Types of Umbilical Cord Problems

The umbilical cord is the lifeline that connects a mother to her baby – it is the baby’s only source of oxygen and nutrients. It also plays a role in removing fetal waste. When there are complications with the umbilical cord, it can put the baby at risk of not getting enough oxygen. This risk increases when medical professionals fail to recognize warning signs and do not intervene in time.
Complications involving the umbilical cord can result in serious injuries to the baby, especially when medical professionals fail to properly perform, monitor and interpret fetal monitoring. Umbilical cord problems can cause birth asphyxia (oxygen deprivation), which can lead to birth injuries such as hypoxic-ischemic encephalopathy (HIE) and conditions like cerebral palsy.

There are several distinct umbilical cord problems that medical professionals should identify and appropriately manage to avoid birth injury. These include:

• Umbilical cord compression
• Nuchal cord
• True knot
• Umbilical cord prolapse
• Short cord
• Vasa previa
• Intrauterine infections or chorioamnionitis
• Placental abruption

It’s critically important that medical professionals recognize umbilical cord problems before an emergency occurs. Pregnancies with umbilical cord issues are considered high-risk and the babies are often delivered early.

There are a variety of medical issues that can impact umbilical cord function. These include:

Umbilical cord compression occurs when pressure prevents the flow of oxygenated blood through the umbilical cord. Minor, periodic compressions are normal during uterine contractions. It occurs in about 1 in 10 deliveries. However, if the cord is compressed more than is normal, the baby may not get enough oxygen and can suffer brain injury, receive inadequate nutrition, and experience fetal acidosis (caused by an accumulation of carbon dioxide in the baby’s blood from not getting enough oxygen). A variety of complications can lead to cord compression, including nuchal cords, true knot, and cord prolapse.

A nuchal cord is a complication that occurs when the umbilical cord wraps around the baby’s neck one or more times. Nuchal cords are common, occurring in about 25 percent of pregnancies. Often, they do not impact pregnancy outcomes. However, certain types of nuchal cords can pose a significant risk to the baby. Nuchal cords can interrupt normal blood, nutrient, and oxygen flow to the baby. This can lead to a variety of birth injuries, including hypoxic-ischemic encephalopathy (HIE), a type of brain injury caused by oxygen deprivation around the time of birth.

When the umbilical cord forms a knot, it’s called a true knot. These are dangerous because severe compression of the umbilical cord 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 baby will have a non-reassuring heart rate 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:

• Monoamniotic twins (share the same amniotic sac)
• Polyhydramnios (too much amniotic fluid in the womb)
• Having had two or more pregnancies in the past (multiparity)
• Long umbilical cords
• Small-sized fetuses
• Male fetuses
• Gestational diabetes

An umbilical cord prolapse occurs when the cord begins to slip through the birth canal ahead of (overt cord prolapse) or alongside (occult cord prolapse) the baby. Cord prolapse is another very dangerous complication because it can lead to cord compression (when the cord is pressed between the baby’s presenting part and the birth canal), birth asphyxia, and HIE.

Medical professionals should monitor for complications like a cord prolapse, and prepare to intervene quickly if needed. They should be especially cautious when managing a pregnancy involving a cord presentation in the third trimester. Cord presentation describes a situation where the umbilical cord is positioned between the baby and the birth canal. If this occurs prior to 32 weeks gestation, it may resolve on its own, but if it occurs in the third trimester, intervention will likely be necessary. Doctors should carefully monitor the baby’s health and be prepared to perform an emergency C-section if they show signs of not getting enough oxygen. With careful medical management, serious birth injuries and permanent disabilities can often be avoided.

Short umbilical cords are at risk of stretching and rupturing. When there is a short cord, fetal movement may cause excessive pulling on the placenta, causing it to tear away from the wall of the uterus (placental abruption). Placental abruption can cause severe maternal bleeding/hemorrhaging and can stop the baby from receiving adequate oxygen. In some cases, a short cord may also indicate a fetal health issue such as intrauterine growth restriction (IUGR). A short cord may be visible in a prenatal ultrasound. A baby with a short cord may also begin to show signs of fetal distress. Medical interventions for a short cord include both C-section and operative delivery.

Normally, blood vessels in the umbilical cord connect the baby to the center of the placenta. Vasa previa is a condition in which these vessels migrate out of the umbilical cord and into the amniotic sac membranes that lie across the opening of the birth canal.

Because of their position, these vessels are at risk of rupturing during labor and delivery. If the fetal blood vessels do rupture, it can lead to massive fetal blood loss and birth injury. Diagnosis is made by prenatal ultrasound. Mothers with a diagnosis of vasa previa should receive a recommendation for an early scheduled C-section delivery. When diagnosed during pregnancy, the rate of live birth is 97 percent. If those blood vessels rupture during delivery, the medical team should be prepared to provide a prompt blood transfusion to the baby.

Chorioamnionitis is an infection of the fetal membranes. Because chorioamnionitis can also spread to the umbilical cord, placenta, fetus, and amniotic fluid, it is now often also called intra-amniotic infection (IAI). If IAI involves the umbilical cord, this is called funisitis. Funisitis could lead to fetal inflammatory response syndrome (FIRS). FIRS is said to be associated with a variety of serious fetal complications and conditions, including preterm birth, neonatal sepsis, periventricular leukomalacia (PVL), and cerebral palsy. Management with antibiotics and timely delivery are imperative when an infection is diagnosed.

When umbilical cord function is impaired, the baby will likely show signs of fetal distress (oxygen deprivation). These signs may be recognized through fetal heart rate monitoring (a “non-reassuring” heart tracing indicates distress) and a variety of other prenatal tests. If a baby is in distress, the medical team should intervene quickly. In many cases, an emergency C-section will be necessary. Physicians should always be prepared for this possibility.

Problems with a baby’s umbilical cord can often be diagnosed during prenatal testing. 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.

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 growth restriction (IUGR). Dangerous umbilical cord problems and evidence of poor fetal well-being are almost always indications for an early delivery. Any signs of fetal distress should also be taken very seriously.

When umbilical cord complications cause hypoxic ischemic encephalopathy (HIE), doctors can treat the baby with therapeutic hypothermia (brain cooling).

During therapeutic hypothermia, the baby’s core body temperature is cooled to a few degrees below normal for 72 hours. Most guidelines dictate that this treatment must be given within six hours of the injury (usually birth asphyxia) that caused HIE, which often means it must be given within six 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.

Any other neonatal issues caused by cord complications (such as seizures or breathing problems) must also be promptly treated or the baby may develop further brain injury.

If you’re seeking legal help for harm resulting from an umbilical cord complication, it’s critical to choose an attorney and firm that focuses solely on birth injury cases. ABC Law Centers has been helping children with birth injuries since 1997. Our attorneys have won many awards for their advocacy of children and are leaders within the Birth Trauma Litigation Group (BTLG) and other prestigious legal associations that advocate for justice.

We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. We give personal attention to each child and family we represent; no one is ever reduced to a case number. Our firm has numerous multi-million dollar verdicts and settlements that attest to our success, and clients pay nothing unless we win their case!

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