The shift had just begun when a persistent bell rang 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...

Should I be worried?

As it turned out, the woman arrived after undergoing an ultrasound examination at the antenatal clinic. Without undue preamble, Julia (that was the name of the pregnant woman) said: "I agree to a caesarean section, relatives will now bring the necessary things." "Wait, wait, let's figure it out first," I answered and invited Yulia to the examination room. It turned out that Yulia's gestational age at the moment is and an ultrasound scan revealed the entanglement of the umbilical cord around the neck of the fetus. 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 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 necessary for life and oxygen, as well as two arteries, through which the venous blood of the fetus removes waste products of metabolism and carbon dioxide into the mother's body.

The vessels of the umbilical cord are surrounded by a special jelly-like substance - Wharton's jelly, which, due to its consistency, plays an important protective role - it protects the vessels from squeezing. 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 - 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, limbs of the fetus, the formation of umbilical cord knots, which, in turn, are divided into true and false. It is important to note that about a fifth of all children born are born with an entanglement of the umbilical cord, and this does not always lead to violations of the intrauterine state of the fetus. The fact is that, while in the uterus, until the moment of birth, the baby does not breathe with lungs, so squeezing the neck, which always scares expectant mothers, is not dangerous for him. Problems can arise when there is a violation of blood flow due to tension or compression of the umbilical cord due to repeated or tight entanglement.

What did the ultrasound show?

According to the ultrasound examination, it was found that there were no signs of hypoxia (i.e. lack of oxygen) in the fetus, during Doppler (a study that determines the blood flow velocity in the main vessels of the uterus and fetus), there were no violations of the uteroplacental circulation. The fetus corresponds to the term, there are signs of a single entanglement of the umbilical cord around the neck of the fetus. “Wow, when they did an ultrasound in me, 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 answered.

Indeed, in practice, there are 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 loops of the umbilical cord, according to ultrasound, were near the neck of the fetus, but there was no entanglement as such, and secondly, when the fetus moved, the umbilical cord entanglement was eliminated on its own (of course, this happens, as a rule, with a single entanglement).

Predisposing factors for the formation of umbilical cord entanglement are increased fetal motor activity, which may be due to intrauterine hypoxia (i.e. lack of oxygen supply), polyhydramnios, increased adrenaline in the mother's blood due to stressful effects. It is natural that in the overwhelming majority of cases, a long umbilical cord leads to the entanglement of various parts of the fetal body.

We make a diagnosis

To make sure that Yulia's baby is feeling well, we recorded a cardiotocogram (CTG). With CTG, the cardiac activity of the fetus is recorded, which is an informative indicator of its prenatal state. To do this, a sensor was attached to the belly of the expectant mother, which is connected to the device. Yulia lay on the bed on her side for 30 minutes, and the machine recorded the fetal heartbeats. No pathological changes were found in CTG. Together with Yulia, who had already somewhat calmed down and cheered up, we went out to the relatives who were waiting for her. I explained to them that in this situation, when we have a premature pregnancy, the intrauterine state of the fetus is completely normal, only because of the entanglement of the umbilical cord, it is not advisable to carry out an emergency delivery. The reassured pregnant woman went home with her husband and mother-in-law.

To fully determine the intrauterine state of the fetus, it is necessary to conduct a set 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 loops of the umbilical cord are near the neck of the fetus or there is an entanglement: in this study, we do not have the possibility of a three-dimensional 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, "curled" in the tight space between the baby's body and the wall of the uterus;
• dopplerometry- a method that allows, firstly, to accurately determine whether there is an entanglement with the umbilical cord, 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 baby's heart rate, but also his reaction to his own movements (when recording CTG during pregnancy) and to an increase in uterine tone (during childbirth), which allows you to find out how well the fetus feels at the moment.

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

The entanglement of the umbilical cord around the neck of the fetus: will there be an operation?

About a month passed, I already managed to forget about that visit of Yulia, when on the next duty I was invited to examine the incoming 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. During the examination, it was revealed that Yulia entered the birth process - the cervix was opened by 3 cm, amniotic fluid did not pour out.

The woman in labor is 24 years old, this is Yulia's first pregnancy, there were no gynecological diseases, abortions or miscarriages. The last ultrasound was performed in, according to his data, the entanglement of the umbilical cord around the fetal neck is preserved. Estimated fetal weight 3400 g gestational age at the moment. During auscultation (listening to the fetal heart tones 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 heart rate of the fetus is 120-160 beats per minute). Contractions at the time of the arrival of a weak force, after 10 minutes, lasting 30 seconds. Having completed the history of childbirth and placed Yulia in the prenatal ward, she was immediately recorded with a CTG (cardiotocogram). Carrying out CTG during childbirth 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 childbirth in each patient - can she give birth naturally or in the interests of the fetus, delivery by caesarean section is necessary. In the case of Yulia, the given CTGs depended on which delivery option 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 give birth through the natural birth canal under careful monitoring of the fetal condition.

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 entangled 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 through 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 separates from the uterine wall after the birth of the fetus), which leads to the need for emergency operative delivery.

In rare cases, if the umbilical cord is wrapped around the neck of the fetus many times, complications such as extensor insertion of the fetal head can occur, which can make it difficult for a child to be born 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 fetal chin is pressed to the chest, which allows the head to be correctly inserted into the pelvic cavity and pass without difficulty through the birth canal in the most "favorable" - 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 do not allow the baby's head to bend, 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 the 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 properly 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 Yulia's admission. Contractions quickly became more frequent, stronger and longer. During the re-examination on the chair, it was revealed that the cervix had dilated by 7 cm, an amniotomy (instrumental opening of the fetal bladder) was performed - 250 ml of light transparent amniotic fluid poured out. According to CTG and regular listening to heart sounds with an obstetric stethoscope, the fetus's condition was satisfactory. Yulia refused the proposed medical anesthesia, saying that she felt quite normal.

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

• the intrauterine 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 appear. If signs of fetal suffering appear in the first stage of labor (the period of cervical opening), when the end of labor is still far away, a caesarean section is performed, if fetal hypoxia is detected in the second period (the period of expulsion of the fetus), then for the speedy completion of labor, when the head is cut through, the perineum is cut (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 late at night, of all the women in labor in the maternity ward, only Yulia remained - all the rest had already given birth safely. Yulia's cervix 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, which 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 had a distinct desire to push during the contraction. Alarming signs appeared on the monitor of the CTG apparatus at the time of the contraction - with an increase in the tone of the uterus, the heart rate of the fetus decreased. It was necessary to complete the delivery as soon as possible and remove the baby, fortunately, the fetal head was already close to the exit plane from the pelvis.

Intravenously, through a special catheter, a drug was administered that enhances the contracting ability of the uterus. Julia was on the delivery table, and the fetal head was moving along the birth canal quite quickly. The woman in labor pushed with all her might and unquestioningly carried out the commands of the midwife. The back of the baby's head appeared from the birth canal, and after the dissection of the perineum, which Yulia did not even feel, the head and the neck of the fetus entwined with two loops of the umbilical cord were born. The midwife deftly and quickly removed the umbilical cord from the neck, and the baby was born completely. But the surprises did not end there - the umbilical cord that followed the child 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 the pediatric neonatologist.

The nodes of the umbilical cord are divided into 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 a knot, it does not pose any danger to the baby. The true knot is formed in early pregnancy, when the fetus is still very small, and the ratio between the size of the fetus and the uterine cavity allows it to slip into the loop of the umbilical cord. A 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 also have this feature during childbirth). The danger of the knot is that it can drag on 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 knot during pregnancy, therefore, its presence is usually found out after delivery, as happened with our patient.

The girl's weight is 3450 g, height is 51 cm. The Apgar score is 7 points immediately after birth, and 8 points after 5 minutes. On the 5th day after the birth, Dasha (as the baby was named) 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. Cord entanglement"

Entanglement of the umbilical cord. Analyzes, research, tests, ultrasound. Pregnancy and childbirth. I had an ultrasound today and they found a single entanglement. Something I don’t understand - she will unravel back. But in 37, a single round of the neck, a double round of the abdomen and a multiple round of the lower leg.

Discussion

they put an entanglement on me, but the doctor explained that there (in addition to what they already wrote to you below, it can unravel) 2 parameters are important:
1) single entanglement or double
2) around something - around the throat / abdomen, etc.
I had a single, not tight, from the neck to the shoulder. It's not scary.
here my sister had 2 times around the neck, the doctors didn’t like it and with a narrow pelvis she was planned to have a CS

I’ll just give moral support about the umbilical cord, I gave birth from the eldest with multiple entanglement, not knowing about it before the birth ...

Childbirth when the umbilical cord is wrapped around the neck of the fetus. Print version. 4.3 5 (663 ratings) Rate the article. Is it possible to give birth naturally with a pelvic floor Children with umbilical cord entanglement around the neck very often died - mainly due to lack of proper experience among midwives.

My girlfriend had an ultrasound today, 24 weeks, entwining 1 time, tell me if this is 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 ...

Entanglement of the umbilical cord. Fetal development. Pregnancy and childbirth. My daughter had the first entanglement of the umbilical cord around her neck. Thank God that everything worked out. My niece had a double cord around her neck and was born that way.

Discussion

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

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

The entanglement of the umbilical cord of a child is quite common, but in most cases it does not pose any threat to the baby.

The umbilical cord and placenta are the main link between mother and fetus, normal blood flow through it is very important for the growth and development of the child. Normally, the umbilical cord has a length of 40-60 cm, this is enough for the baby to be born without difficulty, but not enough for a large number of loops to form and the child could get confused. However, if the umbilical cord is too long, more than 70 cm, the risk that the fetus becomes entangled in it increases.

If during pregnancy the umbilical cord entanglement is detected on an ultrasound before 34 weeks, there is a high probability that the baby is both confused and unraveled, that is, such a diagnosis does not mean that the intrauterine cord entanglement will necessarily remain until childbirth, and may interfere.

The umbilical cord entanglement of the neck is most common, while on ultrasound, the doctor sees a loop in the neck of the child with a distinct blood flow with Doppler.

Is it dangerous to wrap the umbilical cord around the neck of the fetus? Usually not, during childbirth, the loops are removed, which makes it possible for the child to be born without difficulty.

The entanglement of the umbilical cord around the neck of the fetus can be single, double or even triple. On the other hand, wrapping the umbilical cord around the child's neck is not the only option; the umbilical cord can entangle the entire body of the child, his arms and legs. The diagnosis is made, as a rule, during an ultrasound examination of a pregnant woman. And although the umbilical cord is clearly visible on ultrasound from the 16th week of pregnancy, doctors begin to attach importance to the entanglement only from a period of more than 32-33 weeks of pregnancy. Breech presentation and entanglement of the umbilical cord may be of particular danger in relation to complications of childbirth.

A single or double entanglement of the umbilical cord of the fetus does not threaten the child as long as the blood flow in the umbilical cord is not disturbed. The baby himself does not breathe, does not eat, the source of life for him is the mother's placenta, and the umbilical cord is the only way to deliver oxygen and nutrients. If blood flow is disturbed in it, he will begin to suffer. However, this requires a tight entanglement of the umbilical cord, which is rare in utero, it can happen during childbirth due to the fact that the umbilical cord is short for the birth of the baby. The tight entanglement of the umbilical cord without disturbing the blood circulation in it does not threaten the fetus in any way.

Signs of umbilical cord entanglement that could be detected when examining a woman or she could notice herself do not exist. This diagnosis is always made by ultrasound or during childbirth. Ultrasound not only makes it possible to determine the entanglement of the umbilical cord, but also to assess the blood flow in it, color Doppler mapping comes to the rescue, which will not only show whether there is blood flow in the vessels, but will also allow you to assess its quality, whether it is sufficient and normal.

If the ultrasound showed an entanglement with the umbilical cord, the woman will just need to be more carefully observed. CTG, dopplerometry allow you to identify intrauterine suffering of the fetus, if the umbilical cord is suddenly pinched.

Cord entanglement, causes

Why does cord entanglement occur? This happens when the umbilical cord is too long and forms multiple loops in the uterus. The baby moves unconsciously, his movements are not coordinated, and he may accidentally become entangled in these extra loops of the umbilical cord. Predisposes to this increased mobility of the fetus, for example, with polyhydramnios.

There are stories among the people that if the mother sits cross-legged, the child may become entangled in the umbilical cord. This is not only partly true. Uncomfortable posture forces the child to move more actively, and theoretically, the chances of getting confused increase. In the same way, hypoxia, which the baby experiences, increases the activity of the fetus if the mother is in a stuffy room, does not walk, moves little or smokes.

If the child is already confused, an entanglement of the umbilical cord was found on ultrasound, exercises and other tricks will no longer help. Either the entanglement will remain so, or the baby will unravel itself by childbirth.

Cord entanglement, consequences

Why is cord entanglement dangerous?

If we talk about whether it is dangerous to entangle the umbilical cord during pregnancy, yes, there is a small risk. With tight entanglement, clamping of the umbilical cord vessels and fetal hypoxia is possible, a strong tension of the umbilical cord can cause placental abruption.

What threatens the entanglement of the umbilical cord in childbirth?

Even a loose entanglement with a short umbilical cord or a two- or three-fold entanglement can become tight, with impaired blood flow in the vessels, as the baby moves through the birth canal. Strong tension on the umbilical cord can cause placental abruption in childbirth with bleeding and asphyxia of the newborn.

Doctors decide how to give birth to a woman based on the approximate length of the umbilical cord. If there is entanglement, but at the same time there are many free loops in the uterus, you can give birth on your own. The entanglement of the umbilical cord during childbirth in such conditions will not be tight, and the baby will be free to be born without harm to himself. In such cases, even if there is a double entanglement of the umbilical cord, the consequences will not be severe.

How to avoid cord entanglement?

It is possible to avoid entanglement with the umbilical cord if a woman walks enough in the fresh air, does not smoke (including passive smoking should be excluded), if polyhydramnios, feto-placental insufficiency can be avoided. But even under all conditions, a certain risk remains, because the length of the umbilical cord depends on the genes, and not on how much the mother walks, and if the umbilical cord is too long, there will always be a risk.

What to do with cord entanglement?

Neither gymnastics, nor conspiracies and herbs will get rid of entanglement, but complications can be avoided by regularly being observed by a gynecologist in a antenatal clinic and if you go to the hospital in a timely manner, having entered there not with contractions and progressive childbirth, but during the day, as planned, so that doctors have the opportunity to choose the correct tactics of childbirth in your particular case.

Read also

Most often, it is difficult to establish the exact cause that led to the development of this disease (each case is studied and considered individually), although doctors name several of the most common points. Among them:

• uncontrolled intake of various medicines, which include biologically active additives and vitamins consumed by expectant mothers without consulting a specialist;
• viral diseases (influenza, acute respiratory infections, acute respiratory viral infections, etc.);
• smoking;
• drinking alcoholic beverages during pregnancy;
• taking illegal drugs, etc.

5413 / 0

During fetal development, the child cannot eat and breathe on its own. It is completely dependent on the mother's body. This connection is provided by the vessels and the placenta. Pathological changes in these organs lead to hypoxia and developmental disorders. But sometimes, with normal development during pregnancy, by the time of delivery, the umbilical cord around the neck appears 1 or more times. How dangerous is this condition and is it worth it to tune in to a caesarean section?

Types of pathological condition

The umbilical cord consists of 3 vessels surrounded by one sheath. Through it, nutrients enter, gas exchange and removal of fetal metabolic products. The shell - vartan jelly - resembles jelly. It protects vessels from stretching, compression and twisting. With pathology of the umbilical cord during pregnancy, the child begins to lag behind in development and weight. But sometimes the pregnancy proceeds normally until the moment of delivery.

Deterioration of the condition, the development of acute hypoxia during childbirth is possible with complete or partial blockage of its lumen and impaired blood flow.

An entanglement is the location of the umbilical cord around the neck of the fetus for 360 ° (one turn) or more. ICD-10 has a code only for births complicated by entanglement with compression (O69.1). Other options are not considered.

A single entanglement occurs in 22% of all births. Double entanglement is recorded less frequently, only in 3% of cases. The share of triple and quadruple accounts for 0.5% and 0.07%, respectively.

Allocate a complete entanglement and incomplete, which is less than 360 °. Complete can be single and multiple. The maximum number of turns recorded in the medical literature is 9. Complete entanglement can occur as true twisting or incomplete knotting.

If the umbilical cord is wrapped around only one part of the body, then this is an isolated entanglement. If several are involved - combined.

Why is the baby wrapped around?

The location of the loops before delivery has no clinical significance. The shorter the gestational age, the higher the fetal mobility. The child rotates freely, changes its position from the head to the pelvic. Therefore, the umbilical cord, located on the neck of the fetus without entanglement, should not be alarming. But as the moment of childbirth approaches, the free space in the uterine cavity decreases. A child after 36 weeks should no longer radically change his position.

The causes of the pathological condition fit into three main factors:

1. . The uterine cavity is overstretched with a large amount of water, the fetus has more space for swimming, and hence for the possibility of changing position.
2. . The condition is a consequence of placental insufficiency. There are many reasons why placental dysfunction occurs. These are preeclampsia, diabetes mellitus, pathologies of the heart and blood vessels in the mother, intrauterine infection. In a state of hypoxia, the child may become more mobile. Some of these conditions are accompanied by polyhydramnios.
3. Stress. The physical activity of the mother and nervous strain leads to an increase in the stress hormone - adrenaline. It also affects the condition of the fetus, leading to its increased activity.

A double entanglement of the umbilical cord around the neck is observed with an increase in its length. The norm is 55-70 cm. The umbilical cord is more than 70 cm long, and less than 40 cm is short. But even with a length of less than 40 cm, entanglement can occur, but the symptoms and consequences will be different.

How is pathology diagnosed?

For the first time, a woman can hear about the entanglement at 31-32 weeks of pregnancy during an ultrasound scan. But such conclusions are of no serious significance. Usually, by the time of birth, children are untangled from the loops on their own.

You need to carefully consider the location of the loops in the neck, which was diagnosed at 38 weeks. The danger can be two- and three-fold entanglement, as well as tight. When the loops are tightened, a state of acute hypoxia develops. This disrupts the supply of oxygen and nutrients, as well as the removal of decay products.

If an abnormal position of the umbilical cord loops is detected on ultrasound, Doppler mapping is necessary to determine the nature of the blood flow. Based on its results, you can find out the number of loops, their exact location and the direction of blood flow. Sometimes nodes or other pathological conditions are simultaneously recorded. allows you to establish whether there is a child suffering from hypoxia.

Also, all pregnant women from the 27th week, regardless of the diagnosis, undergo CTG at each visit to the doctor. With tight entanglement, the following signs of hypoxia are most often observed:

• a decrease in the basal rhythm and a decrease in the number of fetal heartbeats;
• the appearance of a large number of decelerations - slowdowns in the heart rate when the child moves or uterine contractions.
• a decrease in the number of accelerations - an increase in the rhythm during movement.

At the same time, the total score of CTG with initial changes in the state of the fetus is 5-7 points, a critical condition is indicated by 4 or less points according to the study (read more about decoding the results of CTG).

Sometimes loose entanglement is an accidental finding during childbirth. It can be suspected by the appearance of deep decelerations at the end of the second stage of labor at the time of head eruption. Already after the birth of the head, the midwife notices the loops on the baby's neck.

Is it possible to recognize the violation on my own?

It is impossible to notice signs of entanglement without a special examination. If the baby is too mobile, and the stomach is very large, this is not a direct indication of the possibility of twisting it into the umbilical cord. Almost 100% of the fetuses for the entire duration of pregnancy can wrap around and get out of it on their own. And it doesn't come with any symptoms.

If childbirth began with entanglement with the umbilical cord, there will also be no symptoms if it is a single non-tight one.

Features of pregnancy and childbirth

What threatens the course of pregnancy the formation of loops on the neck of the fetus? Considering that most children are in this position at least once, it becomes clear that the consequences cannot be called tangible. Therefore, the management of pregnancy does not differ from uncomplicated.

Concerns can be caused by the identification of the incorrect position of the umbilical cord in the late period. If this happens after 38 weeks, then it is necessary to comprehensively assess the condition of the child and the possibility of childbirth through the natural birth canal.

In the case of diagnosing simultaneous breech presentation and cord entanglement, several additional parameters must be taken into account. By itself, it is not an indication for a caesarean section. But with entanglement, acute hypoxia can develop. This is due to the fact that with head presentation, immediately after the birth of the head, the midwife frees it from possible loops. In breech presentation, the buttocks are born first, and the head lingers in the pelvic cavity. Therefore, tension or clamping of the vessels of the umbilical cord and the development of oxygen starvation are possible.

The condition of the fetus is also taken into account. Cord entangled childbirth can occur in a fetus with intrauterine growth retardation. Therefore, a caesarean section can be performed: during the operation, children in serious condition are less stressed and have a better chance of a good recovery.

The greatest danger is entanglement with a short umbilical cord. A sign of such a condition may be protracted. Sometimes, due to vascular tension, placental abruption can occur, which threatens the death of the fetus and the development of massive blood loss in the mother with the formation of DIC. Fortunately, this complication is extremely rare.

Sometimes it is possible to combine the location of the loops on the neck with other anomalies:

• twisting of blood vessels;
• hypo- or hypertortuosity;
• knot formation;
• absence of an umbilical vessel or its hypoplasia;
• improper attachment to the placenta.

In this situation, the combination with entanglement can lead to more severe consequences for the fetus. Malformation of the umbilical cord is rarely isolated. Often there are malformations or chromosomal abnormalities. Therefore, at the stage of diagnosis in pregnant women, the outcome of previous pregnancies and childbirth, as well as the state of the fetal site, are clarified.

If by the end of gestation there are a sufficient number of pregnancy complications or threats to the fetus and mother, then a decision is made to conduct a planned one.

Hospitalization before childbirth is provided if, according to the results of ultrasound, it is established:

• multiple entanglement;
• presentation of the umbilical cord or its vessels;
• combination of fetal growth retardation with single artery syndrome.

If childbirth began to be conducted through natural routes, then a fetal CTG is mandatory for the timely diagnosis of deterioration. With the development of acute hypoxia, childbirth is completed by emergency caesarean section.

Consequences for the child

The consequences of entanglement of the umbilical cord around the neck are not dangerous if this happened during pregnancy: the child unravels on its own and there are no signs of deterioration in his condition. If the clamping of the vessels provoked acute hypoxia, then the complications for the child will depend on the time of occurrence of the pathological condition and medical actions.

According to various studies, 21-65% of all cases of entanglement cause hypoxia. And in 2.5% of all births with umbilical cord loops around the neck, fetal death occurs during or after birth.

Consequences for the child in the future may be associated with acute oxygen starvation. In this case, violations begin to appear already at the time of childbirth. A child experiencing oxygen starvation empties the intestines during childbirth. Meconium (original feces) enters the posterior amniotic waters and stains them in a greenish cloudy color, unpleasant flakes appear in them. The child swallows such water, which worsens his condition.

For 3-4 days, such children undergo neurosonography - ultrasound of the brain. The study is necessary to identify traces of cerebral edema, the presence of hematomas and hemorrhages. According to the results of the examination, a consultation with a neurologist and appropriate treatment can be prescribed.

Long-term effects can manifest in the form of neurological problems that are very difficult to treat:

• epilepsy;
• mental retardation;
• encephalopathy.

In mild cases, there may be manifestations in the form of hyperactivity syndrome, persistent headaches, restlessness, inability to concentrate.

Is prevention possible?

Many mothers are concerned about whether the entanglement of the umbilical cord is visible on ultrasound. The doctor can notice this sign at any time, but it is almost impossible to avoid its appearance with the help of external influences. The task of the mother in prevention is to create conditions in which the development of polyhydramnios and fetal hypoxia is impossible:

1. Even at the planning stage of pregnancy, it is necessary to get rid of bad habits.
2. Treat chronic diseases. If they are classified as incurable, then try to stabilize the condition. This is especially true of diabetes, obesity, hypertension, in which it is a frequent companion of pregnancy.
3. Avoid infection, when signs of illness appear, do not self-medicate, but take antibiotics in doses and courses recommended by your doctor.
4. Eat right, get enough rest, exercise regularly.
5. Avoid stress. Nervous strain is always associated with excessive release of adrenaline. The female body and reproductive system are largely exposed to its action. Therefore, in pregnant women, on the background of stress, the uterus comes into tone, the child suffers from hypoxia, becomes restless and can change the position of the body several times.
6. See a doctor and follow his recommendations.

“Your baby has an umbilical cord entanglement,” the doctor reports during an ultrasound, and the expectant mother immediately imagines a terrible picture: the precious baby is floundering in the fetal waters, and a noose is slowly squeezing his delicate neck ... Calm, only calm! The umbilical cord is not a rope, and the child in your stomach does not breathe at all with lungs, therefore, even if the “loop” wraps around his neck, there will be no catastrophe - oxygen and nutrients will still enter the small organism. And now let's deal with all this in more detail.

What is the umbilical cord

The umbilical cord, also known as the umbilical cord, connects the developing fetus with the mother's body. This “lace” consists of connective tissue and three vessels: the umbilical vein carries arterial blood rich in oxygen and nutrients from the placenta to the child, and venous blood with the baby’s metabolic products flows back through the two umbilical arteries. A unique jelly-like substance called warton jelly protects the vessels of the umbilical cord from being squeezed. The more Wharton's jelly, the thicker the umbilical cord (normally 1.5-2 cm) - respectively, the vein and arteries are less susceptible to unwanted effects, and the blood flow through them is better. Due to its structure, the umbilical cord can withstand significant loads (tension, compression and twisting) without any harm to the fetus.

The umbilical cord can be long (more than 70 cm), normal (56-70 cm) or short (40-55 cm). Only an absolutely short umbilical cord is considered a pathological option, which prevents the fetus from moving through the birth canal - this diagnosis is made during childbirth, and the only method of delivery in this case will be a caesarean section.

There are single and multiple (two-, three-, four-fold), as well as isolated (around one part of the body) and combined (for example, around the neck and trunk or trunk and legs) cord entanglement.

Cord entanglement: causes

A developing child makes a huge number of movements - moreover, the shorter the gestational age, the faster the toddler (as the birth approaches, it becomes more and more crowded in the uterus, and, therefore, activity decreases).

Imagine frolicking dolphins - somersaults, somersaults, somersaults, spirals of varying complexity. The baby moves inside your stomach in the same way - and any of these “tricks” can cause the umbilical cord to wrap around one or another part of his body. In fairness, it should be noted that the child is equally good at both twisting and unwinding the loops of the umbilical cord. That is why an ultrasound diagnosis of “umbilical cord entwined around the neck (trunk, arms, etc.)” is not yet a reason for parents to immediately start tearing their hair out. Rather, this is a signal for the obstetrician - from now on, it is necessary to observe the expectant mother and her child a little more carefully, and, in addition, an additional examination needs to be carried out.

Is umbilical cord entanglement dangerous?

It is impossible to answer the question unambiguously - it depends on many factors. For example, if the cord is very long, the baby can wrap it around him several times without experiencing any discomfort. But when entwined with a normal or short umbilical cord, alas, the occurrence of hypoxia (lack of oxygen) is not excluded - fortunately, as a rule, it is short-term: the fetus feels discomfort associated with a decrease in blood flow, and tries to eliminate it on its own, that is, in most cases it successfully unwinds.

The real danger arises when, due to the entanglement, the blood flow between the organisms of the mother and the fetus suffers and the child cannot cope with solving this problem on his own. This situation is fraught with acute hypoxia and, as a rule, requires medical intervention.

Nutrition at risk of cord entanglement

Not always "unaccustomed" behavior of the child in the womb is associated with acute hypoxia. A similar picture can be observed if the mother drank or ate something that has a stimulating effect on the central nervous system (strong tea, coffee, chocolate, cocoa, fresh garlic, etc.). The woman herself may not feel any changes - an adult has a protective blood-brain barrier, which tenfold reduces the effect on the central nervous system of any active substances that come with the blood. In addition, regular consumption of "stimulating" foods causes addiction to biologically active substances. But a child is a completely different matter! But even if you are absolutely sure that the problem is caused by just a violation of the recommended one, it is better to be vigilant once again and make sure that the baby is all right.

Can you feel the entanglement of the umbilical cord

But how can a mother understand that everything is in order with the child or, on the contrary, you need to sound the alarm? As in many other cases, the answer is very simple: you need to carefully listen to your condition. For the baby, the mother is literally the whole universe, and it is to her that he “informs” about the problem that has arisen. The trouble is that not all women recognize this "cry for help." Will learn!

The main indicator of the condition of the fetus, which a woman can evaluate on her own, is movements (they become noticeable already at 16-22 weeks). Each child has its own daily rhythm, and most expectant mothers can easily name the time when their babies are sleeping or awake. The strength and frequency of movements are also individual - and a woman knows exactly how her child usually “frolics”. However, when hypoxia occurs, the nature of fetal movements changes. If we are talking about a slight decrease in blood flow (chronic hypoxia), the movement will slow down slightly and be more lethargic.

In the case of acute hypoxia, everything is just the opposite: a sharp and significant lack of oxygen causes panic in the fetus, the movements become violent, the child pushes hard and can even roll over. This behavior has two goals at once: firstly, the baby is trying to eliminate the cause of hypoxia, and secondly, to bring to the attention of the mother that he is having serious difficulties. If these efforts are ineffective, the second phase of acute hypoxia sets in - the fetal strength runs out, and the movement stops abruptly. Sudden silence should not only alert the pregnant woman, but make her immediately seek obstetric help - and it’s better to immediately!

Entwining the child with the umbilical cord: how to behave

Cord entanglement is not a pathological condition, it occurs in 20-25% of women - and the vast majority of them give birth without complications. The main thing in your situation is not to be nervous! Excess production of stress hormones is absolutely useless - think only about pleasant things, look around with optimism! Try not to listen to horror stories like “but a friend of mine had just such a case, so it happened there ...”. The less you know - sleep tight! Meet people you like, do only those things that give you pleasure, spend more time outdoors. If the doctor does not mind, it is very advisable to do special exercises for pregnant women and. One “BUT” - no extreme sports, even if you were a daredevil in your “past” life: adrenaline in the mother’s blood increases the baby’s motor activity, makes him worry and, possibly, even more entangled in the umbilical cord.

Diagnostic methods

As we have already said, in some cases an additional . What is it?

With the help of this study, the general condition of the fetus and the dynamics of its growth, as well as the condition of the placenta, umbilical cord and amniotic fluid, are assessed. Do not worry - such manipulation is absolutely harmless for a child, even if the doctor prescribes it quite often (in difficult situations - several times a week).

This study reveals the features of blood flow in the placenta, umbilical cord and arteries of the child's brain. Disturbances in the movement of blood in the "mother-placenta-fetus" system is an alarming signal and a reason for prescribing treatment (what it will be depends on the severity of the problem).

Cardiotocography (). During the 40-60-minute procedure, the condition of the fetus is assessed by the nature of the heartbeat and the frequency of movements. The study requires a special device with a sensor that is attached to the pregnant woman's abdomen. The result of CTG is a curve that displays the work of the child's heart, his movements, hiccups. When the umbilical cord is entwined around the baby's neck during stirring, a decrease in heart rate is noted - according to the severity of this symptom, the doctor judges the danger of the situation and the need to take additional measures. CTG is performed from the 33rd week of pregnancy. At earlier dates, this study does not make sense due to the immaturity of the fetal cardiovascular system (for this reason, the curve indicators can be misinterpreted, which will lead to the appointment of a completely unjustified treatment).

Cord entanglement: how to treat

It is not necessary to treat the entanglement of the umbilical cord itself, which in no way affects the condition of the fetus and its development. The question of prescribing therapy is raised in cases where intrauterine fetal suffering is diagnosed. With a moderate violation of blood flow, supportive treatment is prescribed - vitamins and nutrients that will help the baby grow normally, despite a decrease in the volume of blood flowing to him, as well as drugs that improve the "fluidity" of the blood. If these measures prove to be effective, no other interventions are required.

Childbirth with entanglement of the umbilical cord

It happens that, having read and heard all sorts of horrors about entanglement with the umbilical cord, the pregnant woman categorically declares to the doctor: only! But giving birth “as usual”, even despite repeated entanglement, is not at all as dangerous as it seems. Such births involve more careful monitoring of the condition of the fetus through long-term monitoring of its heartbeat. In the event of acute hypoxia, the obstetrician can quickly change the tactics of delivery - this depends on the condition of the child, the stage of labor and the severity of the violations.

An emergency caesarean section is chosen with significant deviations from the norm in the first stage of labor, when the cervix is ​​just opening and the baby is still far from being born. If violations occur at the end of the second period (when the fetal head has already sunk to the pelvic floor and is ready to appear), the perineal dissection will be the best tactic. As soon as the head is born, the loops of the umbilical cord wrapped around the neck can be removed.

Irina Timoshina

Oh, and it's hard to be a future mother. There are few physical ailments and nerves shattered by hormones, but there are still plenty of “well-wishers” around who are eager to tell the next “horror story” to the pregnant woman. For example, about the double entanglement of the child's umbilical cord. Let's find out whether we should be afraid of this "terrible" phenomenon.

The umbilical cord is a kind of "rope" that connects the mother's body and the fetus, or rather, their circulatory systems. The umbilical cord has 3 vessels: 1 vein and 2 arteries. Through the vein, oxygen-enriched blood with nutrients from the mother's body through the placenta enters the circulatory system of the child, and through the arteries, blood with the waste products of the unborn baby is sent to the placenta and then to the mother's body.

The length of the umbilical cord, as a rule, is 40-60 cm. Moreover, this indicator is inherited, that is, your child will be connected to you by an umbilical cord of the same length as the one that once connected you to your mother.

Why does the umbilical cord wrap around the fetal neck?

It happens that too long an umbilical cord is formed, for example, 70 cm - this in itself is a factor in increasing the risk of cord entanglement.

It is often heard, especially from representatives of the older generation, that knitting, sewing, and weaving during pregnancy lead to entanglement of the umbilical cord. The modern expectant mother should know that this is nothing more than a myth. Such an explanation existed in the old days, and it is quite clear that it was formed far from in the scientific community, by analogy with the loop of the umbilical cord with loops and knots of thread in needlework.

It is also a myth that raising arms and exercising during pregnancy can lead to entanglement of the umbilical cord. This is wrong. A short-term raising of the hands of a pregnant woman can in no way affect the position of the umbilical cord. And moderate physical activity is even useful for expectant mothers (of course, provided that the set of exercises is selected especially for you by a doctor or a certified fitness trainer specializing in working with pregnant women).

Meanwhile, the entanglement of the umbilical cord has completely real reasons that have nothing to do with myths. Modern doctors identify three main reasons.

1. Stress. Strong experiences or excessive loads of the expectant mother lead to a stressful state, that is, increased production of adrenaline, which, in turn, increases the mobility of the fetus, and hence its chances of “confusing” the umbilical cord.
2. Fetal hypoxia(insufficient oxygen saturation of the blood, which can be caused by various reasons). With hypoxia, fetal mobility also increases.
3. Polyhydramnios. In a polyhydramnios pregnancy, the fetus has more room to move, which also increases the risk of entanglement.

Based on the above possible causes of cord entanglement, the recipe is simple. Avoid stress and too much exercise, spend more time in the fresh air, and if you are prone to polyhydramnios, control the amount of fluid you consume.

First of all, it must be said that there are different types of entanglement, and not every entanglement is dangerous. The entanglement of the umbilical cord is single, double and multiple; tight and not tight; isolated and combined (when, in addition to the neck, the limbs of the child also fall into the loop of the umbilical cord).

A single and tight entanglement of the umbilical cord is not dangerous; during childbirth, the midwife easily releases the born head from the umbilical cord loop.

Double and multiple, tight entanglement of the umbilical cord can have unpleasant consequences in the form of fetal hypoxia and placental abruption in late pregnancy and during childbirth. However, I hasten to reassure expectant mothers who showed signs of cord entanglement: in these cases, everything is not so scary. Firstly, the child in the womb does not stop moving until the very birth, and it may well unravel the loop of the umbilical cord in the same way as it confused it. And secondly, doctors have long developed tactics for managing pregnancy and childbirth with entanglement of the umbilical cord.

With a loose single or double entanglement, childbirth usually occurs naturally. During childbirth, the fetal heart rate is monitored every half an hour and after each attempt. If the baby's heart rate is not normal, the doctor may decide to speed up labor by pacing. Immediately after the birth of the head, the midwife releases it from the loop of the umbilical cord to avoid strong tension and disruption of blood flow.

In case of tight entanglement, it is dangerous to give birth naturally due to the risk of acute hypoxia and asphyxia of the fetus and premature detachment of the placenta. Usually, with a tight entanglement, planned caesarean section after 37 weeks.

So, we found out that with the modern development of medicine and in the case of an attentive and responsible attitude towards pregnancy, entanglement of the umbilical cord does not pose a serious danger to mother and child. Therefore, we can advise future mothers not to worry about this, trust your doctor and wait for the happy moment of the baby's appearance.