What you Need to Know about Coiled Umbilical Cords
Otherwise known as the navel or pusod in Filipino, the umbilical cord is a hole or a depression in the baby’s tummy connecting the long structure likened to a rope to the mother’s womb. It transmits blood, oxygen and nutrients from the placenta to supply the fetus’ needs for survival, thus it is its lifeline.
The umbilical cord is described as follows:
• It is made up of 2 arteries that return waste products such as carbon dioxide and deoxygenated blood back to the mother’s placenta, and a single vein that brings much-needed oxygenated blood and nutrients from mom to baby.
• These blood vessels are protected and wrapped in a thick sticky substance known as Wharton’s Jelly, and the thicker this structure is or the bigger the diameter of the cord, the less likely the vessels become compressed, thus ensuring adequate and continuous blood flow to the baby.
• The average length of the umbilical cord is 20 inches or around 50 centimeters. Short cords are associated with limited or constrained fetal movements, while longer ones are prone to getting entangled with fetal body parts such as a leg, an arm or, more commonly, the neck.
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Nuchal Cord Coil (or coiled cord)
In the 60’s, a young British physician named Dr. Crawford pioneered an observational study on the different types of cord accidents among in-utero-fetus and its impact on the outcome of delivery:
• Type A - cord wrapped around the neck 360 degrees
• Type B - true knot that has a more fatal outcome
To date, there are limited prospective studies on the real reason why babies coil and uncoil their cords, that is why much effort has been diverted into identifying its incidence and forewarn expectant mothers on how to detect problems, such as these four tests:
1. Ultrasound Detection
Using gray scale or the black and white 2-dimension scan of the fetus, the cord is identified as circular structures on the opposite sides of the neck or faint white lines traversing the fetal neck. A color flow scan is more helpful as it will confirm the presence of the red and blue colors of the vein and artery overlying the nape.
One must keep in mind that it isn't possible to know through ultrasound how tight the nuchal cord is. What the sonologist could do is to look for signs of asphyxia or loss of oxygen due to strangulation by performing the biophysical score (BPS), or perform the non-stress test (NST).The baby is observed for 20-30 minutes to identify movement, tone, breathing, and heart reactivity.
2. Biophysical Score / Profile (BPS or BPP at 28 weeks onwards)
In any exam, a low score means a deterioration of function. At 28 weeks, the premature baby already has complete faculties to function as a normal human being. The Biophysical Profile is a test conceived by Manning et al (1980) to assess wellbeing and detect fetal distress based on these components:
• Breathing (upward/downward motion of the abdomen, including hiccups)
• Movement (kicks, rolling)
• Tone (opening and closing of hands, stretching of limbs)
• Amnionic fluid (adequacy of water)
The BPS is good indicator of fetal asphyxia (oxygen deprivation). The highest score a baby can get is 8, with 2 points assigned to each component. A score of 6 is equivocal and a declining score is reflective of the severity of fetal distress.
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3. Non-Stress Test (NST)
When you are in action, your heart naturally beats faster. During the late '80s, Clark et al came up with with a test called acoustic stimulation of the fetus (by ringing a bell) and by instructing the mother to push a button which marks the fetal movement in a recorded fetal heart rate (FHR) strip.
Likened to any living being stimulated to move or kick or exert physical effort, a baby’s heart, if functioning normally, will respond by beating more rapidly, hence the Non-stress test is read as reactive when the fetal heart rate accelerates 15 beats per minute from the baseline, signifying the absence of distress in the baby.
4. Fetal Movement Counting (FMC) at Home
A simple yet lifesaving procedure that can be done by both expectant mom and dad would be to count the baby’s kicks, rolls or any perceptible movement by placing their hands over the womb or listening by the use of a stethoscope.
It is important for mom to be well-fed or hydrated prior to doing this test as the fetus depends on the mother’s nourishment to have energy to move.
If the baby’s neck is squeezed, it loses oxygen and blood supply and eventually becomes immobile. Therefore, the absence of fetal movement in a period of 1-2 hours of observation warrants an examination in a nearby clinic.
Because of overwhelming fear upon ultrasound identification of cord coil, most patients become oblivious to the doctor’s advise. It is important to listen and not to panic.
Retrospective data covering thousands of deliveries have failed to link nuchal cord coil as a direct cause of fetal demise. According to research, this condition is quite common, and for as long as you are sensitive to your baby’s kicks and keep your appointments with the doctor, it shouldn't be any cause for worry.