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How to find out if a child is entwined with an umbilical cord. Umbilical cord entanglement around the fetal neck - real danger or exaggerated anxiety

In 2017, for a period of 33 weeks, my baby stopped moving (at night), the pregnancy was proceeding with complications, I raised everyone to their ears, made a scandal. The manager was on duty, she came into the ward at night and talked to me and persuaded me to wait until morning, ktg showed "0", the daughter only hiccupped, the doctor listened to her stomach and said the heartbeat was bugged. In the morning, we gathered a consultation, I was reluctant to assert that I should be operated on urgently, because the fetus has a threefold entanglement, tight and intrauterine delay is developed, that day there was no movement at all. As a result, at 17:31 a girl was born, 1555 kg, 46 cm, with a three-fold tight wrap around the neck, hypoxia was. Thank God everything worked out, now her daughter is 1.4 years old, healthy, and runs. It seems to me, thanks to my instinct, my beloved survived! The son was born with a single tight entanglement around the neck, the umbilical cord was all taut like a string and twisted like a serpentine - the baby tumbled very violently in the belly.
They said about entanglement on a Doppler at 37 weeks and immediately asked not to worry - they might still somersault in the right direction and unravel.
I asked the doctor at a lecture at the Central Clinical Hospital about this situation - he said that it was not at all an obstacle to natural childbirth - both single and triple - the main thing is that the doctor responds in time when the situation worsens. She gave birth herself with a triple entanglement of the umbilical cord, plus there was a true knot. Until then, everything is fine and good to the last. How it was possible not to see this and let it into natural childbirth I do not understand. Bottom line: severe hypoxia, hospital instead of discharge, in short, remembering is scary to tears. Throughout the first year, the boy was nursed by massages, medications, etc. Now he is often very ill, physically weak, his muscles are weak. But thank God not cerebral palsy!
Conclusion: it would be a cesarean, there would be no such problems, it all began in childbirth. Maybe that's why they got off easily because there was no hypoxia during pregnancy. ZhK213p-ki what a horror ... I sympathize ...
How often did you get CTG? Or did they ignore the ktg? Yes, by the way, my girl was born with a triple tight entanglement around the neck and one tight one around the shoulder (armpit) and just above the umbilical cord from her neck 2 knots. neck (knot) and 2nd entanglement .. They wrote to observe the ultrasound in dynamics .. but in my LCD the doctors ignored my requests to give directions to the ultrasound (in 213 the ultrasound machine is broken!) .. As a result, the child suffocated at 39 weeks. She gave birth, knowing that she would not scream ...
With all my heart, I would like to wish Mr. Biyaslanova and the head of ZhK 213 p-ki to get away from gynecology, especially since we are not the first with such grief, even in the last few months!
And I strongly advise you, pregnant women, not to let the desired pregnancy take its course and carefully choose doctors and get them to fulfill their duties, because no one will replace and return your children and health to you! I can conclude that it depends on the length of the umbilical cord.
My son was born with a single tight entanglement around his neck, with a short umbilical cord, did not scream, he was brought to his senses with some kind of apparatus with oxygen, in a hill. I remember very well the moment when the doctor listened to the heartbeat during attempts and when it began to "suffer", he pressed on my stomach. I did it right away. So one more conclusion - it depends on the doctor, it depends very much !!!
Now the ultrasound has determined the entanglement around the neck, not tight. Now I'm afraid, maybe I know that this is how lucky
Who looked at the length of the umbilical cord on the ultrasound, determined correctly? On my 3m, the ultrasound showed 1 multiple entanglement, and on 4m 2 times, the doctors did not express the slightest excitement about this. Born in the end with a 1-fold, the only thing that the whites of the eyes were red, but this is a trifle. everything is in order with the child) Hello everyone.

The question has matured after the last ultrasound.
We have pelvic closeness and double cord entanglement. See a doctor only after a week.
Maybe someone has already come across this.

It is necessary to do gymnastics in order to help the child turn over according to the logic of things. But suddenly because of this, the umbilical cord on her neck will tighten? Now the Doppler is good, so not tight entanglement. What if, by my actions, I tighten the umbilical cord around her neck? After I myself successfully gave birth to a daughter, I found out that we had one tight entanglement around our neck. The main thing is not to panic and good doctors are there. Born in Seversk. Both my children were born with a tight single entanglement around the neck. And on the ultrasound, everything was in order. But everything is fine with the children, there was no asphyxia and now they are healthy) we were diagnosed with a single entanglement on the Doppler, 36 weeks are going on. I’m even worried so that it’s not spinning yet, and a single one doesn’t make me happy ((sometimes we also have anxious pushing, I’m even upset ... On the contrary, my child had an absolutely short umbilical cord with a large fetus, BUT the doctors did not see this during pregnancy ( mk the last ultrasound was at 32 weeks, when everything was normal), and I was not given a large fetus (but on the contrary they put a maximum of 3200 g). already 42 weeks pregnant, and I was sent to stimulate labor without prescribing an additional ultrasound, the cervix was ready and there was a small opening.In labor, fetal hypoxia immediately began, but the doctor pulled and did not even panic and pretended that everything was under control, everything is so My childbirth was the first and I certainly trusted the doctor ... As a result, after 10 hours of painful childbirth, already in the attempts (which for some reason began to stop), the child's pulse dropped to 40, then everyone of course ran, jumped , all mine The pregnant women began to study papers and ultrasounds, and they sent me to the cesarean ... I woke up without understanding anything, I asked - where is my son, they answer me in intensive care. Already when I was able to walk, I found out the reasons - she gave birth to 4.06 kg (instead of 3.2) / 55 cm, and at the same time the child had an umbilical cord only 15-20 cm (this is called the Absolutely short umbilical cord) - such parameters are a direct indication for cesarean ! My son suffered a serious birth trauma - in addition to hypoxia during childbirth, cerebral hemorrhage and torticollis (he was large and pulled his neck out). Of course, this did not pass without a trace, we treat him from birth, but there is still a delay in psycho-motor and speech development. Thank God they cared for me, otherwise my son would not have survived, and if they had cured me right away, then I now had a healthy child ... Hello everyone, my daughter had a 3-fold entanglement, prescribed pills to the hospital, but did not drink and did not worry about on this occasion - I felt that everything was normal - and I did not go to the hospital, I gave birth to myself normally, the doctors did not even help, the shift was absolutely bad, but maybe it’s for the better - so the main thing is to feel like the baby is there - if something is wrong, then to the doctors and not worry and, most importantly, rely on yourself more on your own strength and negotiate with the baby better - the main thing is not to lose faith in your children and love for them, and there are all sorts of doctors. site.

Any woman, hearing from a doctor at a scheduled ultrasound that her child has been observed to be entwined with an umbilical cord, begins to worry and worry, because there are many rumors about such a phenomenon. There is even a sign according to which the expectant mother should not be engaged in knitting or sewing, otherwise she will face such a problem.

Many people advise against exercising during pregnancy to avoid the cord around the fetus's neck. However, all signs and superstitions should not be trusted, since there is not a grain of truth in them.

Medical practice shows that do not be afraid of entanglement of the umbilical cord... Many women face this phenomenon. Modern doctors make every effort during the birth process in order to protect the child from negative consequences, for example, asphyxiation.

Reasons for the entanglement of the umbilical cord around the neck of the fetus

The umbilical cord is the main link that connects a woman and her unborn child, allowing him to receive the necessary nutrients. The umbilical cord is formed at the time of conception and only at 13-14 weeks does it take its final form.

The umbilical cord entanglement around the neck of the fetus can occur for the following reasons:

  • long umbilical cord (more than 70 cm). Because of this, loops can form in the uterus around the baby's neck. The length of the umbilical cord depends on hereditary factors;
  • polyhydramnios. It creates more room for the fetus to move. The umbilical cord floats absolutely free. This fact increases the likelihood that entanglement will occur;
  • hypoxia. Due to the lack of oxygen coming from the mother through the umbilical cord and placenta, the baby may begin to move excessively and fall into the formed loop.

The above reasons do not always lead to entanglement. Sometimes this can happen purely by accident.

Umbilical cord entanglement is detected on ultrasound... The identified loops do not mean anything yet. First, a child before delivery can not only "get entangled" in the umbilical cord, but also "untangle" itself. The loop found on ultrasound may not last long and not affect the condition of the fetus. Secondly, not every umbilical cord entanglement around the neck is dangerous. Only 10% of such cases end in various complications.

The entanglement detected by ultrasound should be additionally examined. Thanks to color Doppler mapping, which shows the direction of blood flow, it is possible to count the number of loops on the baby's neck, that is, in this way, the frequency of entanglement is determined. Most often, there is a single entanglement of the umbilical cord around the neck.

With the help of cardiotocography, it is possible to find out whether the existing loop leads to hypoxia. Further, if there are signs of a lack of oxygen, an ultrasound scan called "dopplerometry" is performed, which allows you to check the intensity of blood flow in the vessels of the umbilical cord, to find out if the baby in the womb is getting enough oxygen.

If hypoxia is suspected, all studies are carried out several times, since the fetus moves and its condition is constantly changing.

Consequences of the entanglement of the umbilical cord around the neck of the fetus

Until almost 37 weeks, doctors do not focus on the cord entanglement, unless it threatens the child. Before giving birth, it can appear and disappear several times.

The danger to the baby is tight multiple or double umbilical cord entanglement around the neck. Because of it, hypoxia can occur. Oxygen deficiency becomes the cause of intrauterine development disorders, the work of the whole organism.

Metabolic processes change, adaptive capabilities decrease, and the nervous system is damaged. The degree of the damaging effect of hypoxia depends on the duration of oxygen deficiency.

Problems with the blood supply to the tissues of the baby can be caused by strong squeezing of the limbs or neck. Tight pulling on the umbilical cord can lead to premature placental abruption and sudden labor.

What should the expectant mother do if the fetus is found to have an umbilical cord entanglement?

The question of what to do when the umbilical cord is entwined around the fetus's neck is of interest to many pregnant women.

Firstly, a representative of the fair sex in a position, having learned about the existence of an entanglement in her baby, shouldn't worry... Stress and anxiety will negatively affect the child.

Secondly, in order to avoid dire consequences, it is necessary follow all recommendations doctor. No need to skip scheduled examinations. Thanks to them, you can find out in time about violations in the condition of the baby and prevent the occurrence of undesirable consequences.

Doctors sometimes in order to prevent hypoxia prescribe special drugs aimed at maintaining the uteroplacental circulation. In certain cases, health care providers may offer a woman early hospitalization.

With repeated entanglement of the umbilical cord around the fetus's neck at 38-39 weeks, a planned cesarean section is performed. Natural childbirth in such situations is unacceptable, as it can pose a danger to the baby. If the fetus has hypoxia that threatens its life, an emergency caesarean section may be prescribed by the doctor.

In conclusion, it is worth noting that the umbilical cord entanglement is not as terrible an event as it seems. The serious consequences of entangling the umbilical cord around the fetus's neck can be avoided by visiting the doctor according to the plan and following his recommendations.

It is also worth walking in the fresh air as often as possible, reconsidering your lifestyle, and giving up bad habits. This will reduce the risk of entanglement.

If, nevertheless, he was found, then there is no need to be afraid of anything. In most cases, such situations are harmless. A single entanglement with the umbilical cord around the neck or twice will not threaten the child until the blood flow is disturbed.

Such cases are very rare and can only appear during childbirth. However, professional doctors will not let the trouble happen. Modern methods of research and control will give birth to an absolutely healthy baby.

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The umbilical cord is the connecting organ between the mother and the fetus, which connects the two organisms during intrauterine development. It includes the arteries that facilitate the removal of metabolic products and carbon dioxide from the fetus along with the mother's blood and the vein - an important blood vessel that provides the fetus with nutrients, oxygen and minerals.

The umbilical cord has a small diameter - about 1.5 cm. Inside the organ, blood vessels are spirally located, which can painlessly stretch, straighten or twist without disrupting the blood flow. After birth, the umbilical cord is cut off and the child begins an independent life.

Sometimes during pregnancy, the umbilical cord is twisted around the fetus (more often around the neck), which threatens the development of a number of complications in its development, and can also lead to the death of the child. To avoid negative consequences, it is important to know what factors can provoke pathology, how it manifests itself and how to prevent it.

Reasons for entanglement of the fetus

The umbilical cord entanglement of the fetus is quite common in obstetrics and is diagnosed in every third pregnant woman. Most often, pathology occurs in the neck and limbs. The likelihood of entanglement is much higher if the umbilical cord is long, however, it is impossible to predict the size of the organ.

The main reasons for the umbilical cord entanglement of the fetus are:

Signs and diagnostics of the umbilical cord entanglement around the fetus

Outwardly, the entanglement of the fetus with the umbilical cord practically does not appear. A pregnant woman can only notice increased fetal hyperactivity, frequent tremors and anxiety of the child.

Fetal entanglement is detected, usually at 18 or 32 weeks of gestation during a routine ultrasound examination. If a pathology is detected, the doctor prescribes additional research methods that will assess the child's condition:

  • Dopplerometry - performed to analyze the blood flow through the vessels of the umbilical cord.
  • CTG - assessment of the fetal heartbeat. A change in heart rate indicates a lack of oxygen.
  • Control of fetal movements.

If, after all the above studies, the doctor did not find pathological changes in the life of the fetus, then the pregnant woman has nothing to worry about. It is enough to lead a healthy lifestyle, have a good rest and visit regularly for examination and control over well-being and health.

Complications and consequences of fetal entanglement

If a single entanglement is observed, then it, as a rule, does not pose a threat to the life and health of the fetus. In some cases, the child independently got out of the loop. However, sometimes there is a high risk of complications, especially if the umbilical cord is very long or there is a twofold (or more) entanglement around the fetus, in particular around its neck.

This pathology, as a rule, provokes the development of hypoxia. Lack of oxygen disrupts the intrauterine development of the fetus, in particular, negatively affects the formation of the brain and can lead to disability in the future. Hypoxia disrupts the functioning of all organs and systems of the child, metabolic processes are inhibited, and a violation of the central nervous system occurs. The longer fetal hypoxia persists, the worse the consequences will be.

If the entanglement is observed around the limbs, then there is a risk of impaired blood flow in the arms and legs, which can lead to tissue necrosis. In addition, as a result of strong tension on the umbilical cord, early detachment of the placenta and premature birth are possible.

The maximum risk of complications arises during the birth of the baby, when the umbilical cord can transmit to the neck during the movement of the fetus through the birth canal. With tight or repeated entanglement, conduction is indicated. Otherwise, the outcome of childbirth depends on the qualifications and care of the doctor, who must regularly monitor the fetal heartbeat. In case of changes in heart rate or other signs of acute hypoxia or asphyxia, immediate surgery is recommended.

Prevention of the umbilical cord entanglement of the fetus

Every pregnant woman wants to know how to avoid cord entanglement and what preventive measures exist. First of all, gynecologists recommend leading a healthy lifestyle and carefully following all the advice of doctors. The last point includes a regular visit to your obstetrician-gynecologist, undergoing a planned ultrasound and CTG, taking vitamins, and, if necessary, hormonal drugs (for example) and anticoagulants. This will preserve the pregnancy and carry a healthy baby.

In addition, experts recommend avoiding stressful situations, limiting the pregnant woman as much as possible from emotional distress and excessive physical exertion. At the same time, moderate physical education will only benefit. Gynecologists recommend that pregnant women do yoga, swimming, and also regularly and a lot of walking in the fresh air. In addition, women during the period of bearing a child are shown performing breathing exercises and.

Compliance with simple recommendations will avoid fetal hypoxia, which is often the main cause of increased fetal activity and leads to entanglement. In addition, this will significantly improve the well-being of the pregnant woman, and, accordingly, will ensure the normal development and formation of the fetus.

This condition, detected by ultrasound, is diagnosed in every third pregnant woman. If it became known about the entanglement in the early stages, then there is no reason for excitement yet. At this time, the fetus is still very small, it has a lot of room for active movements. He floats, rolls over. And sometimes, several times a week, it first falls into the loop from the umbilical cord, and then just as easily gets released from this loop. Measures should be taken if the entanglement is found closer to childbirth, when the child has already taken its final position before birth.

Question 2. Why does the entanglement of the umbilical cord occur?

The umbilical cord is a special organ that connects the placenta to the fetus. The formation of the umbilical cord begins at 11 weeks. By the time of delivery, its thickness reaches 2 cm: at this time, it consists of two arteries and one vein. The arteries carry the fetal blood to the placenta, saturated with carbon dioxide and metabolic products. And through a vein, blood, enriched with oxygen and nutrients, enters the child. The vessels of the umbilical cord are surrounded by a special substance - warton jelly. This jelly-like substance prevents them from being squeezed.

Normally, the length of the umbilical cord is from 40 to 70 centimeters. If it is longer, then in late pregnancy, loops of the umbilical cord can form, into which the head, arm, leg of the child or his torso can fall. The size of the umbilical cord does not depend in any way on the external conditions or the woman's lifestyle. This is a hereditary factor.

Another factor that increases is polyhydramnios. In a large volume of amniotic fluid, the fetus continues to actively move in later stages. Polyhydramnios is a complication of pregnancy. To identify its causes, you need to consult a gynecologist.

Some babies are even more active in utero than others, and this increases the risk. Often, mobility is associated with the characteristics of the child's character, which are manifested even before childbirth. But it happens that it is due to chronic hypoxia (oxygen starvation of the fetus). When there is not enough oxygen, the fetus begins to worry. The stress hormone cortisol is produced in his body. The heart begins to contract more often in order to saturate the entire body with a small amount of oxygen. Against this background, motor activity increases and, as a result, the risk of entanglement of the umbilical cord.

One of the main reasons for insufficient oxygen supply to the fetus is smoking during pregnancy. Under the influence of nicotine, blood vessels narrow, normal blood circulation is disrupted. This happens not only in the mother's body, but also in the fetus's body, since nicotine easily passes through the placental barrier. Smoking increases the risk of many complications, fetal hypoxia is just one of them.

Hypoxia is often provoked by the wrong lifestyle of the expectant mother, violation of the regime, physical inactivity. For a child to have enough oxygen, a woman must receive enough oxygen herself. It is necessary to ventilate the room, walk in the fresh air, move. Of course, we are not talking about serious physical activity, but special exercises, swimming and walking at a calm pace will only benefit.

Hypoxia of the fetus may occur due to the nervousness of the expectant mother. When a woman is worried, stress hormones are released into her bloodstream: adrenaline and cortisol. They pass the placental barrier and get to the fetus, as a result, the baby begins to move more than it should.

Fetoplacental insufficiency can also be the cause of hypoxia. It is provoked by hypertension, blood diseases, including thrombophilia, as well as diabetes and kidney disease. Preeclampsia (gestosis) and intrauterine infections are also dangerous.

Question 3. What types of entanglement are there?

The most common and safest case is a single, loose entanglement. Although it happens that the umbilical cord has formed not one, but two or even three loops around the fetus. To find out exactly what kind of entanglement you have to deal with in each specific case, one ultrasound is not enough. A woman is prescribed color Doppler imaging (do not confuse it with Doppler). This technique allows you to see the direction of blood flow in large vessels and, from this data, determine exactly how many loops the umbilical cord has formed. In some cases, it is also required to conduct a three-dimensional echographic study.

Question 4. Can the fetus suffocate if the umbilical cord wraps around the baby's throat?

The fetus cannot suffocate either during intrauterine development or during childbirth. The lungs begin to work only after the baby is born and his oral cavity is free of mucus. Until this moment, the respiratory tract is not involved in providing the baby with oxygen. Therefore, it is not so important whether the umbilical cord wrapped around the throat, arm, leg or torso. Important . It is through her, and during intrauterine development, and during the birth itself, the fetus receives oxygen and nutrients. As long as the blood flow in the umbilical cord is not disturbed, the child does not suffer, even if his throat is entwined. A dangerous condition is when the lumen of its vessels narrows from tension or clamping of the umbilical cord. In this case, the fetus experiences a lack of oxygen - hypoxia.

Question 5. Does entanglement affect the intrauterine development of the fetus?

To understand if there is a threat, cardiotocography (CTG) is prescribed. During this study, using an ultrasound sensor, the fetal heartbeat, its movement, and also the contraction of the uterus are recorded. The study is carried out for all expectant mothers, starting from 33 weeks of pregnancy. If, during movements, the number of heartbeats decreases, then there is a danger to the child's health. In this case, doppler ultrasound is also done. It makes it possible to assess the nature and speed of blood flow in the vessels of the placenta and umbilical cord: if these indicators are normal, then everything is in order, and the pregnant woman only needs to accurately follow all the doctor's prescriptions. Usually, when entwining, dynamic observation is prescribed. This is necessary in order to suspect violations in the baby's condition in time and take the necessary measures as soon as possible. Research can be carried out once every 4-7 days, or it can be done every day: it all depends on the condition of the fetus. If daily observation is required, then the woman is usually offered to go to the pregnancy pathology department.

If the dopplerometry showed abnormalities, this indicates that the child is already experiencing hypoxia. This condition is acute and chronic. Acute hypoxia is an indication for emergency delivery. Simply put, the child needs to be rescued urgently. But this is still a great rarity. Chronic hypoxia is more common. Insufficient oxygen supply can lead to changes in metabolic processes, impaired intrauterine development, and a decrease in the adaptive capabilities of a newborn baby. The nervous system is especially sensitive to hypoxia. The longer the fetus experiences a lack of oxygen, the more pronounced all these complications can be. To eliminate undesirable consequences, doctors can prescribe to a woman drugs that support uteroplacental blood circulation. They are also usually recommended for the prevention of hypoxia.

Question 6. Are there ways to untangle the umbilical cord entanglement while still in the womb?

No medical manipulations will help free the fetus from the loop. And if some "healers" promise to do this by some "folk" methods unknown to medicine, you should not believe them. There are no such methods. The doctor may prescribe exercises related to changing the position of the body of a pregnant woman, such as "Kitty". In the starting position, you need to get on all fours with support on your palms and knees. Keep your head straight. Take a deep breath, tilting your head down, while bending your back up. Slowly return to starting position. Do not hold your breath. The well-known "Bicycle" is also prescribed. Pregnant women need to do it at a leisurely pace. Six or nine "turns" will be enough. Another good exercise is done against a wall. Starting position: lying on your back, arms along the body, legs bent at the knees. Raise your legs, rest them against the wall. Then, while inhaling, continuing to rest, spread your legs. On exhalation, slowly return to the starting position. Repeat 4-5 times. The essence of the exercises is that with a change in the position of the body of a pregnant woman, the position of the fetus can also change, and it can independently free itself from the loop. But it's better not to expect a 100% result from them. And do not get upset if it became clear that special exercises did not help. It's much better to just calm down. The less the expectant mother is nervous, the less the child will worry. This means that the risk of tightening the loop will decrease.

Question 7. Is an umbilical cord entanglement an indication for a cesarean section?

A single, loose, in itself, most often does not become an indication for operative delivery. But in this case, the entire period of childbirth requires careful monitoring of the child's condition. In case of acute hypoxia, an emergency caesarean section is performed.

During contractions, the baby's heartbeat is monitored using fetal CTG. This allows you to understand how the baby reacts to sharp contractions of the uterus. In the second stage of labor, the risk of hypoxia increases. Therefore, the baby's heart is listened to every 3 minutes and after each attempt with the help of an obstetric stethoscope - in other words, a tube. If your heart rate is abnormal, your doctor may give stimulation to speed up labor. In some cases, episiotomy is also used - dissection of the perineum. If the umbilical cord has wrapped around the throat, then the obstetrician releases it from the loop immediately after the birth of the head of the crumbs. At this moment, you cannot push. The doctor will definitely warn about this.

If the entanglement is tight and the umbilical cord is significantly stretched, the tactics of delivery will be different. In this case, the risk of acute hypoxia in natural childbirth is very high. The reason is that when the child passes the birth canal, the umbilical cord is stretched even more, the lumen of its vessels is significantly narrowed. There is another danger as well. The loop makes the umbilical cord shorter. This length may not be enough to allow the fetus to move freely through the birth canal. There is a threat of premature placental abruption. Normally, it separates from the wall of the uterus after the baby is born. Premature placental abruption is one of the most serious complications of pregnancy and childbirth. This is a very dangerous condition for a child, since it is through the placenta that he receives oxygen until the moment he begins to breathe on his own. To minimize the risks in the event of tight entanglement, a woman is usually offered a planned caesarean section.

Question 8. Is it possible to somehow prevent the entanglement of the umbilical cord?

Quitting smoking (including passive smoking), the correct daily routine, and the absence of stress will help to avoid hypoxia in the fetus, and therefore, to reduce the risk of entanglement of the umbilical cord. The expectant mother needs to register for pregnancy at a medical institution as early as possible, undergo all the necessary examinations on time and follow the doctor's recommendations. It is especially important to be under constant supervision if there is a history of diseases that increase the risk of developing hypoxia.

If a knot has formed ...

Many expectant mothers are interested in whether the condition in which the umbilical cord is tied into a knot is dangerous? Distinguish between true and false knot. What appeared to be a knot during the first ultrasound may actually turn out to be a varicose expansion of one of the vessels or a twisted section of the umbilical cord. There is no threat to the child's health in this. A true knot is very rare. It occurs if the umbilical cord first formed a loop, and then the fetus swam through this loop. There is no way to prevent the formation of a true node, since neither the woman nor the doctor can control all the movements of the fetus. The knot itself is not dangerous unless tightened tight. When tightly tightened, the vessels of the umbilical cord can be pinched. This leads to impaired blood flow and, as a result, to hypoxia in the child. To understand if the node is a threat, the doctor also prescribes a Doppler test.

Do not raise your hands up?

Many women, especially the older generation, are still convinced that entanglement occurs due to the fact that a pregnant woman raises her arms high, for example, when hanging clothes or curtains. From this, the fetus allegedly turns over and becomes entangled in the umbilical cord. All this has nothing to do with reality. No modern research has confirmed that raising arms is in any way harmful to a child. This pose is completely natural and cannot lead to undesirable consequences.

The watch was just beginning when an insistent call rang out in the emergency room. A pregnant woman was standing on the threshold of the maternity hospital, accompanied by her husband and a middle-aged woman (mother-in-law, as it turned out during the conversation). They were all very excited ...

Is it worth worrying?

As it turned out, the woman arrived after undergoing an ultrasound examination at the antenatal clinic. Without unnecessary preambles, Yulia (that was the name of the pregnant woman) said: "I agree to a cesarean section, the relatives will now bring the necessary things." "Wait, wait, let's figure it out first," I replied and invited Julia to the examination room. It turned out that Yulia's gestational age at the moment is, and the ultrasound scan revealed that the umbilical cord is entwined around the fetus's neck. This fact worried the pregnant woman and her relatives very much, so they decided to go to the maternity hospital without delay.

The umbilical cord (or umbilical cord) is an organ that functions only during pregnancy and performs an extremely important function of communication between the mother and the fetus. The main component of the umbilical cord is the vessels - one vein through which arterial blood flows from the mother to the fetus, delivering all the substances and oxygen necessary for vital activity, as well as two arteries through which the venous blood of the fetus removes waste products and carbon dioxide into the mother's body.

The vessels of the umbilical cord are surrounded by a special jelly-like substance - warton jelly, which, due to its consistency, plays an important protective role - it protects the vessels from being squeezed. On average, the length of the umbilical cord is 50-60 cm, the thickness is 1.5-2 cm. If the length of the umbilical cord is more than 70 cm, it is considered long, if less than 40 cm, it is considered short. An increase in the length of the umbilical cord can lead to various pathological conditions, such as entanglement of the umbilical cord around the neck, trunk, fetal limbs, the formation of umbilical cord nodes, which, in turn, are divided into true and false. It is important to note that about a fifth of all babies born are born with an umbilical cord entanglement, and this does not always lead to disturbances in the intrauterine state of the fetus. The fact is that, being in the uterus, until the moment of birth, the baby does not breathe with lungs, therefore, squeezing the neck, which is always very frightening for expectant mothers, is not dangerous for him. Problems can arise in cases where blood flow is disturbed due to tension or squeezing of the umbilical cord due to repeated or tight entanglement.

What did the ultrasound show?

According to the data of ultrasound examination, it was found that there are no signs of hypoxia (i.e., lack of oxygen) in the fetus; when performing dopplerometry (a study in which the blood flow rate in the main vessels of the uterus and the fetus is determined), no violations of the uteroplacental circulation were detected. The fetus corresponds to the date, there are signs of a single entanglement of the umbilical cord around the fetus's neck. “Wow, when they did an ultrasound scan, they didn't say anything about the entanglement,” said Yulia. "It is quite possible that it did not exist then, and it is not at all necessary that it will remain until the birth," I replied.

Indeed, in practice, there are often cases when, according to ultrasound, an entanglement of the umbilical cord was found, and the child was born without it. This may be, firstly, due to the fact that the umbilical cord loops according to ultrasound were near the fetal neck, but there was no entanglement as such, and secondly, during fetal movements, the cord entanglement was self-eliminated (of course, this happens, as a rule, with a single entanglement).

The predisposing factors for the formation of an umbilical cord entanglement are increased fetal motor activity, which may be caused by intrauterine hypoxia (i.e., lack of oxygen supply), polyhydramnios, increased adrenaline in the mother's blood due to stress. Naturally, in the overwhelming majority of cases, a long umbilical cord leads to entanglement of various parts of the fetus.

We make a diagnosis

To make sure that Yulia's baby is feeling well, we made a cardiotocogram (CTG) recording. With CTG, the fetal cardiac activity is recorded, which is an informative indicator of its intrauterine state. For this, the expectant mother had a sensor attached to her belly, which was connected to the device. Julia lay on her side on the bed for 30 minutes, and the device recorded the fetal heartbeats. No pathological changes were revealed during CTG. Together with Yulia, who had already calmed down a little and had become cheerful, we went out to the waiting relatives. I explained to them that in this situation, when we have a premature pregnancy, a completely normal intrauterine state of the fetus, only because of the entanglement of the umbilical cord, it is inappropriate to deliver urgently. The reassured pregnant woman with her husband and mother-in-law went home.

To fully determine the intrauterine state of the fetus, it is necessary to conduct a complex of studies, which includes:

  • ultrasonography, in which it is possible to see or suspect the entanglement of the umbilical cord around the neck or other parts of the fetus, since in some cases it is very difficult to distinguish whether the umbilical cord loops are near the fetal neck or if there is an entanglement: in this study, we do not have the possibility of a volumetric image that allows us to view the object from all sides - for example, look back. It should be noted that it is not possible to determine the length of the umbilical cord according to ultrasound data during pregnancy, since the umbilical cord is, as it were, "folded" in a tight space between the baby's little body and the wall of the uterus;
  • dopplerometry- a method that allows, firstly, to accurately determine whether there is an umbilical cord entanglement, since the movement of the blood flow is displayed in a color image, and secondly, to diagnose the blood flow velocity in various vessels of the uteroplacental complex;
  • cardiotocography, which allows you to determine not only the heart rate of the baby, but also his reaction to his own movements (when recording CTG during pregnancy) and to an increase in the tone of the uterus (during childbirth), which allows you to find out how well the fetus is feeling at the moment.

If, after carrying out the entire complex of examinations, it is determined that the baby feels satisfactory, then only the fact that the umbilical cord is entwined is not an indication for prompt delivery. Such indications can arise either with the existing signs of oxygen deficiency (fetal hypoxia), or with a combination of cord entanglement with other indications for cesarean section.

Umbilical cord entanglement around the fetal neck: will there be an operation?

About a month passed, I had already managed to forget about that visit of Yulia, when on the next watch I was invited to examine the arriving pregnant woman. Arriving at the emergency room, I again met with Yulia and her husband. It turned out that for 3 hours the woman was worried about pulling pains in the lower abdomen, which became regular and more intense an hour ago. On examination, it was revealed that Julia entered the labor process - the cervix was open by 3 cm, the amniotic fluid was not poured out.

The woman in labor is 24 years old, Julia's real pregnancy is the first, there were no gynecological diseases, abortions and miscarriages. The last ultrasound was performed in, according to his data, the entanglement of the umbilical cord around the neck of the fetus is preserved. The estimated weight of the fetus is 3400, the gestational age at the moment. With auscultation (listening to the fetal heart sounds through the anterior abdominal wall with a special tube - an obstetric stethoscope), the fetal heartbeat is clear, rhythmic, the heart rate is 144 beats per minute, which is normal (the normal fetal heart rate is 120-160 beats per minute). Contractions at the time of arrival of weak force, after 10 minutes, lasting 30 seconds. After filling out the birth history and placing Yulia in the prenatal ward, she was immediately recorded with CTG (cardiotocogram). Conducting CTG during labor is an absolutely harmless and informative method for determining the intrauterine state of the fetus and its response to the contractile activity of the uterus, which determines the tactics of labor management for each patient - she can give birth naturally or in the interests of the fetus, delivery by cesarean section is necessary. In the case of Yulia, given CTGs, it depended on which option for the management of childbirth would be chosen. Fortunately, no pathological changes were detected on CTG. Julia really wanted to give birth herself. Since she had every chance for this, they decided to carry out childbirth through the natural birth canal under close monitoring of the state of the fetus.

When the umbilical cord is entwined, it is very important to monitor both the condition of the fetus and the course of the birth process in the mother, because it is during childbirth that the entanglement of the umbilical cord can lead to a number of complications.

The most common complication that occurs when the umbilical cord is entwined is the appearance of fetal hypoxia, which occurs as a result of squeezing the vessels of the umbilical cord when it is pulled or tightly wrapped around the body, neck or limbs of the child. Quite often this happens at the moment when the fetus begins to move along the birth canal.

With repeated entanglement of the umbilical cord, a short umbilical cord is formed, which, firstly, can prevent the fetus from moving along the birth canal, and, secondly, stretching with each contraction, can lead to premature detachment of the placenta from the uterine wall (normally the placenta is separated from the uterine wall after the birth of the fetus), which leads to the need for urgent surgical delivery.


In rare cases, with repeated entanglement of the umbilical cord around the fetal neck, complications such as extensor insertions of the fetal head can occur, which can make it difficult to give birth to a child naturally. The fact is that with normal insertion of the fetus into the mother's pelvis, the head is in a state of moderate flexion (in this case, the chin of the fetus is pressed against the chest, which allows the head to correctly insert into the pelvic cavity and pass without difficulty through the birth canal in the most "advantageous" that is, in the smallest size) - in this position, it passes through the birth canal in the smallest, most convenient size. The loops of the umbilical cord located on the neck prevent the baby's head from bending, which leads to the fact that the head is installed in the mother's pelvis not with the back of the head, but with the crown, forehead or even face, which can lead to significant difficulties in the birth of the fetus and, as a result, to its traumatization.

In fairness, it must be said that the above complications occur quite rarely and, with timely and correctly provided assistance, do not lead to adverse consequences for the mother and fetus.

Childbirth with entanglement of the umbilical cord

4.5 hours have passed since Julia was admitted. The contractions quickly became more frequent, became stronger and more prolonged. During a second examination on the chair, it was revealed that the cervix opened by 7 cm, an amniotomy was performed (instrumental opening of the fetal bladder) - 250 ml of clear transparent amniotic fluid was poured out. According to CTG and regular listening to heart sounds with an obstetric stethoscope of the fetus, his condition was satisfactory. Julia refused the proposed medication anesthesia, saying that she felt quite normal.

When the umbilical cord is entwined, the principles of labor management have a number of important points:

  • the fetal state of the fetus is carefully monitored by CTG and by listening to the fetal heartbeat through the anterior abdominal wall;
  • when signs of fetal hypoxia appear, tactics will depend on the period of labor when these signs appeared. If signs of fetal suffering appear in the first stage of labor (the period of cervical dilatation), when the end of labor is still far away, a cesarean section is performed, if fetal hypoxia is detected in the second period (the period of fetal expulsion), then for the early completion of labor when the head erupts, a dissection is performed perineum (episiotomy), at the birth of the head, without waiting for the birth of the entire body of the child, the loops of the umbilical cord are removed if possible.

Happy ending

It was already deep night, of all the women in childbirth in the maternity ward, only Julia remained - all the rest had already safely given birth. Yulia's cervical dilatation was complete, she walked around the ward, noting that during the contraction she felt a moderate feeling of pressure on the rectum. "This is very good, it means that the baby's head gradually began to sink into the pelvis, attempts will soon appear, and we will give birth," I said.

After 15 minutes, the woman in labor developed a distinct desire to push during the contraction. On the monitor of the CTG apparatus at the time of the contraction, alarming signs appeared - with an increase in the tone of the uterus, the fetal heart rate decreased. It was necessary to finish labor as soon as possible and remove the baby, fortunately, the fetal head was already close to the plane of the exit from the pelvis.

Intravenous through a special catheter was carried out the introduction of a drug that enhances the contractile ability of the uterus. Julia was on the delivery table, and the head of the fetus moved along the birth canal quickly enough. The woman in labor was pushing with all her might and unquestioningly followed the commands of the midwife. Already from the birth canal, the back of the baby's head appeared, and after the dissection of the perineum, which Julia did not even feel, the head was born and the fetal neck entwined with two loops of the umbilical cord. The midwife deftly and quickly removed the umbilical cord from the cervix, and the baby was born completely. But the surprises did not end there - the umbilical cord that followed the baby was more than 1 meter long, and in the middle third of it there was a true umbilical cord knot! The newborn girl screamed loudly and was handed over to a pediatric neonatologist.

The nodes of the umbilical cord are classified as true and false. A false knot is a thickening of the umbilical cord due to varicose veins or a local increase in the thickness of Wharton's jelly and got its name only for its external resemblance to the knot; it does not pose any danger to the baby. A true knot forms early in pregnancy, when the fetus is still very small, and the relationship between the size of the fetus and the uterine cavity allows it to slip into the umbilical cord loop. The predisposing factor for the formation of a true umbilical cord knot is an increase in its length, the reasons for this deviation have not yet been precisely established, but a genetic predisposition is clearly traced (if the mother had a long umbilical cord, it is likely that the daughter will have this feature during childbirth). The danger of the knot is that it can tighten and lead to a decrease or cessation of the blood supply to the fetus, but, fortunately, this did not happen, and the true knot was only a "find" that did not adversely affect the condition of the fetus. Since it is extremely difficult to establish the presence of an umbilical cord node during pregnancy, therefore, as a rule, they will find out about its presence after delivery, as happened with our patient.

The girl's weight is 3450 g, her height is 51 cm. The Apgar score immediately after birth is 7 points, after 5 minutes - 8 points. On the 5th day after the birth, Dasha (that was the name of the baby) and her mother were discharged home.

Nina Abzalova, obstetrician-gynecologist, Ph.D. honey. sciences,
Altai State Medical University, Barnaul

Comment on the article "Insidious loop. Umbilical cord entanglement"

Umbilical cord entanglement. Analyzes, studies, tests, ultrasound. Pregnancy and childbirth. Was today at an ultrasound scan - identified a single entanglement. Something I don’t understand - it will unravel back. But at 37, one round around the neck, two rounds around the abdomen and multiple rounds around the lower leg.

Discussion

they put an entanglement around me, but the doctor explained that there (in addition to what they already wrote to you at the bottom, it can unravel) 2 parameters are important:
1) single entanglement or double
2) around something around the throat / abdomen, etc.
I had a one-shot, not tight, from neck to shoulder. It's not scary.
here the sister had a 2-fold around the neck, the doctors did not like it, and with a narrow pelvis, she had a KS on a planned basis

I’ll just morally support the umbilical cord, I gave birth from an older one with multiple entanglements, not knowing about it before giving birth ...

Childbirth when the umbilical cord is entwined around the neck of the fetus. Print version. 4,3 5 (663 ratings) Rate the article. Is natural childbirth possible with pelvic children? Children with an umbilical cord entwined around the neck very often died - mainly due to the lack of proper experience of midwives.

My friend had an ultrasound scan today, 24 weeks, 1 time entanglement, tell me is it dangerous? can oxygen not be supplied? than it is dangerous In rare cases, with repeated entanglement of the umbilical cord around the neck of the fetus, such ...

Umbilical cord entanglement. Fetal development. Pregnancy and childbirth. My daughter had 1 umbilical cord entanglement around her neck. Thank God that everything worked out. My niece had a double umbilical cord around her neck, and she was born like that.

Discussion

let him try to talk good with the child, sometimes they themselves turn and take off the entanglement (especially since he is still sitting with his booty). exercises can and can be done, but I would be afraid - you can turn it over, but suddenly it goes through the other side and winds the second entanglement ...

My daughter had 1 umbilical cord entanglement around her neck. Thank God that everything worked out.