Umbilical Cord Problems Leading to Birth Injury
The umbilical cord connects the mother to her baby; it is the baby’s lifeline, source of nutrients, and only oxygen source. For this reason, umbilical cord problems may cause serious injuries in the baby. Umbilical cord problems can reduce oxygen flow to the baby (birth asphyxia), which is one of the most common causes of birth injuries like hypoxic-ischemic encephalopathy (HIE), neonatal encephalopathy, and cerebral palsy. There are several distinct umbilical cord problems that medical professionals should identify and appropriately manage to avoid birth injury. These include nuchal cord, knotted cord, short cord, cord prolapse and compression, and others. With all umbilical cord problems, recognition before an emergency situation occurs is critical. Babies with umbilical cord issues are considered high-risk and are often delivered early.
Umbilical Cord Problems and Birth Injury: An Overview
An unborn baby receives oxygen-rich blood from the mother by way of the umbilical cord. Complications that cause the umbilical cord to rupture or become compressed can deprive the baby of oxygen; this is an emergency and must be treated promptly.
The medical team will be able to recognize oxygen deprivation and birth asphyxia through heart tracings provided by the fetal heart rate monitor. Oxygen deprivation manifests on the heart monitor through a “nonreassuring” heart tracing response. As soon as these tracings occur, the baby should be delivered quickly, usually by emergency C-section. While preparations are being made for prompt delivery, certain maneuvers may be performed in an attempt to decrease cord compression and birth asphyxia. Some of the most serious umbilical cord problems include:
- Nuchal cord (cord wrapped around baby’s neck)
- True knot
- Umbilical cord prolapse
- Short umbilical cord
- Vasa previa
- Umbilical cord infection
A nuchal cord occurs when the umbilical cord is wrapped around the baby’s neck, which can be very dangerous and lead to birth asphyxia if treated improperly. Nuchal cords can cause cord compression, compression of the blood vessels in the baby’s neck, and a backup of venous blood, which greatly hinders circulation. Nuchal cords can sometimes turn into true knots as well. The most common sign of a nuchal cord is decreased fetal activity. If the knot occurs during labor, the fetal monitor will detect a nonreassuring heart rate.
When the umbilical cord forms a true knot, severe cord compression can occur, which can lead to serious birth injuries. Decreased fetal activity after 37 weeks of gestation is a common sign of a true knot. A nonreassuring heart rate will occur when the knot is serious enough to cause a lack of oxygen to the baby’s brain. True knots often occur in association with the following factors:
- Pregnancy of monoamniotic twins
- Polyhydramnios (too much amniotic fluid)
- Having had 2 or more pregnancies in the past (multiparity)
- Long umbilical cords.
Umbilical Cord Prolapse
Cord presentation – which occurs when the umbilical cord is the first presenting part of the fetus – can become a serious medical risk when the mother’s water breaks. The amniotic fluid rushes from the uterus and can take the cord with it in a phenomenon known as cord prolapse. Cord prolapses can cause fetal oxygen deprivation during labor and delivery when the cord becomes compressed against the baby’s head, the mother’s pelvis, or by overly strong contractions. There are two types of umbilical cord prolapse:
- Overt umbilical cord prolapse: This happens when the cord comes out of the cervix or vagina before the presenting part of the baby and is either visible or able to be felt by the medical practitioner.
- Occult umbilical cord prolapse: This occurs when the cord descends alongside but not past the presenting part of the baby. It can happen with ruptured or intact membranes.
Because the risk of cord prolapse is so high, medical professionals should monitor cord presentation, usually after 32 weeks, and take measures (such as recommending a planned C-section) to prevent the risk of cord prolapse and oxygen-deprivation related injuries such as HIE, cerebral palsy, and intellectual and developmental disabilities. The most obvious sign of a prolapsed umbilical cord is seeing or feeling the cord before the baby is delivered. A nonreassuring heart tracing from a lack of oxygen will also usually be seen.
Video: Occult Cord Prolapse
Short Umbilical Cords
Short umbilical cords are at risk of stretching and rupturing. Short cords may also pull on the placenta, causing the placenta to tear away from the wall of the uterus in a complication known as placental abruption. Placental abruption can stop the baby from receiving adequate oxygen, and can become severe very quickly. Vessel rupture and placental abruption are major risks associated with short umbilical cords, and these conditions can cause severe maternal bleeding/hemorrhaging and birth asphyxia.
The umbilical cord can be visualized with ultrasound by about the 8th week. It is the standard of care to perform second and third trimester ultrasound exams to determine the number of vessels in the cord. However, 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). 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.
Normally, the baby’s blood vessels are located inside the umbilical cord, which connects into the central area of the placenta. Vasa previa occurs when the baby’s blood vessels are exposed and sit across the opening to the birth canal. The exposed fetal blood vessels are unprotected by placental tissue or the umbilical cord. Blood vessels affected by vasa previa are at risk of rupturing when the fetal membranes rupture or during labor and delivery. A vessel rupture can cause the baby to lose a lot of blood – up to 50% or more of the baby’s total blood volume – which is why vasa previa is such a dangerous condition and must be recognized prior to delivery.
If a rupture occurs, the medical team must immediately order blood products so the baby can receive a transfusion right after birth. In cases of vasa previa, the baby’s health depends on a timely diagnosis based upon ultrasound findings. Due to the risk of sudden and severe bleeding if vessels rupture, a C-section delivery is almost always needed.
Umbilical Cord Infection
Chorioamnionitis, an infection of the placental and fetal membranes, can spread to the umbilical cord. This can rarely cause possible fetal inflammatory response syndrome (FIRS), or funisitis. Funisitis is usually benign, but can occasionally cause the flow of oxygen and nutrients to the baby to become compromised. In very rare case, funisitis, combined with HIE or other factors, can result in stillbirth and birth injury.
Diagnosing Umbilical Cord Problems Before They Cause Birth Injuries
Problems with a baby’s umbilical cord can be diagnosed with an ultrasound, Doppler, and fetal monitoring. It is the standard of care to perform ultrasound exams of the umbilical cord during the second trimester or earlier if the mother has certain risk factors. During prenatal testing, fetal distress caused by umbilical cord problems will show up on the fetal monitor as nonreassuring heart tracings. In addition, if there is a long-term (chronic) umbilical cord problem that is causing oxygen and nutrient deprivation, prenatal tests may show decreased fetal movement and intrauterine (fetal) growth restriction (IUGR / FGR). Dangerous umbilical cord problems and evidence of poor fetal well-being are almost always indications for early delivery.
Treating Injuries Caused by Umbilical Cord Problems
When umbilical cord complications cause oxygen deprivation-related neonatal brain injuries (hypoxic-ischemic encephalopathy or HIE), doctors can treat the baby with hypothermia therapy (brain cooling). During hypothermia therapy, the baby’s core body temperature is cooled to a few degrees below normal for 72 hours. This treatment must be given within 6 hours of the insult (usually birth asphyxia) that caused the HIE, which often means it must be given within 6 hours of birth. Research shows that therapeutic hypothermia halts almost every injurious process that starts to occur when the brain experiences a hypoxic-ischemic insult. It can prevent a baby with HIE from developing cerebral palsy, or it can reduce the severity of cerebral palsy.
Hypothermia treatment is the only treatment for hypoxic-ischemic encephalopathy. However, conditions that a baby has as a result of the HIE, such as seizures and breathing problems, must be promptly treated or the baby may develop further brain injury.
Video: Michigan Hypoxic-Ischemic Encephalopathy Lawyers Discuss Birth Asphyxia, HIE, and Umbilical Cord Problems
In this video, birth injury and hypoxic-ischemic encephalopathy (HIE) lawyers Jesse Reiter and Rebecca Walsh discuss HIE and umbilical cord problems. They will also cover some of the other causes of birth asphyxia.
Trusted Legal Help for Umbilical Cord Complications | Our Niche Experience
If you’re seeking legal help for an injury resulting from an umbilical cord complication, it’s critical to choose an attorney and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries since its inception in 1997. Our attorneys have won numerous awards for their advocacy of children and are leaders within the Birth Trauma Litigation Group (BTLG) and other industry associations.
We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally-recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success.
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