A nuchal cord is an umbilical cord wrapped around a baby’s neck. Umbilical cords connect a fetus with the mother and can be wrapped around a baby’s neck once, or even more than once. A body cord occurs when the umbilical cord is wrapped around a baby’s shoulder or abdomen. About 1 in 4 deliveries involve a nuchal cord. Nuchal cords and body cords typically do not lead to injury.
If the cord is loosely wrapped around the neck, medical professionals can often easily slip it over the baby’s head during the delivery process. However, in some cases the cord is tightly wrapped, and more difficult to remove.

Risk Factors

Factors like age and maternal weight before pregnancy don’t increase the risk of nuchal cords, and neither does a baby’s weight or sex. Common risk factors associated with nuchal cords include:

• Excessive amniotic fluid
• Excessive fetal movement
• Long umbilical cord
• Poor cord structure
• Twins or multiples pregnancy

Medical professionals can detect nuchal cords about 70% of the time during a mother’s routine ultrasound. However, they typically aren’t able to determine whether the cord is short or tightly wrapped around the fetus’s neck. Some of the possible symptoms of an umbilical cord around the neck include:

• The baby suddenly starts moving less in the last few weeks of pregnancy. Most babies at that time kick around five times in 30 minutes.
• A baby moves suddenly and forcefully, followed by a noticeable reduction in movement. This may be an indication that they are trying to reposition themselves to relieve the compression of their nuchal cord.
• The baby’s heart rate may decrease during labor.

Diagnosis

The diagnosis of a nuchal cord only requires 75% of the baby’s neck to have the cord around it. This is because 360-degree imaging in utero isn’t always possible. There are two main criteria doctors use to classify nuchal cords:

1. How many times is the cord wrapped around the baby’s neck? Depending on this number, there can be a single, double or triple nuchal cord.
2. Is the cord tightly or loosely wrapped around the neck? It’s considered to be a tight nuchal cord if doctors can’t slip it over the baby’s head during delivery.

You can also classify nuchal cords as either Type A or Type B:

• Type A nuchal cords are “unlocked,” meaning the umbilical end is under the placental end. Fetal movement can typically undo Type A nuchal cords easily.
• Type B nuchal cords are “locked,” meaning the placental end is under the umbilical end. This can potentially lead to a kind of umbilical cord complication called a “true knot.” These typically can’t be resolved via fetal movement.

If an infant has a tight or locked nuchal cord during delivery, doctors may first try a somersault delivery before they seek out other possible options. Somersault deliveries happen during vaginal childbirth and entail pushing a baby’s head to one side toward the mother’s thigh.

Usually, medical professionals pull an infant’s head down during delivery. Pushing the infant’s head to one side can allow the remainder of the baby’s body to somersault out. This avoids tightening the cord further and enables the physician to unwrap the umbilical cord.

Somersault delivery isn’t always successful. If the umbilical cord remains wrapped around the infant’s neck for too long, serious complications can occur. A doctor may also have to cut the cord sooner than what’s usually recommended, which can lead to infant anemia.

If the baby is in extreme distress, a doctor may suggest an emergency C-section delivery.

Risk to Fetus

Brain damage is one of the most severe types of birth injuries. Oxygen deprivation can happen if the cord is tightly wrapped and compressed. This can lead to other medical complications, including:

• Developmental delays
• Infant death
• Intellectual disorders
• Meconium aspiration syndrome
• Motor disorders
• Organ failure
• Seizures

Treatment

When a nuchal cord leads to umbilical cord compression during labor, there will be changes in the fetal heart rate that will alert the doctors and nurses to the problem. Short of delivery, the treatments for umbilical cord compression include maternal position changes and amnioinfusion. If the cord compression is severe and the baby is showing signs of oxygen deprivation, delivery is the only treatment. The failure to act upon the signs of significant cord compression and oxygen deprivation can have devastating consequences for the baby including death, brain injury, and cerebral palsy.

Prevention

While there isn’t a way to prevent nuchal cords from occurring, there are ways injuries can be prevented. Most importantly, healthcare professionals need to be vigilant to detect and act upon fetal heart rate abnormalities during labor.

However, if you suspect that your doctor failed to detect or act upon signs of cord compression and your child developed a birth injury or cerebral palsy as a result, there are resources to support you. The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs have helped over 30,000 families across the country, and we can help you too. Contact us today for a free consultation.