Double entanglement of the umbilical cord around the neck during childbirth. Single entanglement of the umbilical cord. What should a future mother do if her child has an entanglement

30.10.2019

Often, during an ultrasound scan during pregnancy, a woman hears from a doctor such a conclusion as a single entanglement of the umbilical cord around the neck of the fetus. This fact causes panic in almost all expectant mothers who are faced with such a situation. Let's try to figure it out and find out: is this kind of phenomenon so scary and how can a single entanglement of the umbilical cord around the neck be dangerous for the baby's health?

What causes entanglement?

To begin with, it must be said that this kind of phenomenon can both arise and disappear on its own. That is why doctors are in no hurry to draw any conclusions, and in most cases take a wait-and-see approach. As a rule, if the entanglement was found around the middle of the gestation period, then the ultrasound is repeated before delivery, at 37 weeks of gestation.

As for the direct causes of a single entanglement with the umbilical cord, experts usually name the following factors leading to this:

the length of the umbilical cord is more than 70 cm;
the presence of a large volume of amniotic fluid - polyhydramnios;
oxygen starvation of the fetus - hypoxia.

So, with polyhydramnios, the baby has a large space for movement, which rarely increases the likelihood of developing an entanglement of the umbilical cord not only around the body, but also around the neck.

As for hypoxia, it is most often considered as a provoking factor, i.e. insufficient oxygen supply to the fetus through the umbilical cord can lead to an increase in its motor activity. Ultimately, the fetus simply falls into one of the loops of the umbilical cord.

What should be done with a single entanglement of the umbilical cord around the neck of the fetus?

According to statistics, only in about 10% of cases this kind of phenomenon leads to complications. That is why the expectant mother should not be very worried and nervous about this. Moreover, excitement from the mother can be transmitted to the fetus, which will only aggravate the situation.

As for the actions of doctors, then, as already mentioned above, if the loop on the neck does not squeeze the fetus, then doctors prefer to use expectant tactics, i.e. waiting almost until birth.

In order to determine the condition of the fetus with a single entanglement of the umbilical cord around his neck, (CTG) can be prescribed and the first study involves recording the baby's heartbeats, and with the help of the second, the state of blood flow intensity in the vessels located in the umbilical cord itself is determined.

Why is such a phenomenon dangerous?

A single loose entanglement of the umbilical cord, as a rule, does not pose any danger to the health and development of the fetus. During the course of pregnancy, such a phenomenon can occur repeatedly and disappear on its own, as evidenced by ultrasound performed during pregnancy.

As a rule, a double tight entanglement poses a danger to the health of the unborn baby. With this phenomenon, the development of oxygen starvation is noted. This violation negatively affects the processes of intrauterine development of the fetus and the development of brain structures in particular. So, as a result, there may be a decrease in adaptive capabilities, a violation of metabolic processes, and damage to the nervous system. The degree of negative impact directly depends on the duration of oxygen starvation of the fetus.

It is also worth noting that the strong tension of the umbilical cord, in view of the shortening of its total length due to entanglement, often leads to premature detachment of the placenta, which requires intervention by doctors.

Thus, as can be seen from this article, a single entanglement of the umbilical cord of the fetus around his neck should not cause alarm for the expectant mother, because. does not affect its development.

When the baby moves in the womb, the umbilical cord can wrap around the baby's neck, forming a loop. Why this happens and why it is dangerous - we will find out further.

Definition of pathology

The umbilical cord is also called the umbilical cord and is a structure that resembles a spirally twisted cord. It has the following characteristics:

gray-blue color;
matte surface;
55-60 cm in length (during the normal course of pregnancy);
about 2.5 cm thick.

When the umbilical cord loops around the fetus, this phenomenon is called entanglement. According to the classification of this pathology, the entanglement occurs only around one part of the fetal body - the neck, but at the same time, depending on the number of turns, the entanglement can be one-, two-, and multiple.

Single entanglement of the umbilical cord around the fetal neck

Almost 20% of pregnant women face the problem of cord entanglement. Most often, there is a single entanglement that does not tighten the neck tightly. There are several reasons and these include:

Exceeding the length of the umbilical cord. It has a diameter of about 2 cm, and the length varies from 40 to 60 cm. These figures are considered normal, but it can be about 70-80 cm long, in such cases, women are at risk, as their baby may be wrapped around the umbilical cord. These sizes are genetically transmitted and very often coincide with the parental ones.
Frequent anxiety and nervousness, adrenaline rush.
An increase in the amount of amniotic fluid (polyhydramnios).

These reasons are not accidental, because a long umbilical cord and polyhydramnios allow the child to move more freely, so entanglement occurs.

Often there are rumors among pregnant women that if the child moves too actively, then he suffers from hypoxia. In fact, active perturbations do not mean anything like that.

When the fetus is 28 weeks old, he will have a daily routine of the day. You can determine when the baby is sleeping or awake. When moving, you need to pay attention to its activity. If the baby began to move less, then we can conclude that he is not well (there should be at least 10 fetal movements per day). Therefore, if the baby is inactive, then you need to visit a gynecologist and consult with him.

With a single entanglement, natural childbirth is allowed. Many mothers give birth on their own, and as soon as the baby's head is shown, the midwife carefully removes the noose.

Wrapping the umbilical cord around the neck twice

There is also a double twist. If at the time of the ultrasound the child has reached 37 weeks, then he will not be able to unravel, since he no longer has enough space for maneuvers in his mother's tummy. But if the double entanglement was observed by ultrasound earlier than this period, then there is still a chance that it will again be able to unravel itself.

Double entanglement somewhat complicates childbirth in a natural way, so the obstetrician must be informed in advance so that the birth goes smoothly.

A lot depends on how the umbilical cord is wrapped. While the baby is in the womb, and the entanglement is not tight, there is no danger, since oxygen continues to flow through the umbilical cord, and not through the trachea. The main thing is that the umbilical cord is not pinched (the baby can press it down himself), therefore, women with umbilical cord entanglement of the fetus are recommended to periodically dopplerometry.

The woman in labor is allowed to give birth on her own, but they still prepare everything for the operation. At the slightest deviation in the health of the fetus, a caesarean section is performed.

Entwining the umbilical cord around the neck of the fetus three times

There may also be a threefold entanglement of the umbilical cord around the child's neck. This phenomenon is not particularly dangerous if it is not tight. The child receives oxygen through the umbilical artery, and if the entanglement is not tight, asphyxia does not occur. If there is a triple tight entanglement, then oxygen starvation can be observed. Gynecologists determine this by dopplerography and CTG. With such a violation, even with the help of a stethoscope, you can determine the arrhythmia in a child.

At longer periods, they begin to stimulate childbirth. With insufficient disclosure of the cervix, the child is removed by caesarean section. But the basis of the operation should be additional reasons:

the fetus has a large weight;
the child is across;
narrow pelvis in a woman in labor;
revealed hypertension.

What threatens the entanglement of the umbilical cord around the neck of the fetus?

Children with double or triple entanglement are at some risk. If there is a tight entanglement or squeezing of the umbilical cord, the child experiences a lack of oxygen and nutrients supplied to the child through the blood. His state of health immediately worsens, which can be registered on CTG.

The state of health of the fetus also depends on the duration of its oxygen starvation. Rarely, but still, it was observed that if the umbilical cord was tightly tied, and its length was significantly reduced, then the placental abruption occurred in the fetus. Therefore, if you do not consult a doctor in time when bleeding occurs, you can lose a child.

The entanglement of the umbilical cord also threatens the fact that the baby can injure the cervical vertebrae during childbirth. Therefore, the obstetrician taking delivery must act in accordance with the instructions.

All children are different and situations with entanglement are also different. So, for example, some children have no consequences, while others develop vegetative-vascular disorders.

Preventive measures

It is worth noting that the entanglement is formed due to the fact that the child is actively moving inside the amniotic sac, twisting the umbilical cord and falling into the loop. But at the same time, the parent can minimize the risk of entanglement if she follows some rules:

Take daily walks outdoors.
Sleep at least 7 hours, and during sleep ensure the supply of fresh air into the room.
Constantly be under the supervision of a gynecologist and follow all his recommendations.
In the third trimester of pregnancy, undergo CTG - a procedure that allows you to identify the nature of the heartbeat and the activity of the child. According to its result, the doctor gives his recommendations.

Don't be alarmed if you find entanglement. The doctor may prescribe drugs that support blood circulation in the fetus-placental region.

Video: Cord entanglement during childbirth

In the following video, the expert will tell you in detail what pregnant women should know about the entanglement of the umbilical cord around the neck of the fetus:

Most often, the child is wrapped around once, and not tightly. Very rarely, repeatedly, combined, that is, when the neck and leg are fixed. A single entanglement is not dangerous. Complicated are considered double and triple entanglement. Sometimes, when they are detected, a planned caesarean section is performed. Prevention is the observance by the woman in labor of the regime of the day and complete calmness.

When, after the next ultrasound, expectant mothers hear the diagnosis “umbilical cord entwined around the neck”, they are very frightened. They imagine a terrible picture: an unborn child is suffocating from the noose that the umbilical cord has become for him. But you should not be afraid. The baby in the womb is not yet breathing, so it cannot suffocate. From the fact that the umbilical cord is wrapped around the neck, nothing terrible will happen. After all, the baby will continue to receive through it all the necessary nutrients.

Despite the fact that such a phenomenon does not pose a direct danger to the health of the child, it will be useful for every expectant mother to learn about the causes and consequences of entanglement of the umbilical cord around the fetus's neck. You will learn about this from this article.

To properly understand the essence of the problem, you must first understand what constitutes umbilical cord.

This is a special cord that connects the organisms of the mother and child. Through it, the necessary nutrition is supplied to the fetus.

The formation of the umbilical cord begins at the 3rd week of pregnancy. It consists of connective tissue, an umbilical vein, and a pair of arteries. Inside the umbilical cord, the vessels are twisted into a spiral.

The vein in the umbilical cord serves to supply the mother's arterial blood, rich in oxygen and nutrients, to the baby's body. Arteries, on the other hand, drain blood from the fetus with metabolic products.

The umbilical cord is a temporary organ. It is needed by the fetus only until the moment of birth. After the baby is born, the umbilical cord is removed: doctors cut it.

In the normal state, it has a length of 40 to 60 cm. If the length of the umbilical cord goes beyond 70 cm, then conditions arise for the umbilical cord to wrap around the fetal neck.

Causes of pathology

Despite the development of medicine and the wide availability of medical information, in modern society there are still many superstitions associated with the umbilical cord wrapping around the neck of the fetus. For example, some "experts" still advise pregnant women not to engage in knitting and weaving, to refuse to raise their hands up in the last stages of pregnancy. Allegedly, this may contribute to the umbilical cord wrapping around the neck of the fetus. Naturally, this is complete nonsense.

Why does entanglement occur? This intrauterine pathology can develop under the influence of the following factors:

Types of pathology

There is the following classification of umbilical cord entanglement of the neck of the fetus:

Tight. Such an entanglement is characteristic of a short umbilical cord.
Not tight. Such an entanglement is characteristic of a long umbilical cord.
Single. One loop.
Double. Two loops.
Triple. Three or more loops.
Isolated. The umbilical cord wraps around only one part of the body. For example, the neck.
Combined. The entanglement affects several parts of the body.

With umbilical cord wrapped around the neck 1 time faced by at least 20% of women. Doctors do not even consider this phenomenon a pathology, since a single loop cannot cause fetal hypoxia.

A single entanglement of the umbilical cord at 32 weeks is not a reason to panic. Obstetricians believe that the child will be able to be born independently.

You can start to worry if doctors find cord entanglement at 33 weeks pregnant. As a rule, before childbirth, the child independently removes the loop. However, if it is a combination entanglement, affecting other parts of the body, then the loop may be too tight. In this case, the fetus will not be able to get rid of it, which can create some difficulties during childbirth.

double cord wrap

In the vast majority of cases, this pathology is also not considered dangerous. Especially if it is detected before 37 weeks. After this period, the likelihood that the fetus will be able to get rid of the entanglement is very small.

Double entanglement of the umbilical cord around the fetal neck may complicate natural childbirth. But even then, only if the obstetrician was not previously informed of the presence of pathology. If the doctor knows exactly how the loops of the organ lie, then the birth goes well. In any case, if a woman in labor has a double entanglement of the umbilical cord around the neck of the fetus, then everything necessary for a caesarean section is prepared. The slightest deviation in the health of the child or mother, and doctors perform an operation.

Triple entanglement of the umbilical cord

This type of pathology is much less common. It can be considered harmless only if the entanglement is not tight. That's why women with triple entanglement checked with particular care. At the same time, they are prescribed dopplerography and CTG in a mandatory case.

Despite the fact that the doctors themselves consider the triple entanglement of the umbilical cord to be safe, they still do not risk it and after the 37th week of pregnancy they prefer to induce labor. At the same time, if the cervix does not open wide enough, doctors do a caesarean section.

It should not be thought that triple entanglement is an absolute indication for surgery. Needed for a caesarean section additional reasons:

The fruit is overweight.
Transverse position of the child in the uterus.
Narrow pelvis.
Hypertonic disease.

As you can see, in general, wrapping the umbilical cord around the neck of the fetus does not pose an immediate threat to the life of the child. However, it is always better to play it safe and be prepared for any development of events. Therefore, obstetricians regularly examine pregnant women after 32 weeks of pregnancy. For pathology diagnosis, they resort to the following methods:

The use of these methods allows doctors to ensure a safe birth with cord entanglement.

Effects

Most often, physicians have to deal with tight and single entanglement. In this case, there is no threat to the health of the fetus. A woman gives birth quite successfully on her own.

The danger arises when entanglement is tight and repeated. There is a direct threat to the health of the fetus due to hypoxia. Doctors immediately warn a woman in labor about possible dangers:

Oxygen starvation of the child during the passage of the birth canal.
Narrowing of the lumen of the vessels that feed the fetus.
Fetal circulation problems.
Hypoxia.
Cessation of cardiac activity.
Placental abruption.

As mentioned above, doctors tend not to take risks and after 37 weeks of pregnancy they do a caesarean section. This operation is also resorted to in cases where the situation becomes critical for any reason.

entanglement prevention

The expectant mother can minimize the risks of developing pathology. To do this, she needs to following:

These measures are sufficient in most cases to prevent the umbilical cord from wrapping around the baby's neck.

During fetal development, the child cannot eat and breathe on its own. It is completely dependent on the mother's body. This connection is provided by the vessels and the placenta. Pathological changes in these organs lead to hypoxia and developmental disorders. But sometimes, with normal development during pregnancy, by the time of delivery, the umbilical cord around the neck appears 1 or more times. How dangerous is this condition and is it worth it to tune in to a caesarean section?

Types of pathological condition

The umbilical cord consists of 3 vessels surrounded by one sheath. Through it, nutrients enter, gas exchange and removal of fetal metabolic products. The shell - vartan jelly - resembles jelly. It protects vessels from stretching, compression and twisting. With pathology of the umbilical cord during pregnancy, the child begins to lag behind in development and weight. But sometimes the pregnancy proceeds normally until the moment of delivery.

Deterioration of the condition, the development of acute hypoxia during childbirth is possible with complete or partial blockage of its lumen and impaired blood flow.

An entanglement is the location of the umbilical cord around the neck of the fetus for 360 ° (one turn) or more. ICD-10 has a code only for births complicated by entanglement with compression (O69.1). Other options are not considered.

A single entanglement occurs in 22% of all births. Double entanglement is recorded less frequently, only in 3% of cases. The share of triple and quadruple accounts for 0.5% and 0.07%, respectively.

Allocate a complete entanglement and incomplete, which is less than 360 °. Complete can be single and multiple. The maximum number of turns recorded in the medical literature is 9. Complete entanglement can occur as true twisting or incomplete knotting.

If the umbilical cord is wrapped around only one part of the body, then this is an isolated entanglement. If several are involved - combined.

Why is the baby wrapped around?

The location of the loops before delivery has no clinical significance. The shorter the gestational age, the higher the fetal mobility. The child rotates freely, changes its position from the head to the pelvic. Therefore, the umbilical cord, located on the neck of the fetus without entanglement, should not be alarming. But as the moment of childbirth approaches, the free space in the uterine cavity decreases. A child after 36 weeks should no longer radically change his position.

The causes of the pathological condition fit into three main factors:

. The uterine cavity is overstretched with a large amount of water, the fetus has more space for swimming, and hence for the possibility of changing position.
. The condition is a consequence of placental insufficiency. There are many reasons why placental dysfunction occurs. These are preeclampsia, diabetes mellitus, pathologies of the heart and blood vessels in the mother, intrauterine infection. In a state of hypoxia, the child may become more mobile. Some of these conditions are accompanied by polyhydramnios.
Stress. The physical activity of the mother and nervous strain leads to an increase in the stress hormone - adrenaline. It also affects the condition of the fetus, leading to its increased activity.

A double entanglement of the umbilical cord around the neck is observed with an increase in its length. The norm is 55-70 cm. The umbilical cord is more than 70 cm long, and less than 40 cm is short. But even with a length of less than 40 cm, entanglement can occur, but the symptoms and consequences will be different.

How is pathology diagnosed?

For the first time, a woman can hear about the entanglement at 31-32 weeks of pregnancy during an ultrasound scan. But such conclusions are of no serious significance. Usually, by the time of birth, children are untangled from the loops on their own.

You need to carefully consider the location of the loops in the neck, which was diagnosed at 38 weeks. The danger can be two- and three-fold entanglement, as well as tight. When the loops are tightened, a state of acute hypoxia develops. This disrupts the supply of oxygen and nutrients, as well as the removal of decay products.

If an abnormal position of the umbilical cord loops is detected on ultrasound, Doppler mapping is necessary to determine the nature of the blood flow. Based on its results, you can find out the number of loops, their exact location and the direction of blood flow. Sometimes nodes or other pathological conditions are simultaneously recorded. allows you to establish whether there is a child suffering from hypoxia.

Also, all pregnant women from the 27th week, regardless of the diagnosis, undergo CTG at each visit to the doctor. With tight entanglement, the following signs of hypoxia are most often observed:

a decrease in the basal rhythm and a decrease in the number of fetal heartbeats;
the appearance of a large number of decelerations - slowdowns in the heart rate when the child moves or uterine contractions.
a decrease in the number of accelerations - an increase in the rhythm during movement.

At the same time, the total score of CTG with initial changes in the state of the fetus is 5-7 points, a critical condition is indicated by 4 or less points according to the study (read more about decoding the results of CTG).

Sometimes loose entanglement is an accidental finding during childbirth. It can be suspected by the appearance of deep decelerations at the end of the second stage of labor at the time of head eruption. Already after the birth of the head, the midwife notices the loops on the baby's neck.

Is it possible to recognize the violation on my own?

It is impossible to notice signs of entanglement without a special examination. If the baby is too mobile, and the stomach is very large, this is not a direct indication of the possibility of twisting it into the umbilical cord. Almost 100% of the fetuses for the entire duration of pregnancy can wrap around and get out of it on their own. And it doesn't come with any symptoms.

If childbirth began with entanglement with the umbilical cord, there will also be no symptoms if it is a single non-tight one.

Features of pregnancy and childbirth

What threatens the course of pregnancy the formation of loops on the neck of the fetus? Considering that most children are in this position at least once, it becomes clear that the consequences cannot be called tangible. Therefore, the management of pregnancy does not differ from uncomplicated.

Concerns can be caused by the identification of the incorrect position of the umbilical cord in the late period. If this happens after 38 weeks, then it is necessary to comprehensively assess the condition of the child and the possibility of childbirth through the natural birth canal.

In the case of diagnosing simultaneous breech presentation and cord entanglement, several additional parameters must be taken into account. By itself, it is not an indication for a caesarean section. But with entanglement, acute hypoxia can develop. This is due to the fact that with head presentation, immediately after the birth of the head, the midwife frees it from possible loops. In breech presentation, the buttocks are born first, and the head lingers in the pelvic cavity. Therefore, tension or clamping of the vessels of the umbilical cord and the development of oxygen starvation are possible.

The condition of the fetus is also taken into account. Cord entangled childbirth can occur in a fetus with intrauterine growth retardation. Therefore, a caesarean section can be performed: during the operation, children in serious condition are less stressed and have a better chance of a good recovery.

The greatest danger is entanglement with a short umbilical cord. A sign of such a condition may be protracted. Sometimes, due to vascular tension, placental abruption can occur, which threatens the death of the fetus and the development of massive blood loss in the mother with the formation of DIC. Fortunately, this complication is extremely rare.

Sometimes it is possible to combine the location of the loops on the neck with other anomalies:

twisting of blood vessels;
hypo- or hypertortuosity;
knot formation;
absence of an umbilical vessel or its hypoplasia;
improper attachment to the placenta.

In this situation, the combination with entanglement can lead to more severe consequences for the fetus. Malformation of the umbilical cord is rarely isolated. Often there are malformations or chromosomal abnormalities. Therefore, at the stage of diagnosis in pregnant women, the outcome of previous pregnancies and childbirth, as well as the state of the fetal site, are clarified.

If by the end of gestation there are a sufficient number of pregnancy complications or threats to the fetus and mother, then a decision is made to conduct a planned one.

Hospitalization before childbirth is provided if, according to the results of ultrasound, it is established:

multiple entanglement;
presentation of the umbilical cord or its vessels;
combination of fetal growth retardation with single artery syndrome.

If childbirth began to be conducted through natural routes, then a fetal CTG is mandatory for the timely diagnosis of deterioration. With the development of acute hypoxia, childbirth is completed by emergency caesarean section.

Consequences for the child

The consequences of entanglement of the umbilical cord around the neck are not dangerous if this happened during pregnancy: the child unravels on its own and there are no signs of deterioration in his condition. If the clamping of the vessels provoked acute hypoxia, then the complications for the child will depend on the time of occurrence of the pathological condition and medical actions.

According to various studies, 21-65% of all cases of entanglement cause hypoxia. And in 2.5% of all births with umbilical cord loops around the neck, fetal death occurs during or after birth.

Consequences for the child in the future may be associated with acute oxygen starvation. In this case, violations begin to appear already at the time of childbirth. A child experiencing oxygen starvation empties the intestines during childbirth. Meconium (original feces) enters the posterior amniotic waters and stains them in a greenish cloudy color, unpleasant flakes appear in them. The child swallows such water, which worsens his condition.

For 3-4 days, such children undergo neurosonography - ultrasound of the brain. The study is necessary to identify traces of cerebral edema, the presence of hematomas and hemorrhages. According to the results of the examination, a consultation with a neurologist and appropriate treatment can be prescribed.

Long-term effects can manifest in the form of neurological problems that are very difficult to treat:

epilepsy;
mental retardation;
encephalopathy.

In mild cases, there may be manifestations in the form of hyperactivity syndrome, persistent headaches, restlessness, inability to concentrate.

Is prevention possible?

Many mothers are concerned about whether the entanglement of the umbilical cord is visible on ultrasound. The doctor can notice this sign at any time, but it is almost impossible to avoid its appearance with the help of external influences. The task of the mother in prevention is to create conditions in which the development of polyhydramnios and fetal hypoxia is impossible:

Even at the planning stage of pregnancy, it is necessary to get rid of bad habits.
Treat chronic diseases. If they are classified as incurable, then try to stabilize the condition. This is especially true of diabetes, obesity, hypertension, in which it is a frequent companion of pregnancy.
Avoid infection, when signs of illness appear, do not self-medicate, but take antibiotics in doses and courses recommended by your doctor.
Eat right, get enough rest, exercise regularly.
Avoid stress. Nervous strain is always associated with excessive release of adrenaline. The female body and reproductive system are largely exposed to its action. Therefore, in pregnant women, on the background of stress, the uterus comes into tone, the child suffers from hypoxia, becomes restless and can change the position of the body several times.
See a doctor and follow his recommendations.

Perhaps, for any woman carrying a baby, hearing the phrase “entanglement of the umbilical cord around the neck of the fetus” at the next scheduled examination by a doctor is tantamount to perhaps not a sentence. And it is completely in vain: according to experts and as practice proves, entanglement, and even around the neck, does not carry any special super-danger in itself. Although certain risks, of course, are associated with such a situation. But, at the same time, current medicine and specialized specialists are very successfully able to reduce these risks to almost zero. And, of course, mothers will also require certain actions and patterns of behavior from “five minutes to a minute”.

The entanglement of the umbilical cord around the neck of the fetus - the general picture

The umbilical cord, as specialized literature indicates, is such a cord-connection between the placenta and the umbilical ring of a baby developing in the womb of a woman. It begins to form from the moment of conception, but the final shape takes shape closer to the 14th week of pregnancy.

The umbilical cord is the link between the mother and the baby, it performs the function of supplying oxygen, nutrients and nutrients to the baby from the body of the pregnant woman, as well as a channel for removing waste elements to the outside. So, two arteries and one vein are stretched along the umbilical cord: the substances necessary for maintaining life and development move along the arteries to the baby, but the carbon dioxide formed as a result of oxygen consumption and decay products are removed through the vein.

The length of the umbilical cord is normally approximately 60 cm, and the width is 20 cm. At the same time, the length of this temporary organ is determined genetically: it can be measured as 40-50 cm (and then it is considered short), and can reach all 70 cm ( then they talk about a long umbilical cord).

With the normal development of pregnancy, the umbilical cord in no way wraps around the baby - tightly tied to the cord, the baby calmly performs a variety of somersaults in the mother's tummy, similar to an astronaut in outer space. However, in certain cases and subsequently for individual reasons, loops and nodules can be created from the umbilical cord. And now, if the baby sticks his head into one of these loops, the doctors will talk about the entanglement of the neck of the fetus. True, even if this happens, it is likely that over time the baby both “wound” itself and “unwound” on its own: medicine records multiple cases in which a baby that is turning over and actively moving leaves the loop formed by the umbilical cord. But even so, almost every fifth woman in the position, in which at some stage entanglement of the umbilical cord was found, comes to the end of pregnancy with the same "violation". And safely gives birth, as a rule, independently and naturally.

This, of course, if we talk about a single, non-tight entanglement of the umbilical cord around the neck of the fetus. That's right: doctors divide umbilical cord entanglement into single and multiple, tight and not tight, isolated and combined (when the entanglement is fixed exclusively around the neck or there is an entanglement of the neck and limbs). Fortunately, in medical practice, the most common is just a single (less often - double) non-tight isolated entanglement, with which the doctor who delivers, in the overwhelming majority of cases, successfully copes - without surgical interventions, allowing a woman to give birth on her own without any harm to the baby.

Causes of the umbilical cord entwining around the neck of the fetus

The reasons why the umbilical cord may form around the neck of the fetus may be different. The most common of them is, as expected, not quite the right way of life and the emotional state of the expectant mother not shown during pregnancy. Among the factors that increase the risk of entanglement of the umbilical cord: smoking, sedentary lifestyle, lack of fresh air in proper quantities, frequent stress and nervous condition. So, nicotine and ignoring the need to stay in the fresh air limit the child's oxygen supply. A baby can also feel a lack of oxygen in the case when mommy neglects walks and exercises, gymnastics for pregnant women. All this in combination and individually provokes hypoxia and increased activity of the baby, which, moving vigorously in the mother's belly, runs the risk of first twisting a loop from the umbilical cord, and then completely falling into it.

Another reason that may be associated with the occurrence of entanglement of the umbilical cord is polyhydramnios during pregnancy. With a larger than usual amount of amniotic fluid, the baby gets the opportunity to somersault in the uterus much more freely, while the umbilical cord floats just as freely. This, in turn, causes a greater risk of the formation of a loop with its subsequent entanglement around the baby's neck.

The loop around the neck of the fetus can also happen due to the umbilical cord being too long than usual. As mentioned above, the length of the umbilical cord is genetically determined: if the mother of a pregnant woman carried her with an umbilical cord, the length of which was up to 70 cm, the same dimensions will most likely be characteristic of the woman now wearing it. And this factor, again, increases the risk of entanglement of the umbilical cord around the neck of the fetus.

Method of childbirth with entanglement of the umbilical cord around the neck of the fetus

With the method of conducting childbirth, when determining the entanglement of the umbilical cord around the neck of the fetus in a pregnant woman, the doctor will be determined based on what type of entanglement she is dealing with. To diagnose the entanglement of the umbilical cord, certain types of studies are resorted to, and it is detected, first of all, with the help of ultrasound. However, it should be borne in mind that a certain entanglement in itself does not mean anything: firstly, we have already said that over time the baby can “unravel” on its own. And, secondly, when an entanglement is detected, additional studies should be carried out in order to establish the nature and specifics of the entanglement - most likely, and more often it happens, the entanglement does not threaten anything serious for the crumbs.

So, in order to clarify the likelihood of entanglement of the umbilical cord in the area of \u200b\u200bthe neck of the fetus, an echographic study is performed. In order to determine the multiplicity of entanglement of the umbilical cord, the doctor will prescribe a pregnant woman with color Doppler mapping: this study displays how blood flows through the vessels. To exclude the possibility of hypoxia in a baby when the umbilical cord is entwined around the neck, a cardiotographic study (CTG) is used, with the help of which possible symptoms of entanglement in the form of a lack of oxygen are established. If signs of lack of oxygen do occur, a Doppler study is performed, the so-called dopleometry, during which the intensity of blood flow in the vessels is determined and it is established whether the baby receives enough oxygen. Please note that when diagnosing hypoxia, such a study must be carried out several times - the baby is constantly moving, and his condition is constantly changing.

In the case when the entanglement of the umbilical cord around the neck of the fetus does not pose any danger to the baby, the doctor takes delivery at the appointed time, while, as a rule, delivery occurs naturally. This is relevant if we are talking about a tight single or double entanglement of the umbilical cord. In such a situation, during childbirth, the heartbeat and the condition of the fetus are monitored every half hour, if everything goes on as usual, the doctor, when the baby’s head is shown, simply removes the loop from the neck and then takes delivery. If the baby's heart rate is not normal, which may indicate the development of hypoxia, the doctor usually resorts to stimulation to speed up labor.

The situation is somewhat more serious if a pregnant woman has a tight double or multiple entanglement of the umbilical cord around the neck of the fetus: usually in such a situation, hypoxia makes itself felt even at the stage of bearing a baby. In this case, in order to avoid the development of asphyxia and eliminate the risk of placental abruption, doctors resort to cesarean section for delivery, the operation is most often performed at 37 weeks. However, if there are indications in the event of a significant threat to the fetus and mother, the operation can be scheduled for an earlier date.

Prevention

Based on the foregoing, we can derive several recommendations, the observance of which will help reduce the risk of entanglement of the umbilical cord around the baby's neck. Of course, you should be outdoors as much as possible, do not give up moderate physical activity, walk more often and enjoy life. Any irritants that can negatively affect the emotional state of the expectant mother, causing stress or nervousness, are best minimized - the baby is very sensitive to changes in the emotional background of the mother.

In order to prevent irreparable consequences, of course, one should regularly, according to indications, visit the doctor who leads the pregnancy, and not ignore the examinations prescribed by him. If an umbilical cord entanglement around the baby's neck is detected, you should not panic: it is quite possible that before the birth, the child himself will “deal with” this entanglement. If this does not happen, perhaps the doctor leading the pregnancy will consider it necessary to prescribe special drugs that support uteroplacental circulation in order to prevent hypoxia.

The main thing when entwining the umbilical cord for mom, in any case, is to remain calm and not afraid of anything. This is exactly the case under which the saying about the fact that the devil is not so terrible as he is drawn fits. After all, with the successful conduct of childbirth, and, if necessary, with the implementation of emergency measures with a positive result, modern medicine, fortunately, successfully copes.