M.D., Ph.D.MAXIMOVA Yuliya
Is cord entanglement dangerous?
We are drawing your attention to an article in the November issue of ShapeMama magazine, where expert Yulia Maksimova, M.D., Ph.D., obstetrician-gynaecologist and endosurgeon of the EMC gynaecology clinic appeared.
What can cause entanglement of the umbilical cord, and how is this condition dangerous for the developing baby? What examinations are required in this case and why? Can the expectant mother with cord entanglement give birth alone?
The entanglement of the umbilical cord can be caused by increased activity of the infant as well as increased length of the umbilical cord. Hyperactivity is often caused by polyhydramnios (oligohydramnios) and increased levels of adrenaline in the blood of women due to stress. Reasons for lengthening of the umbilical cord are not precisely known, but there is clearly a genetic predisposition. The length of the umbilical cord during pregnancy is almost impossible to determine, since it is "folded" between the body of the baby and wall of the uterus. There is nothing particularly to worry about in the event of entanglement, as it is present in almost 80% of cases. This does not result in intrauterine fetal irregularities, because the fetus does not use the lungs to breathe. At the same time, only a fifth of babies are born with the umbilical cord entanglement. The rest of babies “unravel” on their own.
Problems can occur if the blood flow is disrupted due to tension or compression of the umbilical cord because of repeated (tight) entanglement. This is about 1% of all “entangled” babies. Therefore, to fully determine the condition of the child, in addition to prenatal ultrasound, cardiotocography and dopplometry are required.
A cardiotocography determines the frequency of heart beats in the child, his reaction to its own movement (during pregnancy) and the toning of the uterus (in childbirth). This will determine how the child currently feels.
Dopplometry will help diagnose the blood flow rate in various vessels of the uterus and the placenta.
Births with entanglement
If a child feels alright, entanglement is not an indication for surgery. A C-section is only performed if there are signs of oxygen deficiency. Special tactics of childbirth are required when combined with other complications, as follows: age (over 35 years), fertility treatment, the use of assisted reproductive technology for conception and pelvic presentation. In other cases, a baby with entanglement (both single and multiple) is born in the usual way. During childbirth, cardiotocography is used, or listening to the heartbeat of the baby through a stethoscope. Immediately after the birth of the baby’s head, the obstetrician frees from his neck the cord, thus preventing strong tension and disruption of blood flow through it.
A short umbilical cord in knots, expanded during contraction, may cause premature detachment of the placenta, leading to an emergency operation. In repeated entanglement of the umbilical cord around the neck, natural childbirth may be more difficult. However, such difficulties occur very rarely.
Today, doctors successfully cope with complications of cord entanglement. This is possible thanks to a special device that allows monitoring of the condition of the fetus and a change in birthing tactics. To minimize the risk of entanglement, try not to stress, do more frequent walking, gymnastics and breathing exercises. Keep track of the movements of the fetus.
In the event of a sharp decline in their number, or their complete disappearance, seek emergency medical attention.