An umbilical cord wrap (NSU) refers to a wrapping of the child's body through the umbilical cord. The wrap can be single or multiple. Only in rare cases does it represent a dangerous complication.

What is an umbilical cord wrap?

In about 30 percent of pregnancies an umbilical cord wrap of the fetus occurs. It is a simple or multiple wrapping of the umbilical cord around a body part such as the neck, arm, leg or trunk. Even several parts of the body can be affected at the same time. The umbilical cord lays around the neck in about 20 percent of cases. Boys are more often affected than girls.

The medical literature speaks of a birth complication, although an umbilical cord wrap occurs in pregnancy to a high percentage. Only in very rare cases is it really a complication dar. As a cause of death for the fetus, it is even less likely. Mostly, the wrap is flaccid and therefore does not pose a threat to the oxygen supply of the fetus.

However, complications are sometimes observed during childbirth, since the wrap around can be tighter. Only in exceptional cases a umbilical cord wrap requires a primary cervical section.

causes

The causes of umbilical cord wrapping are manifold. Often the umbilical cord is very long. In other cases, there is a strong increase in the amount of amniotic fluid (Polyhydramnion). Observations have shown that boys are more likely to be affected by NSU than girls. This fact is probably due to the greater mobility of male fetuses in the amniotic fluid. An increased amount of amniotic fluid increases the probability of NSU, because the fetus in this case has a greater range of motion.

In this case, a polyhydramnios can in turn be triggered by several causes. Fetal causes include malformations of the digestive tract, spinal cord malformations, heart defects, absence of the cerebrum, fetal infections, genetic disorders of cartilage and bone formation, cleft lip and palate or chromosomal aberrations.

Other causes of maternal polyhydramnios may be incompatibility of maternal and fetal blood types with development of fetal hemorrhage or diabetes mellitus. In diabetes mellitus, the amount of amniotic fluid is increased by a polyuria of the fetus. Although the polyhydramnios as a result of other disorders can cause an umbilical cord, in which case the majority of the underlying disorder is the main risk to the fetus.

Symptoms, complaints & signs

An umbilical cord wrap occurs in 20 percent of pregnancies. However, only in half of the cases is there noticeable changes in the blood circulation and heart rate. In most cases, the drop in fetal heart rate (deceleration) is short-lived and has no major impact. In case of prolonged, tight NSU around the neck, fetal hypoxia (fetal oxygen deficiency) may, in exceptional cases, lead to an intrauterine fetal death.

Due to the nature of the umbilical cord, oxygen deficiency is rare. The fetus is supplied via the umbilical cord with oxygen-rich blood from the maternal bloodstream. This supply can only be disturbed by compression of the umbilical cord and the vessels located therein. However, the umbilical cord is not so easy to compress due to its nature and structure.

Thus, it is internally equipped with a compression-protecting connective tissue of fine collagen fibrils, hyaluronic acid and proteoglycans, which is called Wharton-Sulze. In fetuses with a low percentage of Wharton's spleen, the risk of hypoxia in NSU is increased. Furthermore, the umbilical cord has spirals turned to the left, which additionally protect it from kinking and compression.

Diagnosis & disease course

An umbilical cord wrap can be detected prenatally easily by a Doppler sonography. However, this examination is only recommended for a previous miscarriage or stillbirth, where a connection with the NSU is suspected. During childbirth, umbilical cord wrap during the recovery phase can lead to pathological changes in fetal heart activity.

Cardiotocography can be used to detect these changes. In this case, variable decelerations (decreases in heart rate) are displayed, which usually last only a short time. A microblood study should then be performed to estimate the child's oxygenation.

complications

An umbilical cord wrap is itself a complication during pregnancy. However, it is rarely dangerous. Only in exceptional cases can it lead to serious complications, which may even be fatal for the fetus. In an umbilical cord, the arms, legs, torso or neck are wrapped by the umbilical cord. Especially with a tight loop around the neck, the blood supply to the brain in the fetus may be at risk.

Then it comes to the so-called fetal hypoxia, which is characterized by a deficiency of the child with oxygen. As a result, an intrauterine fetal death may occur. Although the umbilical cord wrap is usually harmless and does not require any special measures, it should be monitored regularly if diagnosed.

Only in this way can it be ensured that even if the situation becomes dangerously acute, a quick emergency medical aid is possible. During the medical monitoring of an umbilical cord, the heart rate of the child is examined on the basis of micro-blood examinations, the oxygen content of the blood and regular heart rate measurements.

A very sharp drop in heart rate may indicate a fatal fetal risk. Then should be acted quickly. In some cases, a primary Caesarean section may be necessary. In this case, the birth is initiated before the contractions by the caesarean section. However, the necessary medical measures always depend on the condition of the fetus.

When should you go to the doctor?

The Umbilical Cord Wrap only affects fetuses in the womb and occurs in a variety of pregnant women. In most cases there is no reason for concern. The wrapping is found in imaging procedures at a gynecologist. An expectant mother should in principle participate in all preventive and check-up examinations during pregnancy.

During these routine appointments, the development and health status of the growing child is documented and compared with the general guidelines. If an umbilical cord wrap is detected, there is a further observation until the end of pregnancy, as there is the possibility of complications at birth.

If a pregnant woman notices sudden irregularities despite participation in all planned check-ups, she should consult a doctor immediately. If the fetus no longer moves, changes in the heart rhythm or an abnormality of the heart activity, a doctor must be consulted.

A vague feeling that something is wrong with the fetus is enough for another visit to a doctor. Changes in the circulation, anxiety or a general malaise should be discussed with a doctor. If there is a sudden and thus unplanned birth, the information of the umbilical cord wrap should be forwarded by the expectant mother to the present obstetrician.

Therapy & Treatment

The umbilical cord wrap usually requires no special measures. However, during the birth process via cardiotocography, the heart rate of the child should be monitored. At the same time, when it comes to longer decelerations, it is indicated to determine the oxygen supply by microblood examinations in order to be able to react quickly in an emergency. In some cases a primary cesarean section (caesarean section) may be necessary.

Especially pregnant women, who have undergone a previous stillbirth, need special attention. It should be noted, however, that umbilical cord wrap is primarily not the cause of death of the child. As already mentioned, various previous injuries and illnesses of a child or mother can increase the probability of an NSU, for example, by a polyhydramnios. However, the cause of stillbirth is often to be found in these injuries.

Outlook & Forecast

The umbilical cord wrap is not uncommon. According to statistical surveys, she turns up at every fifth birth. It is often detected during the ultrasound examination. The child in the womb, however, is usually unimpressed by the umbilical cord wrap. Since it is very elastic, it usually results in no complications. The birth is smooth. Overall, this results in a positive forecast.

It should be noted that an umbilical cord wrap does not have to be on the neck. Many laypersons wrongly fear that the child strangles itself. A wrap can be given in contrast to an arm or leg. Such a situation significantly reduces the risk in the run-up to childbirth.

While the prognosis is consistently positive, treatment options are inadequate. Doctors are unable to alter a wraparound of the unborn child in the womb. It remains only to check the heartbeat regularly. Experience has shown that nature knows how to best help. If the condition of the child deteriorates during pregnancy, a caesarean section may be indicated as a life-saving measure. In practice, this action is an exception.

prevention

Prevention of umbilical cord wrap in the adolescent fetus is not possible. The NSU is a common side effect of childbirth and usually has no major impact on the child. Only in cases of risk should Doppler sonography and cardiotocography be performed during pregnancy.

There is a risk if a pregnancy ended in the past with a miscarriage or death. Even with certain diseases of the mother, such as diabetes mellitus stronger surveillance is recommended. Especially in this case, however, the expectant mother can help reduce the risk of umbilical cord entanglement through a healthy lifestyle.

aftercare

In most cases, only very limited, sometimes limited, follow-up measures are available to the affected person in case of umbilical cord wrap. For this reason, sufferers should consult a doctor early to prevent the onset of other symptoms or complications. It usually can not come to an independent healing, so even at the first signs and symptoms, a doctor should be contacted.

The treatment of umbilical cord wrap is usually done by a minor surgery. It also comes to no special complications, which even after the procedure, regular checks and examinations by a doctor are necessary. However, if the umbilical cord wrap leads to death before birth, no further treatment is possible.

Most sufferers are then dependent on psychological help, whereby above all loving and intensive discussions with the own family can have a very positive effect on the mental state of the parents. Further aftercare measures are not available to parents. The umbilical cord may also reduce the life expectancy of the child if it is detected late.

You can do that yourself

An umbilical cord wrap is often detected by chance during pregnancy ultrasounds. This shows how important it is for pregnant women to take all the tests offered. In this way, it is best ensured in everyday life that recognizable problems and health hazards to the unborn child are determined by the preventive services.

The mother herself can do nothing at a detected umbilical cord wrap. There is no way to remove the umbilical cord from the baby's neck from the outside. That's why self-observation in everyday life plays a big role. Pregnant women whose child in the abdomen has been diagnosed with such a loop of the umbilical cord must be aware of possible warning signs of impending shortages, so that they can act quickly. For example, if they notice declining child movements, they can not clearly diagnose or treat them themselves.

The only way to become active is to visit a gynecological practice or a hospital with obstetrics and have the child's care diagnosed via CTG. A well-known umbilical cord wrap should not only be held in the maternal passport. The pregnant woman should always address this known danger in unclear situations again, because not all wraps, which can cause problems for the child, are always recognizable as such on the ultrasound.

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