The umbilical cord connects the placenta to the fetus, supplying oxygen and nutrients. Sometimes, it wraps around the baby’s neck. Known as a nuchal cord, this common occurrence is frequent, though it might seem alarming.
What Nuchal Cords Are
A nuchal cord occurs when the umbilical cord encircles the baby’s neck. Wraps can be single or multiple loops (double or triple). They are described as “loose” or “tight,” with loose wraps being more common.
Nuchal cords are common, observed in 10% to 30% of all deliveries. Their incidence increases as pregnancy progresses. They primarily form due to the baby’s natural movement within the amniotic sac. Other factors include a long umbilical cord, excessive amniotic fluid, or multiple pregnancies.
Addressing Common Concerns
While an umbilical cord around a baby’s neck can cause concern, nuchal cords are often benign and pose no significant risk. Babies do not breathe air in the womb, so a nuchal cord does not impede oxygen intake. The umbilical cord is designed to withstand compression. It contains Wharton’s jelly, a gelatinous substance, which cushions blood vessels within the cord. This padding prevents vessels from collapsing, ensuring continuous blood flow even if wrapped.
Complications from nuchal cords are rare, especially with loose wraps. A tight nuchal cord can lead to temporary changes in the baby’s heart rate during uterine contractions. After birth, very tight wraps might rarely result in mild, transient signs such as facial petechiae, temporary facial discoloration, or skin abrasions around the neck. These usually resolve quickly and are not indicative of severe or lasting harm.
Detection and Management Approaches
Nuchal cords are sometimes identified during routine prenatal ultrasounds, though often not reported due to their common and harmless nature. More often, they are discovered visually by medical staff during delivery. During labor, consistent monitoring of the baby’s heart rate is standard practice to detect potential umbilical cord compression. No method exists to “undo” a nuchal cord before labor.
If a nuchal cord is present during delivery, healthcare providers use specific management techniques. For a loose nuchal cord, the cord is gently slipped over the baby’s head once it emerges. If the cord is too tight, a “somersault maneuver” may be used, delivering the baby’s body through the cord loop while keeping the head close to the perineum. In rare situations, if other methods are not feasible or fetal distress signs appear, the cord might be clamped and cut before delivery. These strategies ensure most deliveries with a nuchal cord proceed without complications.