What Is A Nuchal Cord? Causes, Diagnosis, And Management

A nuchal cord in pregnancy is a condition when the umbilical cord is wrapped around the baby’s neck. The umbilical cord connects the mother and baby and supplies oxygen and nutrients through blood vessels in it. However, an umbilical cord around the neck can prevent normal movement of the baby during delivery. In most cases, the nuchal cord in pregnancy is harmless. However, doctors may recommend C-section delivery if there is a concern that the cord may not slip over the baby’s head before vaginal delivery.

Read on to know the effects, diagnosis, and management of the nuchal cord during pregnancy and delivery.

What Is A Nuchal Cord?

Nuchal cord occurs when the umbilical cord wraps 360° around the fetal neck (1). It could be a single loop or multiple loops that can be loosely or tightly wrapped around the neck.

The nuchal cord is classified into:

• Type A: Nuchal cord with a sliding pattern that can undo itself.

• Type B: Nuchal cord with a locked pattern, making a true knot that cannot be undone without assistance.

Nuchal cords are common and are routinely checked for by the doctors during delivery.

How Common Is A Nuchal Cord?

Nuchal cord occurs in 10-29% of pregnancies. Its incidence increases as the pregnancy progresses – the incidence rate is around 12% at 24 to 26 weeks and increases to 37% at term (2) (3). As mentioned earlier, the nuchal cord is a common occurrence and not a cause of worry in most cases.

The next section lists out the various reasons for the occurrence of a nuchal cord. Keep reading.

What Causes A Nuchal Cord?

Regular movement of the baby in the womb is considered to be healthy. However, a rapid fetal movement could cause a nuchal cord. Other factors that could lead to a nuchal cord include (4):

• Extra long umbilical cord
• Excess amniotic fluid that allows more fetal movement
• Single amniotic sac shared by multiples (5)
• Fetus in breech presentation (6)
• Large infant size (7)

Sometimes, nuchal cords can get wrapped tightly around the fetal neck and need to be manually untangled at the earliest after birth to prevent any complications.

Is It Possible To Detect A Nuchal Cord?

There are no noticeable symptoms in the case of a nuchal cord as it may not affect your body in any way. So, you may not know about it until any complication arises. But should you feel a sudden slowdown in the fetal movement, tell your doctor about it and get an ultrasound done to rule out any possibilities of cord entanglement.

Your doctor may also suggest other diagnostic procedures.

How is nuchal cord diagnosed?

A nuchal cord can be assessed through the following ways (3):

• A combination of ultrasonography and color Doppler imaging can help identify 72% of single and 94% of multiple nuchal cords.

• Also, the doctor may perform a transabdominal manual compression of the fetal neck to detect the nuchal cords before delivery. During the procedure, if the fetal heart rate drops, then the test ascertains the presence of nuchal cord.

• Vibroacoustic stimulation is a non-invasive method used to detect a nuchal cord. It helps to identify the fetal heart rate deceleration, if any, at a particular frequency.

The section below tells you about the management of nuchal cord during labor.

How Is The Nuchal Cord Issue Addressed During Labor?

It is difficult to ascertain if the baby has a nuchal cord during labor. However, the doctors check for it when the baby’s head comes out first. If the loop is loosely held around the neck, it will easily slip over the head. If not, the doctors clamp and cut the cord before the baby’s shoulder is delivered.

Instead of cutting the cord, doctors might also do a somersault maneuver (rolling the mother’s feet over the head). This procedure involves somersaulting the baby’s head toward the mother’s thigh, while it emerges through the birthing canal and unwinding the cord immediately (8).

Most of the times, the nuchal cord gets unwinded on its own before delivery. Its complications are very rare. However, early detection and timely management can make the process of delivery smooth without posing any risks to the baby.

References

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