Short Umbilical Cord and Hypoxic-Ischemic Encephalopathy (HIE)
Umbilical cords provide a developing baby with blood, oxygen, nutrients, and waste disposal. Usually, when a baby moves around, the tension on the cord promotes growth, lengthening the cord. If the cord is too short, it means that the baby might not be moving around enough, signaling a potential health issue. Short cords can also pose a risk for numerous delivery complications and birth injuries. Specialists can make detailed evaluations of the cord using ultrasound. If there is an issue, it is important to closely monitor mother and child using prenatal tests, and sometimes to admit the mother for continuous monitoring for optimal health outcomes. The biggest complication of a short cord is placental abruption, a condition in which the baby’s movement pulls on the cord enough to cause the placenta to pull away from the uterus, resulting in severe bleeding. This requires a rapid C-section to prevent the child from experiencing dangerous oxygen deprivation and sustaining permanent brain damage.
Birth injuries are a very serious problem associated with umbilical cord abnormalities. A cord can become wrapped around a baby’s neck (nuchal cord), it can develop a true knot, and it can exit in front of the baby, which is called a prolapsed cord. Another type of umbilical cord problem that can be very dangerous is when the cord is short.
Short Umbilical Cord
An umbilical cord can get as long as 300 centimeters, with a diameter up to 3 cm. The average length of an umbilical cord is 55 cm long, and average diameter is 1 – 2 cm. An umbilical cord is considered short if it is less than 35 cm at term, although some researchers and clinicians consider 40 cm or even 45 cm to be short.
If the baby is to be delivered vaginally, the cord length must reach from the part of the placenta to which it is attached to the vaginal outlet. A short cord may be unable to do this, and can therefore cause delivery complications and birth injuries. When a baby moves around in the womb, the tension placed on the cord promotes growth. The less movement there is in the womb, the less growth. Therefore, short cords could be markers of a growth problem. Short cords may also restrict a baby’s movement.
Complications associated with a short umbilical cord include the following:
- Non-reassuring fetal heart rate associated with cord compression
- Fetal movement disorders such as fetal inactivity
- Placental abruption
- Rupture of the cord
- Neurological disabilities
- Delivery complications and operative vaginal delivery (forceps and vacuum extractor use)
- Intrauterine growth restriction (IUGR)
Risk Factors for a Short Umbilical Cord
Umbilical cord length is, in part, determined by hereditary factors. Listed below are other factors associated with a short umbilical cord:
- A woman who is of average weight or less (normal or below normal body surface area)
- A woman who is pregnant for the first time
- A female fetus
- A fetus that is small for gestational age
- Lack of fetal movement during the first half of pregnancy/intrauterine constraint/conditions that limit the baby’s movement in the womb
- Smoking and alcohol consumption
Signs, Symptoms, and Treatments for Short Umbilical Cord
The umbilical cord can be visualized with ultrasound exam by about the 8th week. Second and third trimester ultrasound examination to determine the number of vessels in the cord is recommended by the American Institute of Ultrasound in Medicine, although many experts prefer a more detailed exam of the cord at this time. A detailed evaluation includes assessment of wharton’s jelly (a mucous tissue that protects the umbilical vessels), evaluation of the fetal and placental insertion sites (including location of the cord on the placenta), and determination of the helical pattern (twisting of the cord). There is a relationship between the number of twists and the ratio between length and thickness of cords. The twists begin to be evident during the early part of the 8th week.
Indeed, it is the consensus of researchers that ultrasound studies of the umbilical cord can improve management of the baby. Ultrasounds that view the umbilical cord are performed during the second trimester and sometimes sooner. Length of the cord should be noted, and very close monitoring of the mother and baby must take place if the cord is short or other cord abnormalities are present.
When a short cord is causing the baby to be compromised, the fetal distress will show up on the fetal heart rate monitor as abnormal or non-reassuring heart tracings. This may be recognized when the mother is having prenatal tests performed, such as non-stress tests and biophysical profiles. Also, a short cord may be present along with IUGR and decreased fetal movement. Close monitoring is imperative, and depending on the severity of the condition, it may be necessary to admit the mother for continuous monitoring of her and the baby.
Placental abruption is the biggest complication of a short cord because any movement of the baby can pull on the cord’s insertion point on the placenta. This can cause the placenta to pull away from the uterine lining, leading to severe maternal bleeding and hemorrhage. We have seen many cases in which a mother is experiencing placental abruption – with very clear signs – and the medical team fails to appreciate it, causing a delay in delivering the baby. When signs of placental abruption are present, the medical team must put the mother in a position in which her baby can be delivered immediately by C-section, particularly if it is known that the cord is short. Placental abruption can turn severe very quickly, and if the tear is at the cord, the baby must be delivered right away to prevent severe oxygen deprivation and brain damage, such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy.
Of course, all labor and delivery units should have the capacity to perform a quick C-section when a baby is showing signs of distress. When a cord is too short, there often is a lot of tension placed on the vessels within it during delivery. This shows up as an abnormal or non-reassuring heart tracing, and an emergency C-section must take place right away. The cord can also rupture, which will cause the baby to be cut off from all or most of her oxygen supply.
Hypoxic-Ischemic Encephalopathy (HIE) Attorneys Helping Children with Short Umbilical Cord Injuries
If your child was diagnosed with a permanent disability, such as HIE, cerebral palsy, periventricular leukomalacia (PVL), learning disabilities, or developmental delays, the award-winning attorneys at ABC Law Centers can help. We help children across the country acquire the resources they need, and we give personal attention to each child and family we represent. Should you and your family pursue a case with Reiter & Walsh, P.C., our team will travel to you as needed. We’ve helped clients in Michigan, Ohio, Arkansas, Mississippi, Tennessee, Texas, Wisconsin, Pennsylvania, Washington D.C., and many other parts of the United States.
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