True knot of the umbilical cord. Anomalies of the vessels of the umbilical cord in multiple pregnancies. What is a true umbilical cord knot

24.04.2019

Among the various pathologies associated with the presence of umbilical cord defects, there are quite dangerous ones. The true knot of the umbilical cord is one of such insidious pathologies. This article will talk about what a true umbilical cord knot is, why it is dangerous for a child.

What does this mean?

Normally, the umbilical cord or umbilical cord is an elongated "cord". It stretches from the baby to the placenta. The umbilical cord can be considered a kind of "bridge", which during pregnancy actively connects developing baby with his mom.

The umbilical cord is quite long. At normal pregnancy the length of a healthy umbilical cord is 50-70 cm. The thickness of the umbilical cord is usually about 2 cm. This rather large length contributes to the fact that the umbilical cord can twist into loops or even knots. Doctors call such nodules true.

It should be noted that This pathology occurs in obstetric practice quite rare. Based on statistics, it can be noted that true nodes on the umbilical cord appear in about 1% of all cases. However, this pathological condition is extremely dangerous. It can significantly aggravate the course of pregnancy and even contribute to the development dangerous pathologies at the fetus.

Reasons for education

The appearance of nodules on the umbilical cord can lead to the most different factors. most common cause The development of this pathology is the intensive physical activity of the baby. Usually a fetus that develops into mother's womb, more mobile in the first half of pregnancy. How smaller sizes child, the easier it is for him to move.

As the baby grows, the number of active movements he makes begins to gradually decrease. This is because the baby gradually becomes crowded in the uterus. This feature is responsible for the fact that true nodules on the umbilical cord are formed mainly before the 3rd trimester of pregnancy. This fact is confirmed by the reviews of mothers who encountered this problem while carrying babies.

Diagnostics

It should be noted right away that the definition of true nodules on the umbilical cord is quite difficult task. Usually, such changes are detected by doctors already retrospectively - after the birth of the child. After the birth of the placenta and umbilical cord, doctors may carefully examine them. With such an examination, as a rule, true nodules are detected.

Unfortunately, to suspect the presence of pathology only for some clinical signs or symptoms are impossible. There are no specific signs that would absolutely indicate the presence of nodules on the umbilical cord.

It is worth noting that sometimes nodules on the umbilical cord are still detected during ultrasound. This usually becomes possible when the study is carried out on expert-level devices, experienced and qualified specialist. The difficulty in detecting true nodules on the umbilical cord is that the umbilical cord is quite long. An ultrasound specialist cannot always examine every centimeter of it.

It is possible to suspect the presence of a node on the umbilical cord through dopplerography. This method allows you to evaluate the blood flow in the umbilical vessels. A decrease in the speed of blood flow in certain areas of the umbilical cord is one of the signs that may indicate the presence of a node.

If, during pregnancy, nodes on the umbilical cord were found in the future mother with ultrasound, then in the future, she is carefully monitored by a doctor. In the time remaining before delivery, doctors must assess the condition of the fetus. For this, cardiotocography is often used. Through this diagnostic test you can determine the heart rate of the baby, as well as evaluate his motor activity.

You can control the activity of the baby yourself future mom. In the second half of pregnancy, she, as a rule, already feels the baby quite well in her stomach.

If a pregnant woman notes that her child has drastically changed her motor activity, then she should definitely notify her obstetrician-gynecologist about this.

Consequences for the child

Imagine full development a baby without an umbilical cord is impossible. With this unique organ that appears in female body only during pregnancy, the fetus receives all the nutrients necessary for its growth. A baby in the womb cannot feed on its own. All essential proteins, fats and carbohydrates he receives through the blood from his mother. At the same time, nutrients enter through the blood vessels that are located directly inside the umbilical cord.

Through the umbilical vessels, the baby receives oxygen dissolved in the blood. During intrauterine life the child's lungs are not functioning. Respiratory system will fully work only after the baby is born and takes his first breath in his life. Up to this point, the baby receives dissolved oxygen through the system of umbilical vessels - from his mother.

The umbilical cord plays another important role: it is involved in the utilization of metabolites. Through the system of umbilical vessels, the fetus "gets rid" of waste chemicals that are unnecessary to its body. Ensuring the functions of the umbilical cord is possible if during pregnancy any anomalies or defects do not develop in the umbilical cord. The presence of nodes contributes to the fact that the blood vessels in the umbilical cord are pinched. In this case, the blood supply to the baby and the placenta is disturbed.

Insufficient supply of oxygen to the blood contributes to the fact that the baby develops an extremely dangerous condition - intrauterine hypoxia. It is dangerous because the blood supply internal organs the child is greatly reduced. This leads to disruption of their functioning.

Persistent intrauterine hypoxia is also dangerous because the baby may develop a violation of cardiac activity. This situation is extremely dangerous and requires urgent intervention by doctors to save the life of the fetus.

In some cases, determine the consequences of long-term intrauterine hypoxia the baby can only after his birth. Children who, during their prenatal development faced with this pathology, may have a lower birth weight, low immunity, as well as a number of concomitant congenital diseases. In some cases, persistent intrauterine hypoxia can contribute to the formation of a number of pathologies of the nervous system.

Another possible complication, which can develop in the presence of true nodes on the umbilical cord, is thrombosis of the umbilical cord. In the clamped section of the umbilical cord, blood flow is significantly reduced. Slowing the flow of blood causes the platelets (platelets) to stick together more quickly, leading to the formation of blood clots.

Through a thrombosed umbilical cord, a full blood flow is impossible. In such situation children's body do not get enough nutrients and oxygen. The stronger the lumen of the blood vessels of the umbilical cord is closed, the more unfavorable the prognosis of the further course of pregnancy. Unfortunately, in such a situation there is high risk abortion (and even stillbirth).

If the nodules on the umbilical cord appeared closer to the birth, then in this case the possibility of self-"unraveling" is rather low. However, even in this situation, a child can be born into the world absolutely healthy. The presence of multiple nodules on the umbilical cord and related indications may lead doctors to resort to performing a caesarean section.

Obstetrician-gynecologists usually choose a surgical method of childbirth if the course of pregnancy is complicated by a number of certain conditions. A caesarean section is performed if the presentation is abnormal (or if the fetus is too large). Big sizes baby at narrow pelvis mothers are also an indication for caesarean section. In this case, independent childbirth can be very dangerous.

During passage through the birth canal, the child may become entangled in the umbilical cord or squeeze it strongly. In this case, there is a sudden cessation of blood flow through the umbilical vessels, which can lead to various dangerous states, including a threat to life for the fetus. To avoid such dangerous complications, doctors and resort to performing a caesarean section.

The choice of obstetric tactics for pregnant women with true nodes on the umbilical cord is carried out individually. To do this, doctors take into account all the factors that affect the course of pregnancy.

For information on how the blood circulation of the fetus during pregnancy, see the following video.

Umbilical cord or the umbilical cord - the organ that connects the baby and the placenta, which is a "cord" consisting of two arteries and one vein. It travels through the umbilical vein to the fetus arterial blood, which was enriched in the placenta with oxygen and nutrients. The umbilical arteries carry venous blood from the baby to the placenta, which carries carbon dioxide with it. Two veins and an artery are fastened together with Wharton's jelly. The umbilical vessels twist in length, resembling a cord.

There are several options for attaching the umbilical cord to the placenta:

Central Attachment The umbilical cord is attached to the center of the placenta.
Side Attachment The umbilical cord is attached to the side of the placenta.
edge attachment- the umbilical cord is attached to the edge of the placenta.
Shell Attachment- the umbilical cord is attached to the membranes, not reaching the placenta; the vessels of the umbilical cord pass to the placenta between the membranes (a rare case).

As the child grows and develops, the umbilical cord grows and thickens. Cord length corresponds to the length of the fetus. In a full-term baby, it is about 50 cm, and the diameter is 1.5 cm. But there are cases when the length of the umbilical cord reaches 60-80 cm (long umbilical cord) or 35-40 cm (short umbilical cord). The thickness can also vary depending on the amount of Wharton jelly.

At long umbilical cord childbirth can occur without problems, but a long umbilical cord is dangerous because the umbilical cord often wraps around the neck, torso and limbs of the baby. At the moment of attempts during the expulsion of the fetus, tension of the umbilical cord, narrowing of the umbilical vessels and, as a result, asphyxia of the fetus can occur. Also, a long umbilical cord can fall out into the vagina in loops, pinch and threaten the child with a lack of oxygen.

short umbilical cord divided by absolutely short and relatively short. An umbilical cord is called absolutely short, the length of which is less than 40 cm. Relatively short is a normal umbilical cord, shortened due to entanglement around the neck or other part of the body of the fetus. When the child is expelled, the short umbilical cord is stretched, making it difficult for the baby to pass or preventing him from moving at all. Also, during the tension of a short umbilical cord, premature detachment placenta. This situation is very dangerous for the baby.

There may also be knots on the umbilical cord. They are divided into true nodes and false nodes.

True knots observed infrequently, they are formed, most likely, in the early stages of pregnancy, when the baby has a lot free space, and it slips through the loop of the umbilical cord. If the knot is not tightened tightly, then the child may be born with a knot on the umbilical cord. But the knot can be tightened (for example, due to the activity of the baby) during pregnancy, as well as during childbirth, then this will mean death.

false knots- this is a thickening on the umbilical cord, formed due to varicose veins umbilical vein or large cluster Wharton's jelly. False knots are not dangerous.

The umbilical cord is a coiled tube that connects the fetus to the placenta. Outside the umbilical cord is covered membranes. It contains two arteries and one vein. Arterial blood flows through the vein of the umbilical cord, carrying oxygen to the organs of the fetus. The umbilical arteries carry venous blood from the fetus to the placenta; this blood contains the metabolic products of the fetus. The vessels of the umbilical cord are in a special jelly-like substance (it is called "Wharton's jelly"), which fixes them and protects them from injury, and also carries out the exchange of substances between the blood of the fetus and amniotic fluid. The umbilical cord begins to form from 2-3 weeks of pregnancy and grows with the baby. By the time of birth, its length is 45-60 cm (the length of the umbilical cord, on average, corresponds to the height of the child), and its diameter is 1.5-2 cm.

Possible problems

The umbilical cord may attach to the placenta in different ways. In some cases, attachment occurs in the center of the placenta (central attachment), in others - on the side (lateral attachment).

Sometimes the umbilical cord is attached to the membranes, not reaching the placenta itself (shell attachment). In these cases, the vessels of the umbilical cord approach the placenta between the membranes. Such attachment of the placenta is a risk factor for the occurrence of fetal placental insufficiency.

The umbilical cord may also have features such as true and false nodes. False nodes are local thickening of the umbilical cord due to varicose veins of the umbilical cord or accumulation of Wharton's jelly. They do not affect the development of the fetus and the process of childbirth. True umbilical cord knots form early in pregnancy, when the fetus is still small, allowing it to slip through the umbilical cord loop. True umbilical cord knots can affect the outcome of labor. When the umbilical cord is pulled, the knot is tightened, the flow and outflow of blood through the vessels stop, and the baby is "cut off" from the mother. ahead of time. In this case, acute fetal hypoxia occurs.

The pathology of the development of the umbilical cord is also a condition in which only one umbilical cord artery is formed instead of two; in some fetuses with a single umbilical artery, various malformations are observed. The reason for this formation of the umbilical cord can be factors that cause malformations of the fetus - the so-called teratogenic factors ( chemical substances, some medications, ionizing radiation, genetic diseases parents and various diseases mother).

Some problems may arise in connection with shortening of the umbilical cord. Shortening of the umbilical cord can be divided into absolute and relative. With an absolute shortening of the umbilical cord, the length of the umbilical cord is less than 45 cm. During pregnancy, this condition does not affect the development of the baby; during childbirth, both with relative and absolute shortness of the umbilical cord, due to its tension, the placenta can prematurely exfoliate, which the umbilical cord pulls along with it, which creates a direct threat to the life of the fetus.

False shortening of the umbilical cord occurs when the umbilical cord is wrapped around the neck and torso of the fetus. The reason for the entanglement of the umbilical cord may be its excessively long length (more than 70 cm), as well as increased motor activity of the fetus, which may be associated with chronic intrauterine fetal hypoxia. The causes of chronic lack of oxygen are different - these are diseases of the mother, and diseases of the fetus, and pathology of the placenta. The entanglement of the umbilical cord can be single, double or even triple. During pregnancy, this condition usually does not affect the fetus, but problems can occur during childbirth. Tension or clamping of the vessels of the umbilical cord leads to disruption of blood flow.

How can you help the baby?

Conditions such as shortening of the umbilical cord (absolute and relative) and true knots of the umbilical cord during childbirth can lead to acute intrauterine fetal hypoxia. It is manifested by a change in the number of heartbeats. (A normal fetal heart rate is 120-160 beats per minute.) In the event of acute intrauterine fetal hypoxia in amniotic fluid the original feces (meconium) appear, the waters turn green.

The appearance of all these symptoms requires emergency treatment. First of all, it is necessary to eliminate the cause of hypoxia, which is achieved by early delivery. The method of delivery depends on the period of labor and how far the presenting part of the fetus (head or pelvic end) has advanced along the birth canal. If acute hypoxia occurs during pregnancy or in the first stage of labor (the period of labor), the woman is given a caesarean section. In the second stage of labor, when the head or pelvic end is already close to the exit from the small pelvis, various obstetric aids are used to speed up the completion of the second stage of labor.

Luckily, similar condition does not occur frequently. That's why entanglement of the umbilical cord and knots of the umbilical cord are not an absolute indication for a planned caesarean section(the absolute shortness of the umbilical cord cannot be diagnosed before delivery). These states are relative indications for surgery, i.e. caesarean section is done only in cases where, in addition to them, there are also other relative readings to surgery (a woman's age is over 30, mild forms of preeclampsia, etc.).

Diagnostics of the pathology of the umbilical cord

The only method that allows us to assume the pathology of the umbilical cord is an ultrasound scan.

With the help of ultrasound, abnormalities of the umbilical cord can be detected, such as abnormal development of blood vessels (the only artery of the umbilical cord), true and false knots of the umbilical cord, entanglement of the umbilical cord. But the length of the umbilical cord during pregnancy is almost impossible to determine.

Special mention should be made of the diagnosis of entanglement of the umbilical cord. Sometimes, during examination, only loops of the umbilical cord in the neck are visible, but it is impossible to determine whether they wrap around the neck. In these cases, a Doppler study helps, during which you can study the movement of blood through the vessels - including the umbilical cord. Particularly accurate data on whether there is entanglement with the umbilical cord can be obtained during a color Doppler study, which is very important for determining the tactics of labor management.

During childbirth, the cardiotocography method is used, which allows you to monitor the number of heartbeats, or listen to the fetal heartbeat with a stethoscope.

Thus, during pregnancy, the pathology of the umbilical cord can only be suspected. However, timely ultrasound examinations help doctors make your birth safe.

Yesterday I was at the third ultrasound screening in the LCD for m/f.
As always, visualization is difficult, everything is fuzzy, we looked more than an hour, rotated in all directions.
They issued a conclusion: The size of the fetus corresponds to 34 weeks of pregnancy. Head presentation. IR: right uterine artery 0.37; in the left uterine artery 0.35; in the arteries of the umbilical cord, the fluctuation is from 0.44 to 0.6. Front front abdominal wall the fetus is determined by the accumulation of loops of the umbilical cord, not excluded. the presence of a true knot of the umbilical cord. Consultation in KRD is recommended.
This morning we rushed to the expert ultrasound and DG to the clinical maternity hospital.
Ultrasound conclusion: The fetus corresponds to 33-34 weeks of pregnancy, the weight of the fetus is 2200 g, cephalic presentation. premature maturation placenta.
Double twist umbilical cord around the fetal neck (not tight), true umbilical cord knot.
Protocol UDS uterus and fetus: Indicators of uteroplacental and fetal-placental blood flow within normal limits.
I was terribly upset ... Eh-h-h, so everything began nicely and developed seamlessly, and on you! Get, fascist, a grenade!
They went to "their" doctor with all the results, did a CTG, no signs of "fetal suffering" were found. We agreed that I would come to the CTG and DG every week, if everything is still fine there, then I go to the PKS on 03/19/2018.
My husband ran away to worry about work, the elders are still at school, and I drink soothing tea, read the features and tune in to a caesarean section.
They say you have to try everything in life! I had terrible natural births, then wonderful ones, and now there will be a CS.
Everything will be fine!
You must, simply, believe in what is destined by fate, and not be afraid of the truth! (With)

02/20/2018 11:31:14 AM, SunReg

My first impulse was the same, but → My first impulse was the same, but the doctor reassured me that there were no indications for an emergency CS, loops and knots are tightened only during childbirth, so it’s better to bring it under supervision until 37-38 weeks. Feb 20, 2018 12:43:12 pm

Nothing more and meet the baby :) 20.02.2018 13:00:15 Flamingo

Baby's heartbeat with a stethophonendoscope → I can listen to the baby’s heartbeats with a stethophonendoscope, but I myself refused a portable CTG, anyway, I don’t know how to decipher these curves. 02/20/2018 02:43:03 PM, SunReg

In the first birth, I also had 2 or → In the first birth, I also had a 2 or 3-fold entanglement, cat. then they didn’t see it on ultrasound, as a result, obstetric forceps were used in EP (I still remember with horror + consequences up to 3 years). why am I writing: if I had known then, I would have laid down on a Cesarean without hesitation, they saw you on time, that's good) the main thing is that everything was ok with the baby)) 20.02.2018 12:57:22, marmiwka

Still, progress is power. Everything is better → Still, progress is power. It is better to know everything and mentally prepare. And we will keep our fingers crossed that everything goes well. 02/20/2018 02:32:23 PM, Tatyana_Sh

I perfectly understand your fear and → I perfectly understand your fear and concerns. She herself was horrified when she had a triple in her first pregnancy! entanglement. I am a perinatal psychologist and in this I was probably more fortunate :) I got nervous, then I pulled myself together and tried to arrange therapy sessions for myself :) you know, surprisingly (surprisingly because a shoemaker, as they say, without boots always) learned a little. She unwound two turns herself two or three weeks before the due date, as a result, she went to the birth with one entanglement and everything went perfectly!
If I can be of any help to you (free of charge) write with pleasure I will help!
[email protected] 20.02.2018 22:13:41, Anna Korneva

The doctor is absolutely right! So what are the reasons → The doctor is absolutely right! So there is no reason to worry
And about the knot .. I won’t argue with you) I’ll just express my opinion: the umbilical cord is very elastic and resembles a silicone flagellum. If you tie such a flagellum into a knot, then of course it will make a knot, but then it will untie :) like hair, try it on them! By the way, an excellent exercise for auto-training: comb your hair in the morning / evening, take the lock into a knot, tie it and when it is untied aloud to yourself (and to the baby) "as my hair is untied, so your baby will untie the umbilical cord knot easily and quickly"
In all seriousness, just try it - an attempt is not torture :) 20.02.2018 22:51:34, Anna Korneva

Mom, don't worry, everything will be fine → Mom, don't worry, everything will be fine and give birth naturally! My daughter-in-law was just as afraid ... there were weekly CTG and DG and entanglement of the umbilical cord around the neck of the fetus and threatened caesarean section! Everything was resolved natural childbirth and appeared? wonderful girl with a good weight and height! And you will be fine! 02/21/2018 00:22:37, Alsu Anvarova

I gave birth to a son EP with an entanglement and a knot on → I gave birth to a son EP with an entanglement and a knot on the umbilical cord. The "specialists" in the LC did not find any entanglement or ultrasound knot on any ultrasound. Only upon admission to the RD was told about a possible node. 21.02.2018 00:46:17, Nikalexna

Don't worry, my son has too → Don't be discouraged, my son also had an entanglement of the umbilical cord and a knot. Now I have already graduated from the Mountain School, everything is fine, I gave birth myself 02/21/2018 01:52:14, Julia

It happens. Everything will be fine) → It happens. Everything will be fine) 02/21/2018 08:22:55, Ekaterina I

Dear author, do not be afraid of the COP, me with → Dear author, do not be afraid of the COP, they gathered a consultation with the twins, is it possible for EP, they decided that it was possible, that for double pregnancy and small sizes abdominal cavity, I wore surprisingly well and had to manage on my own. But fate decreed otherwise, I had an emergency CS. Later, 2 independent specialists confirmed that in my case, the EP could have ended very sadly.
In my opinion, if you can give birth on your own, then it is better to give birth on your own, if there are problems, then PCS is a very good way out. Everything will be fine! 02/21/2018 10:07:54 am, Imuranka

02/21/2018 04:54:01 PM, Jakito

I have three children and all are born with → I have three children and all were born with cord entanglement All children are healthy 28 years old 18 years old and 9 years old 02/21/2018 18:23:07, Tatyana1972

Start from what will be best for → Decide what is best for the child. In any case, I thought in this vein :)) PCS is not so scary (I'm not a theorist), but health problems are much less likely with your history. Good luck to you, let everything be fine :) Maybe it's better to go to bed early for preservation, at least to do CTG more often? But I’m generally a reinsurer, of course, I don’t know about you, I would definitely have surrendered to the doctors earlier, I would have been calmer. Today I was at the repeated DG and CTG in the KRD - everything is fine, we continue to observe ... 26.02.2018 18:45:23, SunReg

The umbilical cord is vital for the fetus, it connects it with the mother, provides nutrition and gas exchange during intrauterine development. Its pathology affects the growth and development of the fetus, and in some cases can lead to intrauterine death.

The pathology of the umbilical cord in twins can be the same as in one fetus, but there are also special forms, characteristic only for multiple pregnancy.

Interlacing of the umbilical cords with twins

Monochorionic monoamniotic twins have a common placenta, an amniotic membrane without a septum between the fetuses. Chaotic movements of the fetus with polyhydramnios or in early period pregnancies can cause cord entanglement.

This condition can be diagnosed using B-mode ultrasound as well as color Doppler imaging. If this condition is detected, pregnancy is supplemented by monthly ultrasound. It is important to determine the presence of hypoxia and intrauterine delay fetal development. The interlacing of the umbilical cords can lead to compression of the artery, which leads to hypoxia and fetal death. This condition can develop both during pregnancy and during childbirth. After the birth of the first child, clamping of the umbilical cord of the second may occur, which leads to acute hypoxia fetus.

The tactics of the doctor is aimed at monitoring the condition of the fetus until it is ready for childbirth. To do this, after the detection of pathology, an ultrasound is performed every month with a measurement of blood flow. From 27 weeks observation is obligatory by conducting CTG. Some experts suggest the appointment of non-steroidal anti-inflammatory drugs, which will reduce the amount of water and the mobility of the fetus.

Upon reaching a viable term, delivery is carried out by caesarean section.

Torsion, twisting of the umbilical cord is not a big danger. A strongly twisted umbilical cord indicates increased motor activity fetus. This could be a sign oxygen starvation, the causes of which need to be established.

Anomalies of attachment of the umbilical cords in twins

Normally, the umbilical cord is attached in the center of the placenta, but under the influence unknown factors abnormal attachment of the umbilical cord may occur.

It has been established that in singleton pregnancies such anomalies occur in 1% of cases, with multiple pregnancies the frequency increases. It is often combined with malformations:

esophageal atresia;
cleft palate;
ventricular septal defect;
congenital dislocation of the hip;
head asymmetry.

Incorrect attachment is that the vessels of the umbilical cord do not reach the placenta and are attached at the edge through the membranes. In twins, the body weight of a child with an anomaly is lower than that of the second. The practical significance of this pathology is that when the membranes rupture, the vessel can be damaged. There will be massive bleeding, which will end in the death of the fetus.

With a full-term pregnancy, childbirth is carried out by surgery.

Anomalies of the vessels of the umbilical cord in multiple pregnancy

Normally, the umbilical cord contains 2 arteries. Chromosomal pathologies mothers, diabetes can cause non-development of one vessel - aplasia of the umbilical artery.

With multiple pregnancies, such a pathology occurs in 7% of cases, usually in one of the fetuses. Often such a defect is combined with malformations:

fistulas between the esophagus and trachea;
defects of the nervous system;
anomalies of the ureters, kidneys;
arenia (absence of kidneys);
with acardia and sirenomyelia occurs constantly.

Given the multiple malformations, the fetus is not viable.

There may also be other vascular anomalies:

increase in the number of arteries up to 3-4;
additional vein;
many capillaries instead of arteries;
aneurysm.

They are also associated with malformations, but their variants are not pathognomonic for a particular vascular pathology. Children who have had a vascular anomaly are often born with low birth weight.

Umbilical cord knots

It is problematic to diagnose nodes located on the umbilical cord. They can be:

true;
false.

The latter do not pose a threat to the life of the fetus and are areas of excessively tortuous arteries, thickening or varicose veins.

True knots of the umbilical cord are formed when its length is excessive, when the moving fetus can slip into the loop formed. This occurs in the early stages of pregnancy, when there is still enough room for voluntary movements. Gradual tightening of the knot will lead to impaired blood flow. In twins, this condition develops in isolation in one of the fetuses, or in monoamniotic twins, nodes form between the two umbilical cords.

The danger is the tightening of the knot and the development of acute hypoxia. This can happen at any stage of pregnancy or during childbirth. This condition threatens the death of the fetus. It is impossible to influence the formed umbilical cord knot either medically, or physically, or surgically. Status to be monitored:

CTG of both fetuses is regularly performed, the expectant mother should independently listen to the movement of the children. Increased activity and lack of movement should alert.
With the appearance of adverse signs - emergency delivery by caesarean section.

Often the true nodes are accidental findings after the birth of the child.

Cord entanglement with twins

With an umbilical cord length of more than 70 cm, cord entanglement may occur with twins. If the twins are located diamniotically, there is a septum between them, then entanglement can occur in the fetus with its own umbilical cord. With monoamniotic twins - entanglement of the umbilical cord of the second fetus.

The entanglement is diagnosed with the help of ultrasound. It can be single or double. Loops are loose or tight. In the second case, this poses a risk of developing fetal hypoxia. A loose single entanglement usually does not have any consequences, it only requires more careful monitoring of the fetal CTG during childbirth.

After the birth of the fetal head, the umbilical cord is released from the neck and labor is completed as usual. Sometimes the entanglement causes some fetal hypoxia, cyanosis is noted after birth skin, hoarseness of voice due to swelling of the ligaments. Such newborns require additional monitoring by a pediatrician to identify long-term effects hypoxia.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site