby moves around in the comb. When a baby stretches, the knot can tighten, causing the blood vessels to become compressed. This can limit the oxygen supply to the baby, causing a range of problems.

Fetuses with a true knot in their umbilical cord may show signs of decreased movement and fetal distress. A true knot can be diagnosed through an ultrasound, which should be performed more regularly if risk factors for this condition are present. These factors include twins sharing an amniotic sac, a mother who is older than 35 and/or has been pregnant two or more times, a long umbilical cord, a smaller fetus, and polyhydramnios.

If a true knot is diagnosed, then the baby’s health should be monitored for signs of distress. Typically, the mother is admitted to the hospital for observation. If the knot tightens, then an emergency C-section may be performed.

Umbilical Cord Prolapse

During a vaginal delivery, the baby should exit the birth canal first, followed by the umbilical cord. Umbilical cord prolapse happens when the cord emerges before or alongside the baby. If this occurs, the cord can become compressed, which may restrict oxygen supply to the baby.

Umbilical cord prolapse may be diagnosed when the cord appears before the baby in the birth canal. Signs of fetal distress, such as a deceleration of the baby’s heart rate, can also be a sign of prolapse. If a healthcare professional notices these signs, then they may be able to maneuver the baby away from the cord. Otherwise, an emergency c-section may be necessary. 

There are several risk factors for umbilical cord prolapse, including:

• Long umbilical cord
• Low birth weight
• Premature rupture of the membranes
• Premature delivery
• Pelvic deformities
• Breech presentation
• Multiples sharing an amniotic sac
• A low-lying placenta
• Prolonged labour
• Excessive amniotic fluid

Short Umbilical Cord

Typically, an umbilical cord ranges from 55 to 60 cm in length. If it is under 35 cm, then it is considered short. A short cord can impact fetal growth and development and may cause complications such as placental abruption, intrauterine growth restriction, HIE, CP, prolonged labour, and umbilical cord rupture.

The risk factors for short cords include gestational diabetes, the mother having a low body mass index (BMI), excessive or decreased amniotic fluid, and a history of smoking during pregnancy. Signs of fetal distress and low fetal movement are common signs of short umbilical cords. If a cord is extremely short or the baby is in distress, then an emergency C-section may be necessary.

Vasa Previa

Normally, fetal blood vessels connect the infant to the placenta. In vasa previa, these fetal blood vessels move outside the umbilical cord. This may happen because the cord implants in fetal membranes instead of the placenta, or when the placenta is divided into 2 lobes. This condition is particularly dangerous because these blood vessels could rupture with the amniotic sac, which can cause the fetus to lose a lot of blood.

There are several risk factors for vasa previa. This includes placenta previa, a multiple pregnancy, accessory placental lobes, IVF pregnancies, and velamentous insertion of the cord. This condition can be diagnosed with a transvaginal ultrasound. Otherwise, it may be suspected that there is blood when the mother’s water breaks or if the baby has an abnormal heart rate.

If a mother has been diagnosed with vasa previa, she should be monitored and given medication to help the baby’s tissues mature. Typically, mothers will be admitted to the hospital around 30 – 32 weeks gestation for monitoring. C-sections will often be scheduled for 35 weeks.

Infected or Inflamed Umbilical Cord

In some cases, a mother may develop an infection in the placenta which then spreads to the umbilical cord. This condition is known as funisitis. While this infection and resulting inflammation isn’t always a problem, it can limit the flow of blood and oxygen. It can also increase the risk of neonatal sepsis and preterm labour.

Risk factors for funisitis include prolonged labour and chorioamnionitis in the mother (placental infection). Chorioamnionitis may be more likely in women who have certain pathogens in the genital tract, who use alcohol and tobacco, who have cervical insufficiency, who undergo internal fetal monitoring, and who have previously had the condition. It can be diagnosed through examination of the cord and tests of the fetal and maternal blood.

This condition can cause birth asphyxia if delivery does not happen quickly. If the condition is severe, then an emergency C-section may be necessary, along with antibiotic treatment.

Contact BILA for Help

A healthy umbilical cord is critical for a healthy pregnancy – and baby. Damage to or compression of the cord can restrict oxygen to the baby, which can cause a birth injury. In many cases, these birth injuries are preventable with careful monitoring and prompt intervention.

If your baby has been diagnosed with a birth injury that you suspect was caused by medical negligence, a birth injury lawyer can advise you of your legal options. For assistance with umbilical cord birth injuries or other types of birth injury claims, call BILA today at 1-800-300-BILA or fill out our online contact form to schedule a free initial consultation with a lawyer in your province.