Umbilical Cord Issues: Risks and Prevention Strategies

Why does the umbilical cord wrap around the neck? Are there any methods to prevent the tragedy of stillbirth?

Dear Dr.
Lu: Why does the fetus get the umbilical cord wrapped around its neck? Are there any methods to prevent stillbirths, such as raising the hips while lying on the bed? I would like to ask if a fetus with a known nuchal cord can suddenly die, especially as the due date approaches, when tragedies often occur.
Why is that? Thank you.

cloudia, 30~39 year old female. Ask Date: 2003/09/24

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello! Nuchal cord is quite common and does not cause fetal death.
This is often a misconception.
Both the fetus and the umbilical cord float in the amniotic fluid, and it is common for the cord to wrap around the fetus's neck, hands, or feet.
Many cases of unexplained stillbirth are simply attributed to this without thorough investigation, which is not accurate.
Nuchal cord does not cause fetal death, so please do not worry.
Common causes of stillbirth close to the due date include insufficient placental function, potential maternal diabetes, and fetal infections.
Therefore, early diagnosis and prevention during prenatal check-ups can help avoid these occurrences.
Best wishes for your health from Dr.
Lu Li-Cheng, Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/09/24

More Info

Umbilical cord issues, particularly when the cord wraps around the fetus's neck (known as a nuchal cord), are a common concern during pregnancy. It is estimated that nuchal cords occur in about 20-30% of pregnancies. While the presence of a nuchal cord can be alarming for expectant parents, it is important to understand that many babies with nuchal cords are born healthy and without complications.

The exact reasons why a fetus may have the umbilical cord wrapped around its neck are not entirely understood. However, it is believed that factors such as increased fetal movement, the length of the umbilical cord, and the amount of amniotic fluid can contribute to this occurrence. In some cases, the cord may become wrapped around the neck during the later stages of pregnancy as the fetus moves and shifts positions.

Regarding prevention strategies, there is no guaranteed method to prevent a nuchal cord from occurring. Some anecdotal suggestions, such as specific maternal positions (like keeping the hips elevated), lack scientific backing and are not proven to be effective. The best approach is to maintain a healthy pregnancy through regular prenatal care, monitoring fetal movements, and discussing any concerns with a healthcare provider.

As for the risk of stillbirth associated with a nuchal cord, it is important to note that while the presence of a nuchal cord can be associated with complications, it does not automatically lead to fetal distress or death. Most nuchal cords are loose and do not affect the blood flow or oxygen supply to the fetus. However, in some cases, a tight nuchal cord can lead to complications such as fetal heart rate abnormalities, particularly during labor. This is why continuous fetal monitoring is often employed during labor to detect any signs of distress.

The concern about sudden fetal death, especially as the due date approaches, is valid. The perinatal period, particularly the time around labor and delivery, can be critical. Factors such as uteroplacental insufficiency, cord accidents (including tight nuchal cords), and other complications can contribute to the risk of stillbirth. Therefore, it is crucial for expectant mothers to be vigilant about monitoring fetal movements and to seek immediate medical attention if they notice a significant decrease in movement or any other concerning symptoms.

In summary, while nuchal cords are relatively common and often not a cause for alarm, they can be associated with complications in some cases. Regular prenatal care, awareness of fetal movements, and open communication with healthcare providers are essential for managing risks associated with umbilical cord issues. If a nuchal cord is detected, healthcare providers will typically monitor the situation closely, especially as the due date approaches, to ensure the safety and well-being of both the mother and the fetus.

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