Umbilical Cord Compression

During pregnancy, labor, and delivery, the umbilical cord serves as the baby’s lifeline. The umbilical cord transports oxygenated blood and nutrients from the mother’s placenta to the baby; in other words, the baby “eats” and “breathes” through the cord. The umbilical cord also transports fetal waste products such as carbon dioxide back to the placenta (1).

If anything prevents the umbilical cord from functioning properly, there may be harm to the infant. One major complication is umbilical cord compression, in which pressure prevents the flow of blood through the umbilical cord. Minor, periodic compressions are normal during uterine contractions. However, if the cord is compressed more than is typical, the baby can become brain damaged from oxygen deprivation, receive inadequate nutrition, or experience fetal acidosis (caused by an accumulation of carbon dioxide in the baby’s blood) (2).

To visualize umbilical cord compression, it may help to think of a garden hose: if it is “kinked” or stepped on, the stream of water will slow or stop. The exact causes of umbilical cord compression are different, but the basic concept is similar: if a tube is pinched or flattened, fluid will not be able to flow through it as effectively.

The following complications can cause or increase the risk of umbilical cord compression.

In a typical birth, the baby’s head will descend into the birth canal first, followed by the rest of the body and the umbilical cord. Umbilical cord prolapse is a complication in which the umbilical cord slips through the birth canal either before or alongside the presenting part of the baby. This can cause the cord to become compressed between the baby and the mother’s cervix or vagina. Umbilical cord prolapse and subsequent compression are more common in births involving premature rupture of membranes (PROM), in which the mother’s “water breaks” before labor begins (2).

Oligohydramnios (too little amniotic fluid) and polyhydramnios (too much amniotic fluid) can both lead to cord compression. Amniotic fluid serves many important functions, including that it provides cushioning for the baby and umbilical cord (3). If there is oligohydramnios, the risk of cord compression increases. However, polyhydramnios can also increase the risk for compression because it can cause PROM and umbilical cord prolapse (4).

A true knot is basically what it sounds like – the umbilical cord becomes tied in a knot. If the knot becomes tight enough, it can cause serious cord compression. True knots are more common during early pregnancy, when the level of amniotic fluid is higher and the fetus tends to move around more. They are also more common if the mother is of advanced maternal age, has previously given birth, or if the umbilical cord is long (5).

The term “nuchal cord” refers to a complication in which the umbilical cord becomes wrapped around the baby’s neck, either once or multiple times. Nuchal cords are fairly common, and babies can often be delivered safely (sometimes, specific maneuvers are needed). However, in certain cases, the cord can tighten around the baby’s neck, preventing blood flow (5, 6). Twin or multiple pregnancies, polyhydramnios, and an unusually long cord all increase the likelihood of a nuchal cord developing (6).

There are many signs of umbilical cord compression that medical professionals can look for. These include increased (7) or decreased fetal movement (8), abnormalities in prenatal ultrasounds, and other signs of fetal distress. If risk factors (such as a oligohydramnios, polyhydramnios, multiples pregnancy, premature rupture of membranes, or an unusually long cord) are present, doctors should monitor the health of the fetus very carefully.

Intrauterine growth restriction (IUGR) should also serve as a warning that there may be cord compression. If the cord is compressed for a long period of time, this can prevent the fetus from getting enough nutrition to grow at a normal rate. IUGR can have serious, lasting consequences.

If cord compression is suspected, doctors may gather more information through additional tests, such as color Doppler imaging, Doppler flow velocimetry, three dimensional ultrasound, or measurements of amniotic fluid volume (8).

The appropriate management of umbilical cord compression depends on the underlying cause, current health status of the baby, and the likelihood of the baby’s health deteriorating. It may include the following:

• Amnioinfusion: If the level of amniotic fluid is low, amnioinfusion may help. This is a procedure in which a saline solution is introduced into the mother’s uterus in order to relieve pressure that can lead to umbilical cord compression (2, 9)
• Increasing maternal oxygen: This may be a solution when umbilical cord compression is minor. Giving the mother more oxygen can increase blood flow through the umbilical cord.
• C-section delivery: If the baby is showing serious signs of distress (such as changes in heart rate), or there is reason to suspect impending danger, an emergency C-section may be needed (2).

If umbilical cord compression is minor and properly managed, the baby may be delivered safely and experience no major health concerns. However, if cord compression is prolonged, or if medical professionals fail to manage it appropriately, the consequences can be severe. Umbilical cord compression can lead to the following issues (among others):

• Fetal acidosis (2)
• Birth asphyxia and hypoxic-ischemic encephalopathy (HIE)
• Cerebral palsy (CP) (10)
• Intrauterine growth restriction (IUGR)
• Death (11)

If medical professionals fail to provide proper fetal monitoring, recognize signs of umbilical cord compression, or intervene once compression has been identified, this is negligence. If this negligence causes physical harm, it constitutes medical malpractice.

The malpractice attorneys at Reiter and Walsh ABC Law Centers: Birth Injury Lawyers specialize in birth injury/neonatal malpractice. We have extensive experience in this area, and may be able to help your child get the resources they need for lifelong care, treatment, and support.

To find out if you have a case, contact our firm to speak with one of our award-winning lawyers. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. We give personal attention to each child and family we help, and are available 24/7 to speak with you.

1. Children’s Hospital. (2014, August 24). Blood Circulation in the Fetus and Newborn. Retrieved July 31, 2018, from https://www.chop.edu/conditions-diseases/blood-circulation-fetus-and-newborn
2. Umbilical Cord Prolapse: Causes, Dangers and Treatment. (2015, November 30). Retrieved July 31, 2018, from http://americanpregnancy.org/pregnancy-complications/umbilical-cord-prolapse/
3. CRNP, L. S. (2018, June 27). Amniotic fluid: Functions and disorders. Retrieved July 31, 2018, from https://www.medicalnewstoday.com/articles/307082.php
4. Children’s Hospital. (2014, August 24). Amniotic Fluid Problems/Hydramnios/Oligohydramnios. Retrieved July 31, 2018, from https://www.chop.edu/conditions-diseases/amniotic-fluid-problemshydramniosoligohydramnios
5. Umbilical Cord Complications: Overview, Cord Length, Single Umbilical Artery. (2018, June 01). Retrieved July 31, 2018, from https://emedicine.medscape.com/article/262470-overview
6. Nuchal Cord: What You Should Know. (n.d.). Retrieved July 31, 2018, from https://www.healthline.com/health/pregnancy/nuchal-cord#management
7. Collins, J. H. (2012). Retrieved July 31, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428685/
8. Sherer, D. M., & Manning, F. A. (n.d.). Prenatal ultrasonographic diagnosis of conditions associated with potential umbilical cord compression. Retrieved July 31, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/10774759
9. Amnioinfusion for potential or suspected umbilical cord compression in labour. (n.d.). Retrieved July 31, 2018, from https://www.cochrane.org/CD000013/PREG_amnioinfusion-for-potential-or-suspected-umbilical-cord-compression-in-labour
10. (n.d.). Retrieved July 31, 2018, from https://www.uptodate.com/contents/umbilical-cord-prolapse?search=umbilical cord compression&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
11. (n.d.). Retrieved July 31, 2018, from https://www.uptodate.com/contents/prenatal-diagnosis-and-management-of-umbilical-cord-abnormalities?search=umbilical cord compression&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1