Umbilical cord entanglement is a pathology characterized by the location of one or more umbilical cord loops around the neck or body of the fetus. Clinically, on the mother’s side, this condition does not manifest itself in any way, there is rarely a risk of premature placental abruption. A child with an umbilical cord is likely to develop intrauterine hypoxia, which is accompanied by a deterioration in heart rate and motor activity. Diagnostics is based on ultrasound data, cardiotocography, color Doppler mapping. Treatment depends on the condition of the child and the mother, wait-and-see tactics are mainly used.
Umbilical cord entanglement is a special condition in obstetrics, accompanied by wrapping the umbilical cord around the trunk, legs or neck of the fetus. This condition refers to the pathology of pregnancy, as it can provoke the development of serious consequences – premature detachment of the placenta, incorrect position and presentation, hypoxia or asphyxia of the fetus. The umbilical cord is a rope of connective tissue, inside which a vein and two arteries pass. It provides a connection between the placenta and the fetus. Pathology is diagnosed in approximately every 4-5 women during gestation at different gestation periods. Loops are located mainly around the fetal neck.
Complications in the process of gestation or childbirth that have arisen against the background develop in about 10% of pregnant women. Entanglement is a threat if the umbilical cord is too short – less than 40 cm. In such a situation, there is a high risk of premature placental abruption. With a long umbilical cord (from 70 cm), entanglement is also dangerous, since it is possible to place several loops around the anatomical parts of the child, as well as the formation of nodes, when tightening which with a high probability, fetal asphyxia occurs.
Disease develops at different stages of pregnancy and can be triggered by several factors. One of the most significant is fetal hypoxia. In this case, due to lack of oxygen, the child begins to make active chaotic movements, as a result of which he becomes entangled in the loops of the umbilical cord. Umbilical cord entanglement is often diagnosed when its length is more than 70 cm . In this case, loops are formed, into which the child slips independently. Umbilical cord entanglement may also be associated with a genetic factor, so it should also be taken into account.
Often the umbilical cord entanglement occurs against the background of polyhydramnios. With such obstetric pathology, there is enough space in the uterine cavity for fetal movements, as a result of which it becomes entangled in loops. With a lack of space, the umbilical cord entanglement develops against the background of low activity of the child. It is proved that in such a situation, the rope tends to form loops on its own, which are subsequently located around the body or neck of the child. Any extragenital pathology of the mother, which provoked fetal hypoxia and, as a consequence, an increase in its motor activity, can also cause umbilical cord entanglement. The risk of pathology increases against the background of iron deficiency anemia in pregnant women.
Fetal umbilical cord entanglement is more often observed in women exposed to negative factors during pregnancy (poor environmental conditions, harmful production conditions). Often, pathology develops if the patient is prone to bad habits – smoking, drug addiction, alcohol dependence. Systematic stress, emotional stress, contributing to an increase in the concentration of adrenaline in the blood of the expectant mother, also increase the risk of this pathology. Insufficient intake of nutritional components from food, unbalanced nutrition is a predisposing factor that can cause umbilical cord entanglement.
Umbilical cord entanglement is divided into several types, taking into account certain significant factors. The prognosis of pregnancy and the delivery plan depend on them. Depending on how many loops are present, the following forms of umbilical cord entanglement are distinguished:
- single – there is one loop localized around the anatomical parts of the fetus;
- multiple – identify two or more loops.
If the umbilical cord entanglement is multiple, its variants are distinguished: isolated (all loops are located around one anatomical area) and combined (in this case, the loops are localized in several anatomical zones, for example, on the neck and body of the fetus). There are also tight and non-tight umbilical cord entanglement. The latter option is diagnosed in 90% of patients with such a diagnosis and has a favorable prognosis. With tight umbilical cord entanglement, there is a huge risk of vasoconstriction and cessation of blood circulation, which causes acute hypoxia and fetal asphyxia.
Fetal entanglement with the umbilical cord is not manifested by pathological symptoms on the part of the mother. The woman does not feel discomfort, but she may notice increased motor activity of the fetus. Such manifestations are characteristic of intrauterine hypoxia. With auscultation of the fetal heartbeat, an increase in indicators is possible. The detection of umbilical cord entanglement up to 32 weeks with a high probability ends with an independent untangling of the child, at a later date, due to a decrease in space in the uterus, the probability of eliminating the entanglement decreases, pregnancy management requires careful supervision by an obstetrician-gynecologist.
It is possible to diagnose umbilical cord entanglement during planned ultrasound during pregnancy from the 14th week of gestation, when the placenta and the cord are fully formed. During the scanning process, the ultrasound diagnostics doctor determines the presence of loops and their localization. It is important to understand that entanglement with the umbilical cord does not always threaten serious complications for the fetus, in the early stages it easily gets tangled and gets out, since it is small in size, and there is enough space in the uterus for movement. When a pathology is detected, color Doppler mapping is assigned. It allows you to see the multiplicity and the direction of blood flow through the arteries and veins. In the presence of 2 or more loops, careful observation and a detailed study of the type of entanglement is required. To do this, a three-dimensional echographic examination is used. It allows you to consider in detail the localization of the umbilical cord and distinguish the entanglement from the true node.
To assess the condition of the fetus when entwined with the umbilical cord, dopplerometry is performed. With its help, the specialist sees the intensity of blood flow in the vessels and identifies a possible insufficient supply of oxygen, pays attention to motor activity. Using cardiotocography, it is possible to evaluate the work of the child’s cardiovascular system, its activity and identify the signs of hypoxia present. A characteristic sign of lack of oxygen, determined by cardiotocomonitoring, is a decrease in heart rate when making movements. During CTG, when the umbilical cord is wrapped, attention is also paid to the tone of the uterus.
Special treatment is not provided. If such a pathological condition is detected, a woman should be ready to visit a gynecologist more often and not refuse to carry out additional diagnostic measures. When the umbilical cord is entwined, cardiotocographic monitoring is shown every week for the purpose of early detection of symptoms of oxygen starvation of the fetus. Hospitalization with fetal umbilical cord entanglement is justified if there are signs of acute hypoxia and disorders of uteroplacental circulation.
When the umbilical cord is wrapped around the patient, any experiences and stresses should be completely excluded. Emotional outbursts contribute to increased synthesis of adrenaline, which negatively affects the condition of the fetus and contributes to disruption of uteroplacental blood flow. Entwining with the umbilical cord also implies compliance with a rational diet. You should eat more healthy fortified food. When entwined with an umbilical cord, it is recommended to avoid exposure to negative environmental factors, including passive smoking, being in smoke-filled rooms, working in hazardous industries.
Medical treatment of umbilical cord entanglement is not routinely prescribed. In some cases, the doctor may recommend taking medications that improve uteroplacental blood flow, vitamin complexes. The method of delivery depends on the type of umbilical cord entanglement, as well as the condition of the mother and fetus. The most favorable option is a non-long single isolated umbilical cord entanglement. In this case, physiological childbirth with a duty or personal doctor is indicated. There is no need for early hospitalization.
In the case of natural childbirth with the umbilical cord entwined, it is important to carefully monitor the condition of the mother and fetus. Every 30 minutes, the doctor should monitor the baby’s heart rate with the help of cardiac monitoring and, if the heart rate slows down, speed up the delivery process. At the birth of a fetus with an umbilical cord around the neck, the loop is removed as soon as the head passes the birth canal. With tight multiple entanglement with the umbilical cord and signs of hypoxia, an emergency caesarean section is indicated regardless of the period of embryogenesis. In this case, hypoxia and even intrauterine fetal death may develop.
With tight multiple entanglement with the umbilical cord, physiological childbirth is contraindicated, since the child is already exposed to oxygen starvation. During contractions and attempts, the vessels narrow greatly, which leads to an even greater shortage of oxygen and the development of suffocation. Also, tight entanglement with the umbilical cord can cause premature placental abruption. In order to prevent this complication in childbirth, planned hospitalization is carried out at 37 weeks, followed by delivery by caesarean section.
Prognosis and prevention
When the umbilical cord is entwined, the prognosis is generally favorable. In most cases, it is possible to carry the pregnancy to 38 weeks and give birth to a healthy baby. The main thing is to follow the instructions of an obstetrician–gynecologist. Prevention involves the elimination of causal factors. The patient should exclude stress, negative environmental influences, occupational hazards and harmful habits. It is also important to ensure a rational diet enriched with vitamins, regular walks in the air.
A special exercise therapy for pregnant women, which can be prescribed by a specialist, will help prevent the entanglement of the umbilical cord. Respiratory gymnastics has a positive effect on the condition of the fetus. Such exercises with the umbilical cord entwining will make up for the lack of oxygen. Prevention also consists in timely diagnosis and treatment of iron deficiency anemia, which pregnant women often suffer from. To avoid obstetric pathology, a woman should follow the doctor’s recommendations and take all prescribed tests.